Absorbable Screws Research Articles

吸収性材料を移植骨固定に用いた臼蓋形成術 (Spitzy変法) の術後短期成績

吸収性材料を移植骨固定に用いた臼蓋形成術 (Spitzy変法) の術後短期成績

Treatment of Type C Pilon Fractures by External Fixator Combined With Limited Open Reduction and Absorbable Internal Fixation

This study was conducted to evaluate the clinical outcome of the treatment of type C pilon fractures by using an external fixator combined with limited open reduction and absorbable internal fixation. Twenty-five type C pilon fractures, including 4 open fractures, were included in this retrospective study. The procedure of first-stage manipulation and external fixation spanning the ankle joint was conducted as early as possible. For the second stage, the tibial and fibular fractures were reduced and fixed with absorbable screws or rods through a limited incision. Clinical and radiographic evaluations were performed. The American Orthopaedic Foot & Ankle Society score (AOFAS) was obtained for evaluation of function. Twenty-one patients were followed postoperatively for a minimum of 18 months. The mean time of union was 4.8 months. Delayed union of the distal tibia occurred in 1 patient. Minor infection occurred in 8 patients and deep infection in 1 patient. No skin necrosis, malunion, loss of reduction, nonunion, or fixation failure was observed during the follow-up period. No hardware removal was needed, nor was adverse tissue reaction to the implants observed. An excellent or good AOFAS outcome was obtained in 81% (17/21) of the patients. External fixator combined with limited open reduction and absorbable internal fixation was a reliable treatment for closed and open AO/OTA type C pilon fractures of the distal tibia.

Contributions about surgical instruments at Sauvé-Kapanji procedure with absorbable screws on rheumatoid wrists

Contributions about surgical instruments at Sauvé-Kapanji procedure with absorbable screws on rheumatoid wrists

Simple and effective Rehabilitation Programme (SERP) for Patients Undergoing Arthroscopic Anterior Cruciate Ligament (ACL) Reconstruction in Indian Scenario

Introduction: Rehabilitation after surgery for an Anterior Cruciate Ligament (ACL) reconstruction is a lengthy process. Return to sports and other activities take months. There are many variations of ACL rehabilitation. Most of the protocols are extensive and do not suite the Indian scenario where the compliance of the patient and cost of physiotherapy are the major limiting factors. Hence, we decided to develop and validate a Simple and Effective Rehabilitation Programme (SERP) for patients undergoing ACL reconstruction in our scenario. Materials and methodology: Fifty patients with isolated ACL tear with or without partial menisectomy were selected for this systematic review from November 2010 to July 2012. All 50 patients underwent arthroscopic ipsilateral quadruple hamstring tendon reconstruction (semitendinosis and gracilis double folded) using endobutton (Smith and Nephew) for femoral fixation and bio absorbable interference screw for tibial graft fixation. They were subjected to SERP. SERP is a home based programme consisting of 5 phases spanning over 6 months. Test- retest was done using Modified Cincinnati Rating system Questionnaire on a prospective basis. The results were than analysed. Results: Applying the Modified Cincinnati Rating System Questionnaire, results were tabulated. 84% of the patients had excellent results and 16 % had good results at the end of 3 months. At the end of 6 months, 94 % of patients had excellent results and 6% had good results. The result remained the same after 1 year of follow-up. There were no fair or poor results. Conclusion: SERP is a home based programme which is understandable, convenient and reliable for patients who are undergoing arthroscopic ACL reconstruction; especially in our setting with excellent functional outcome.

Preclinical and Clinical Cases of New Absorbable Composite Interference Screws in Osteoarticular Surgery

The objective of this study deals with preclinical and clinical cases of absorbable composite interference screws of next generation in osteoarticular surgery. These implants are made of resorbable polymers PLA either amorphous or semi-cristalline, associated with granules of microporous biphasic calcium phosphate ceramic. A preclinical study was performed on goats in femoral and tibial epiphysis during 4 and 6 months. Histological and histomorphometric results were obtained by micro CT, light and scanning electron microscopy. The comparative statistical in vivo study of the kinetics of resorption and bone regeneration have shown the superiority of the composite compared to control (polymer alone). Thus the presence of Biphasic Calcium Phosphate granules in the composite has a major role for bone regeneration at the expense of the implant (buffering effect and properties of osteoconduction). An observational and functional study involving 10 patients, with a follow-up from 17 to 33 months (mean 25.7), was performed. Data were analyzed according to Good Clinical Practice and International Conference on Harmonisation. Clinical observations have revealed no complications and no serious event was reported; quantitative functional indices confirm the good observational results. The clinical study supports the functionality and performance of this new composite with properties of osteoconduction related to the osteogenicity of microporous biphasic calcium phosphate granules in the field of knee ligament fixation.

Application of absorbable plate in oral maxillofacial fractures

To explore the biological features and clinical efficacies of absorbable plates and screws for rigid internal fixation. From June 2006 to June 2010, 201 FIXSORB(TM)-MX absorbable plates were used in 57 patients, including 41 males and 16 females aged from 11 - 81 years. And 185 plates were used in 53 patients of maxillofacial fracture and 16 plates in 4 undergoing orthognathic operations with rigid internal fixation. All wounds healed primarily and there were no major complications. Forty-five cases were followed up for an average period of 12 months (range: 3 - 36). No obvious adverse effect and absorbable implants rejection were observed. The fracture lines were in the right position in 56 cases. As a kind of fine material for internal fixation with strong elasticity and strength, absorbable plate shall be widely used clinically.

Arthroscopically assisted internal fixation of the symptomatic unstable os acromiale with absorbable screws

Symptomatic meso- type os acromiale is a common pathology with inconsistent outcomes of treatment with various surgical techniques. We report the outcome of a new technique for arthroscopic fusion of symptomatic os acromiale with absorbable screws. The study included 8 shoulders in 8 patients with symptomatic meso- type os acromiale who were treated with the use of a new technique for arthroscopic fusion with absorbable screws. The mean age was 54 years (range, 38-67 years), and the mean time from onset of symptoms to surgery was 18 months (range, 9-25 months). No patients reported a specific traumatic event before the onset of symptoms, and all noted the insidious onset of pain with no precipitating event. The average length of follow-up was 22 months (range, 12-36 month). The average Constant score improved from 49 points (range, 35-57 points) to 81 points (range, 75-86 points). The average satisfaction score improved from 4.5 of 10 (range, 2-6) to 8.5 of 10 (range 7-9). All patients made a good clinical recovery at 3 to 6 months after surgery. At the last follow-up, full radiographic union was observed in 6 patients, partial union in 1 patient, and persistent radiologic nonunion in 1 patient. Anterior bulging of the absorbable screws was noted in 2 patients, and the screws were trimmed 6 months after the first procedure. We have found that this new arthroscopic technique of fixation of os acromiale with absorbable screws provides promising clinical, cosmetic, and radiologic results with high patient satisfaction.

Evaluation of Knee Muscles in Patients undergoing Anterior Cruciate Ligament Reconstruction with Hamstring Tendon Graft

The objective of this study is to determine whether muscle strength loss in the knee muscles develops or not due to the hamstring tendons used for anterior cruciate ligament (ACL) reconstruction with some clinical and functional measures. 25 patients undergoing autogenous hamstring tendon graft with arthroscopic endbutton cruciate ligament (CL) due to ACL tear were evaluated in this paper. Operated knees of patients were compared those healthy. As femoral fixation, endbutton CL was selected while as tibia fixation, bio absorbable screw was selected. The patients were involved in the study in the 9th month at least. During 9 months, the patients were subject to specific exercise program. During the evaluation, dynamometric measurement of knee muscle strength, single and triple leg hop test for distance, crossover hop test, Lysholm II score and Cincinnati knee score were used. In the dynamometric measurements implemented following the surgical evalua¬tion, no significant differences were detected between the site on which ACL repair was performed and the one on which ACL repair was not performed in the end of 9th month (p>0.005). Upon the evaluation of leg symmetry index with single and triple leg hop test for distance, crossover hop test, no significant differences were detected between the knee which was exposed to ACL repair and the other one which was not exposed to ACL repair (p>0.05). It was showed that no loss of knee muscles was detected following the ACL repair performed with the use of arthroscopic endobutton CL and hamstring tendon graft. Both functional recovery and high satisfaction rates were acquired in the patients. J. Exp. Clin. Med., 2012; 29:23-27

A comparison of absorbable screws and metallic plates in treating calcaneal fractures

Intra-articular calcaneal fractures are more likely to suffer consequences in terms of pain and disability. Many studies have suggested that operative treatment for these fractures may result in better outcomes than nonoperative treatment. The metallic screws and plates are among the most common alternatives to stabilize calcaneal fractures. However, the complications of plating of calcaneal fractures are not uncommon. Complications such as infection, poor wound healing, and soft tissue irritation exist. With the advent of bioabsorbable screws, many reports have demonstrated favorable results in treating intra-articular fractures with these screws. The comparative outcomes of operative treatment of calcaneal fractures stabilized with plates and absorbable screws are rarely reported. The purpose of this study is to compare the clinical outcomes and complications related to fracture stabilization with plates and absorbable screws. Ninety-seven patients with intra-articular calcaneal fractures were managed at our institution between February 2007 and March 2009. In this prospective, randomized study, the plates were used in 52 cases (group A), and the absorbable screws were used in 47 cases (group B). There were 71 men and 26 women who had a mean age of 41 years (range, 19–67 years). The clinical outcome and complications were assessed and compared. The adjusted American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (subjective component only), Foot Function Index, and the calcaneal fracture scoring system were used to assess the results. The patients were followed up at an average of 23 months (range, 15–32 months). Radiographically, there were no nonunions in either group. One year after operation, in group A and B, the mean adjusted American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score were 71.6 ± 12.5 and 72.3 ± 17.4, respectively (p > 0.05); the mean Foot Function Index score were 21.4 ± 6.6 and 22.7 ±5.2, respectively (p > 0.05); and the mean calcaneal fracture scoring system score were 73.5 ± 8.3 and 75.1 ± 6.9, respectively (p >0.05). In group A, there were six cases of poor wound healing, one case of deep infection, and four cases of peroneal tendon irritation.In group B, there was one case of superficial infection, and no deep infection and soft tissue irritation. In this report, the outcomes of operative treatment with absorbable screws are comparable with the outcomes of operative treatment with plates. Both plates and absorbable screws showed favorable results in the surgical treatment of calcaneal fractures. However,the metallic plates were associated with increased complications. The stabilizations of displaced intra-articular calcaneal fractures with bioabsorbable screws are reasonable with advantages of fewer complications and without the need for screw removal.

The use of an absorbable bone screw as a transphyseal bridge for the correction of fetlock varus deviations in six foals

SummaryThis report describes and evaluates the use of a single‐positional absorbable screw (Smart Screw)1 as a temporary transphyseal bridge of the lateral aspect of the distal metacarpus in 6 foals with fetlock varus deformities. Using radiographic and visual assessments, an improvement in the severity of the deviation was identified in all cases. There were no complications encountered during screw placement or post operatively.The use of absorbable screws in the treatment of angular limb deformities in foals has potential and offers several advantages over the use of traditional stainless steel implants.

Posterior cruciate ligament reconstruction by double bundle-double tunnel Y-shape of the anterior tibialis tendon allograft

Objective To investigate the clinical results of posterior cruciate ligament (PCL) reconstruction by double bundle-double tunnel Y-shape of the anterior tibialis tendon allograft. Methods From March 2001 to January 2008, 47 patients underwent PCL reconstruction were included. The allogeneic adult anterior tibialis tendon was prepared into the Y-shape double bundles with the length of 130 mm; A bundle was defined as A-side; B-side was two short bundle (B1, B2 bundle). A bundle was 70 mm in length with a diameter of 10-12 mm. B1 bundle (anterolateral bundle) was 55 mm long with a diameter of 6 mm; B2 bundle(posteromedial bundle) was about 50 mm with a diameter of 6 mm. The allograft ligament was installed through the antero-medial approach. Absorbable interface screws were fixed in the tibial tunnel firstly, and then in the femoral tundles. When being fixed, anterolateral bundle was in flexion of 90°, postero-medial bundle was in 30°. Assisted exercise with knee an angle-locked walking aid had continued for 8-10 weeks. Results The average operating time were 45 min. The average follow-up time was 49.5 months. Preoperative Lachmann was positive in all cases while Lachmann was negative in 39 cases, weakly positive in 5 cases, and positive in 4 cases postoperatively. Post-operative KT-1000 testing, Lysholm score and Tegner activity levels has improved significantly compare with the pre-operative ones. Conclusion The double folded bundles of adult anterior tibialis tendon has sufficient length and diameter for posterior cruciate ligament reconstruction with power tension. The methods of ligament passing through the tunnel has improved to ease the procedure. Key words: Arthroscopy; Posterior cruciate ligament; Knee joint; Muscle, skeletal

A Use of Poly-l-Lactide, d-Lactide Sheet on Posterior Orbital Floor Fracture

We present the cases of orbital posterior wall fractures that were fixed with poly-l-lactide, D-lactide (PLDLA) sheets. Poly-L-lactide, D-lactide sheet (0.5-mm thickness) was shaped exactly to fit to the area of orbital floor, and then an extended 1 cm was bent across on the infraorbital rim. That part was fixed with 2 absorbable screws to prevent the sheet from crumpling. Orbital floor fractures of 6 patients (3 posterior-one-half defects and 3 posterior-two-thirds defects) were repaired using PLDLA sheets. Diplopia in 5 patients before surgery was improved, usually within 6 months postoperatively. Clinical enophthalmos was not appreciated in any patient. However, preoperative exophthalmometry measured -1.3 +/- 0.3 mm and postoperatively -0.4 +/- 0.2 mm, respectively. Poly-l-lactide, d-lactide sheet is applicable to safely repair the orbital posterior floor fracture.

Radial head fixation under arthroscopy for Mason II radial head fractures

Objective To evaluate the early therapeutic effects of arthroscopic procedure used for Mason Ⅱ radial head fractures. Methods From October 2006 to October 2008, 36 cases of fresh Mason Ⅱ radial head fractures were treated under arthroscopy by 2 protocols. Group A (16 cases) used prone position, brachial plexus anaesthesia and 4 portals while group B (20 cases) side-lying position, general anaesthesia and 3 portals. After debridement and anatomical reduction, the fractures were fixed by absorbable screws. The range of motion (ROM) was compared at 12 and 24 weeks postoperatively among all the patients.Comparisons were also done between the 2 groups at 12 and 24 weeks postoperatively in the ROM and Mayo elbow performance score(MEPS). Results Fine union was achieved in all the 36 cases without complications. The average ROM of flexion-extension was 128.4°± 12. 7° at 12 weeks and 132.5°± 10. 2°at 24weeks, without any significant difference ( t = 2. 713, P = 0. 539); the average ROM of rotation was 115.3°± 24.0° at 12 weeks and 118.1 °± 19. 3° at 24 weeks, without any significant difference ( t = 5.120, P =0. 778) . No significant differences were found between the 2 groups at either 12 or 24 weeks in ROM of flexion-extension, ROM of rotation or MEPS points ( P ＞ 0. 05). Conclusions Short term results show that a satisfactory functional outcome can be achieved by arthroscopy via proper portals in treatment of Mason Ⅱ radial head fractures. Advantages of arthroscopy are minimally invasive approaches, direct visualization of the fracture and early recovery. Key words: Arthroscopy; Radius fractures; Fracture fixation, internal

Meniscal repair with absorbable screws: Medium-term follow-up

Purpose To analyze the results obtained by patients subjected to meniscal suturing with absorbable screws as well as the characteristics of the meniscal lesions present. Patients and methodology This is a prospective clinical assessment of a consecutive series of 35 patients with meniscal lesions treated exclusively with absorbable screws over an 8 year period. We assessed patient evolution on the basis of the Barrett, Lysholm, IKDC and Tegner rating scales. Mean follow-up was 35 months and mean age 26 years. 73% of our patients were male; 62% of patients presented with a tear in their anterior cruciate ligament, which was reconstructed during the same surgical procedure. 1.8 screws were placed in each patient. 62.9% of sutures were applied in the medial meniscus and 37.14% in the lateral meniscus. 69% of the screws were placed in the posterior horn, 21% in the middle third and the posterior horn, 8% in the middle third and 2% in the anterior horn, middle third and posterior horn. Results The percentage of retears confirmed by MRi was 10%. Post-operative scores were: Lysholm 95.9 points, IKDC 90.8 and Tegner 6.09 points. Conclusions Meniscal repair with resorbable screws offers good to excellent clinical results in a high proportion of cases.

Huneral greater tubercle fracture treated with minimal incision combined with absorbable screws

Objective To investigate the effect of the humeral greater tubercle fracture treated with minimal incision combined with absorbable screws. Methods Totally 41 cases accepted by our department from 10 of 2002 to 11 of 2005 were treated with minimal incision combined with absorbable screws. Results The patients were followed up for an average of 9 months( ranged from 6 to 14 months). According to the Neer functional index,the outcome was excellent in 36 patients, good in 3 effective in 2, the excellent and good rate was 95.12%. Conclusion This operative method of minimal incision combined with absorbable screws has the advantages of stable fixation, less operative time, less amount of operative bleeding, minimum tissue trauma and quicker bone union. Key words: Humeral greater tubercle; Absorbable screws; Minimal incision; Fracture

Lateral hip approach used in the treatment of Pipkin fractures

Objective To investigate the clinical results of lateral hip approach used in the treatment of Pipkin fractures. Methods We retrospectively reviewed 13 male patients who had been treated for Pipkin fractures through lateral hip approach between May 1999 and January 2008. They were all male. Their mean age was 34.5 （rang, 19 to 59） years. According to the Pipkin classification, there were 4 cases of type Ⅰ, 5 type U, 2 type m and 2 type IV. All the femoral head fractures were fixed by absorbable screws. Lag screws were used for fixation of aeetabular and femoral neck fractures. The outcomes were estimated by indexes like radiographic union, traumatic arthritis, avaseular necrosis of the femoral head, heterotopic ossification and Thompson-Epstein scores. Results The mean follow-up time was 48.5 （ 13 to 105） months. All the patients obtained radiographic union of the fracture. One suffered traumatic arthritis, one avascular necrosis of the femoral head and 4 heterotopie os- sification. By the Thompson-Epstein scoring scale, 6 patients had excellent results, 4 good, 2 fair and one poor. The rate of good to excellent was 76. 9%. Conclusion Since the lateral hip approach allows sufficient si- multaneous exposure and fixation of the posterior aeetabular wall_ and femoral head fractures, it may be an ideal surgical approach for the treatment of Pipkin fractures with satisfactory results. Key words: Hip dislocation; Femur head; Fracture fixation, internal; Bone nails; Lateral approach

Evaluation of the sterilizing efficiency on absorbable poly-L-lactide screws with two sterilants

Objective To evaluate the sterilizing efficiency ofabscrbable poly-L-lactide (PLLA) screws sterilized with ethylene oxide and 60Co-γ radial. Methods One group of PLLA screws was sterilized in the ethylene oxide sterilization ease. In order to eliminate the rudimental ethylene oxide, the sterilized screws was put in the air for five days. The other group of PLLA screws was sterilized with 60Co-γ radial with absorbable dose of 15 kGy. Then all sterilized screws were characterized. Results Compared with the primal bend intensity of the PLLA screws, the bend intensity of sterilized screws did not descend remarkably (P＞0.05). Compared with the primal molecular weight of the PLLA screws, the molecular weight of screws with 60Co-γ radiation sterilization re-markably decreased 11%. It indicated that the material had degraded. The molecular weight of screws with ethylene oxide sterilization ordy decreased 3%. It indicated that the material didn't degrade obviously. Conclusion Ethylene oxide sterilization is a better way for sterilizing absorbable PLLA screws. Key words: Absorbable poly-L-laetide screws; Ethylene oxide; 60Co-γ radial; Sterilization

Treatment of ankle joint fractures with absorbable screws and Kirschner wire

Objective To discuss treatment of the ankle joint fractures with absorbable screws and Kirschner wire. Methods From July 2003 to May 2007, 42 patients with ankle joint fracture were treated with absorbable screws and Kirschner wire. Fractures were fixed with 1 to 2 Kirschner wires around the absorbable screws in operation, and plaster slabs were applied at functional position for 4 to 6 weeks after operation. Their Kirschner wires were removed in outpatient service about 4 weeks after operation and func-tional exercise was encouraged gradually. Results All the 42 cases were followed up for an average of 24 months. All the fractures healed without nonunion and infection According to the evaluation criteria of American Orthopaedic Foot and Ankle Society (AOFAS), the results were rated as excellent in 35 cases, good in 6, mod-erate in 1, and poor in none. The total good to excellent rate was 97.6%. Conclusion Absorbable screws and Kirschner wire can be applied for the ankle joint fracture, leading to satisfactory healing rate and good ankle functional recovery, as well as sparing the patient secondary operation. Key words: Absorbable implants; Kirschner wire; Ankle joint; Fracture; Fracture fixation, internal

Diagnosis and treatment of osteochondral fractures of the patella

Objective To assess the clinical characteristics.diagnosis and curative methods of 06- teochondral fractures of the patella.Methods From October 2002 to December 2006.21 patients with osteochondral fracture of the patella were operatively treated in our department.Of the 17 fresh fractures,2 received wire internal fixation.4 fixation with 2 to 3 AO mini-screws.4 fixation with Ethicon absorbable Su- ture.5 fixation with l to 2 tiny absorbable screws.and 2 knee arthroscopy.Of 4 old fractures.2 underwent open repair ofmedial patellar surface and removal of free bone debris,l arthroscopy to remove bone fragments and 1 internal fixation with AO mini-screwS. Results The patients were all followed up for 32.3(12 to 48) months on average.Twenty cages got bony healing and eomplete functional recovery.Only l case had knee paln and motion hmitation. Conclusions Osteoehondral fractures of the patella are likely to be misdiagnosed.Thin CT,MRI,and arthroseopy can help avoid misdiagnosis.Operation should be performed once diagnosis is confirmed.Open reduction,internal fixation with absorbable screws or suture,and arthroscopy ale effective methods to treat the disorder. Key words: Patella; Osteochondral; Fractures; Diagnosis; Treatment

Clinical application of home-made absorbable screws in treatment of olecranon fractures

Objective To evaluate the results of internal fixation for olecranon fractures with home-made poly-DL-lactic acid (PDLLA) absorbable screws. Methods Fifty-four patients diagnosed as olecranon fracture were treated with internal fixation by PDLLA absorbable screws and tension band wiring respectively. In the experimental group, 22 patients were fixed using absorbable screws. In the control group,32 patients were fixed with tension band wiring. Results The follow-ups lasted for 7 to 49 (average,24. 8) months. All the fractures obtained solid union. The outcome was evaluated by Weseley rating system.The elbow function was good to excellent in 90.9 % of the patients in the experimental group, without pain or posterior apophysis of the elbow. Proximal radioulnar joint stiffness due to the screw was found in 1 patient,whose function of rotation recovered 5 months later. Invalid internal fixation was found by roentgenogram 2 weeks postoperatively in another 1 case who had been complicated with fractures of middle radius and ulna,and consequently had to be changed into tension band wiring. The elbow function recovered 12 months later.In the control group, the function was good to excellent in 93. 8%. Nine patients (28. 1% ) complained about posterior apophysis of the elbow and pain during motion. Roentgenogram revealed the K-wires backing out in 3 cases (9. 4% ). All the patients in this group had to have the internal fixators removed 8 to 15 months postoperatively. Data were statistically analyzed with SPSS 11.5. Rank sum test was used for pairwise comparison. There was no statistical significant difference in the good to excellent rate between the 2 groups ( W =845.0, P = 0. 485 ) . Conclusions Open reduction and internal fixation with home-made absorbable screws is an effective way for treatment of olecranon fractures. As the screws can be degraded completely,patients need not undergo a secondary operation, obviously reducing the treatment expenditure and time. Key words: Ulna fractures; Fracture fixation, internal; Absorbable screws