DendroPrime as an adhesion barrier on fracture fixation plates: an experimental study in rabbits.

Johanna von Kieseritzky,Patrik Stenlund,Yalda Bogestål,Marianne Arner,Daniel Hutchinson,Joakim Håkansson,Viktor Granskog,Henrik Alfort,Michael Malkoch

doi:10.1177/1753193420932477

Abstract

We tested the anti-adhesional effect of a new thiol-ene-based coating in a rabbit model. In 12 New Zealand white rabbits, the periosteum and cortex of the proximal phalanx of the second toe of both hind paws was scratched. Stainless steel plates were fixated with screws. One plate was coated with DendroPrime and the other left bare. The non-operated second toes of both hind paws of an additional four rabbits served as controls. Seven weeks after surgery, the soft tissue adhesion to the plates was evaluated macroscopically, and joint mobility was measured biomechanically. Toe joint mobility was about 20% greater and statistically significant in specimens with coated plates compared with the bare plates. Soft tissue overgrowth and, in some cases, synovitis or adhesions between the plate and the tendon were observed on all bare plates but not on any of the coated plates. We conclude that the thiol-ene-based coating can improve joint mobility by about 20%. This material has a potential to reduce adhesion around plates in fracture surgery.

Highlights

Open reduction and plate fixation of phalangeal fractures often results in adhesion formation and finger stiffness (Brei-Thoma et al, 2015; Egloff et al, 2012; Kurzen et al, 2006; Onishi et al, 2015; Page and Stern, 1998; von Kieseritzky et al, 2017)
The measurements of the toes with bare plates had statistically significantly reduced distal interphalangeal (DIP) joint mobility compared with the non-operated native toes in all measuring points except at 0.5 N
Coating of the plate significantly increased the mobility in the rabbit toes DIP joints compared with bare plates at the measuring points 1, 3, 4 and 5 N (p < 0.05 or p < 0.01) (Figure 2)

Summary

Introduction

Open reduction and plate fixation of phalangeal fractures often results in adhesion formation and finger stiffness (Brei-Thoma et al, 2015; Egloff et al, 2012; Kurzen et al, 2006; Onishi et al, 2015; Page and Stern, 1998; von Kieseritzky et al, 2017). We have reported an incidence of reoperation of more than 40%, including hardware removal and tenolysis due to postoperative adhesions in phalangeal fractures (von Kieseritzky et al, 2017). Kappos et al (2016) reported on the use of an adhesion barrier in fracture surgery using a cellulose membrane to cover phalangeal plates with short term positive effects Adhesion barriers have previously been tested in hand surgery; these studies have mostly focused on flexor tendon injury models (Golash et al, 2003; Hagberg and Gerdin, 1992; Hakansson et al, 2012; Lees et al, 2015; Wiig et al, 2011).

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