Use of resorbable magnesium screws in children: Systematic review of the literature and short-term follow-up from our series

Abstract

Purpose Biodegradable implants are of major interest in orthopaedics, especially in the skeletally immature population. Magnesium (Mg) implants are promising for selected surgical procedure in adults, but evidence is lacking. Thus, the aim of this study is to analyze the safety and efficacy of resorbable Mg screw in different orthopaedic procedures in skeletally immature patients. In addition, we present a systematic review of the current literature on the clinical use of Mg implants. Methods From 2018 until the writing of this manuscript, consecutive orthopaedic surgical procedures involving the use of Mg screws performed at our centre in patients < 15 years of age were retrospectively reviewed. In addition, a systematic review of the literature was performed in the main databases. We included clinical studies conducted on humans, using Mg-alloy implants for orthopaedic procedures. Results A total of 14 patients were included in this retrospective analysis. Mean age at surgery was 10.8 years (sd 2.4), mean follow-up was 13.8 months (sd 7.5). Healing was achieved in all the procedures, with no implant-related adverse reaction. No patients required any second surgical procedure. The systematic review evidenced 20 clinical studies, 19 of which conducted on an adult and one including paediatric patients. Conclusion Evidence on resorbable Mg implants is low but promising in adults and nearly absent in children. Our series included apophyseal avulsion, epiphyseal fractures, osteochondritis dissecans, displaced osteochondral fragment and tendon-to-bone fixation. Mg screws guaranteed stable fixation, without implant failure, with good clinical and radiological results and no adverse events. Level of evidence IV – Single cohort retrospective analysis with systematic review

Surgical outcomes of scaphoid fracture osteosynthesis with magnesium screws

“…They reported that recovery was achieved at 12 weeks, and there were no complications. Baldini et al[ 21 ] reported that clinical and radiological outcomes were good, and no side effects were observed in 14 children treated with an Mg screw. In our study, union was achieved in all patients, and no complications developed in any patient.…”

Use of resorbable magnesium screws in children: systematic review of the literature and short-term follow-up from our series

“…We read with interest the above publication by Baldini et al 1 Scherer et al 2 used the biodegradable MAGNEZIX ® implant for fixation of medial humeral epicondyle fractures in 2 children and stated that absorbable implants are increasingly used in the treatment of pediatric fractures in order to avoid a second operation for metal removal. This is not supported by the recent systematic review of medial humeral epicondyle fracture management by Pezzutti et al, 3 with none of the 37 included studies having reported the use of resorbable implants and the vast majority of metal screws used in children aged 11-14 years not having been removed.…”

“…We would like to ask the authors 1 why they did not provide any supporting outcome data for their conclusion, such as data from outcome questionnaires, functional recovery over time, and/or return to sportive activities from neither the 19 adult and the one publication including potentially skeletally immature patients listed in their systematic review nor for their own 14 cases? Baldini et al 1 stated that only one of their patients had a complication (detachment of a screw head) and recorded for another patient who had fixation of a patella fracture with 3 MAGNEZIX ® implants that the patient was only able to do fitness training in a gym at 18 months, without being able to do any other sport. The inability to return to sport could be related to part of all 3 screws being outside the cortical bone (which the authors stressed to avoid), potentially causing chondrolysis in addition to the extensive osteolysis seen around the screws, which would weaken the bone.…”

“…Journal of Children's Orthopaedics 16 (1) In summary, we have concerns about the use of Mg implants in skeletally immature patients because of the extensive osteolysis caused by these implants, which would limit return to contact activities over extended periods and the possible detrimental effect of such lysis on small osteochondral fragments and therefore have doubts about Baldini et al's 1 conclusion that such implants are safe and effective in skeletally immature patients.…”

“…We read with interest the above publication by Baldini et al 1 Scherer et al 2 used the biodegradable MAGNEZIX ® implant for fixation of medial humeral epicondyle fractures in 2 children and stated that absorbable implants are increasingly used in the treatment of pediatric fractures in order to avoid a second operation for metal removal.…”