OPERATIVE TECHNIQUE FEATURES IN APPLICATION OF BIOABSORBABLE IMPLANTS FOR LIMB FRACTURES TREATMENT
Abstract
Bioabsorbable screws and rods were used for treatment of different types and locations limb fractures in the CCH of RAS orthopedic trauma department between 2014 and 2016 for 120 patients. Interfragmentary fixation with bioabsorbable implants was applied as a single fixation method for 53 patients (44%), and in 67 (56%) cases it was combined with metallic plates and screws. Bioabsorbable implants were recognized as effective devices for interfragmentary fixation. Generally, bioabsorbable screws and rods did not require particulary scills for the surgeons brigade and accorded with AO principles of fracture management. However there were find out some features of that implant type application like implant destruction possibility when incorrect instrumentation was used, X-ray and visual transparency while implanted, that lead to some difficulties in length measurement and implant position assessment, a possibility of implant length adaptation, drilling through implanted device that eliminates risks of implants conflict, and gives an opportunity for augmentation of bone defects by screws. Also it is desirable to fix implants in two cortexes, and to use fully threaded and lag-screws together in a pair.
About the Authors
V. G. Golubev
Russian Medical Academy of Continuous Professional Education, Central Clinical Hospital of Russian Academy of Sciences
Russian Federation
Russian Federation
A. N. Starostenkov
Central Clinical Hospital of Russian Academy of Sciences
Russian Federation
Russian Federation
References
1. Загородний Н.В., Волна А.А., Панин М.А. Удаление имплантатов. // Вестник РУДН, серия Медицина. 2010. №4. С.44-51
2. Böstman O.M. Metallic or absorbable fracture fixation devices. A cost minimization analysis. // Clinical Orthopaedics and Related Research. 1996. V.329. P.233-239.
3. Böstman O. Economic considerations on avoiding implant removals after fracture fixation by using absorbable devices. // Scandinavian Journal of Social Medicine. 1994. V.22(1). P.41-45.
4. Haseeb M., Butt M.F., Altaf T., Muzaffar K., Gupta A., Jallu A. Indications of implant removal: A study of 83 cases // International Journal of Health Sciences (Qassim). 2017. V.11(1). P.1-7.
5. Reith G., Schmitz-Greven V., Hensel K.O., Schneider M.M., Tinschmann T., Bouillon B., Probst C. Metal implant removal: benefits and drawbacks- a patient survey. // BMC Surgery. 2015. V.15(96). P.1-8.
6. Busam M.L., Esther R.J., Obremskey W.T. Hardware removal: indications and expectations. // The Journal of the American Academy of Orthopaedic Surgeons. 2006. V.14(2) P.113-20.
7. Richards R.H., Palmer J.D., Clarke N.M. Observations on removal of metal implants. // Injury. 1992. V.23(1) P.25-8.
8. Wagner M. General principles for the clinical use of the LCP. // Injury. 2003. V.34. P.B31-42.
9. van Manen C.J., Dekker M.L., van Eerten P.V., Rhemrev S.J., van Olden G.D., van der Elst M. Bio-resorbable versus metal implants in wrist fractures: a randomised trial. // Archive of Orthopaedic Trauma Surgery. 2008. V.128(12). P.1413-1417.
10. Gaiarsa G.P., Dos Reis P.R., Mattar R. Jr., Silva Jdos. S., Fernandez T.D. Comparative study between osteosynthesis in conventional and bioabsorbable implants in ankle fractures. // Acta Ortopedica Brasileria. 2015. V.23(5). P.263-267.
11. Zhang J., Ebraheim N., Lausé G.E. A comparison of absorbable screws and metallic plates in treating calcaneal fractures: a prospective randomized trial. // Journal of Trauma Acute Care Surgery. 2012. V.72 (2) P.E106-10.
12. Podeszwa D.A., Wilson P.L., Holland A.R., Copley L.A. Comparison of bioabsorbable versus metallic implant fixation for physeal and epiphyseal fractures of the distal tibia. // Journal of Pediatric Orthopaedia. 2008. V.28 (8) P.859-63.
13. Zamora R., Jackson A., Seligson D. Correct techniques for the use of bioabsorbable implants in orthopaedic trauma // Current Orthopaedic Practice. 2016. V.27(4). P.469-473.
14. Eglin D., Alini M. Degradable polymeric materials for osteosynthesis: tutorial. // European Cells and Materials. 2008. V.16. P.80-91.
15. Washington M.A., Swiner D.J., Bell K.R., Fedorchak M.V., Little S.R., MeyerT.Y. The impact of monomer sequence and stereochemistry on the swelling and erosion of biodegradable poly(lactic-co-glycolic acid) matrices // Biomaterials. 2016. V. 11(037). P.1-23.
16. Waris E., Ninkovic M., Harpf C., Ninkovic M., Ashammakhi N. Self-reinforced bioabsorbable miniplates for skeletal fixation in complex hand injury: three case reports. // The Journal of Hand Surgery. 2004. V.29(3). P.452-457.
17. Zhang J., Xiao B., Wu Z, Surgical treatment of calcaneal fractures with bioabsorbable screws. // International Orthopaedics (SICOT). 2011. V. 35. P.529-533
18. Böstman O., Laitinen O.M., Tynninen O. Tissue restoration after resorption of polyglycolide and poly-laevo-lactic acid screws. // Journal of Bone and Joint Surgery Br. 2005. V.87. P.1575-1580.
19. Хонинов Б.В., Сергунин О.Н., Скороглядов П.А. Возможности применения биодеградируемых материалов в травматологии и ортопедии (обзор литературы). // Вестник Российского государственного медицинского университета. 2014. №1. С.20-24.
20. Rokkanen P.U., Böstman O., Hirvensalo E. Bioabsorbable fixation in traumatology and orthopaedics. (BFTO) // Helsinki. 1997. 170 p.
21. Raikin S.M., Ching A.C. Bioabsorbable fixation in foot and ankle. // Foot Ankle Clin. 2005. V.10 (4). P.667-684.
22. Joukainen A., Partio E.K., Waris P. Bioabsorbable screw fixation for the treatment of ankle fractures. // Journal of Orthopaedic Science. 2007. V. 12(1). P. 28-34.
23. Noh J.H., Roh Y.H., Yang B.G. Outcomes of operative treatment of unstable ankle fractures: a comparison of metallic and biodegradable implants. // J Bone Joint Surgery Am. 2012. V.94 (22). P.166-174.
24. Maurus P.B., Kaeding C.C. Bioabsorbable implant material review. // Operative Techniques in Sports Medicine. 2004. V.12(3). P.158-160.
25. Хонинов Б.В., Сергунин О.Н., Скороглядов П.А. Анализ клинической эффективности применения биодеградируемых имплантатов в хирургическом лечении вальгусной деформации I пальца стопы. // Вестник Российского государственного медицинского университе- та. 2015. №3. С.20-24.
26. Rokkanen P.U., Böstman O., Hirvensalo E. Bioabsorbable fixation in traumatology and orthopaedics. (BFTO) // Helsinki. 1997. 170 p.
27. Nielson D.L., Young N.J., Zelen C.M. Absorbable fixation in forefoot surgery: a viable alternative to metallic hardware. // Clinics in podiatric medicine and surgery. 2013. V.30(3). P.283-293.
28. Young A.A., Maia R., Moraga C., Liotard J-P., Walch G. Latarjet- Bristow Procedure Performed with Bioabsorbable Screws Computed Tomography Evidence of Healing. // Techniques in Shoulder and Elbow Surgery. 2010. V.11(3). P.85-89.
29. Rano J.A., Savoy-Moore R.T., Fallat L.M. Strength comparison of allogenic bone screws, bioabsorbable screws, and stainless steel screw fixation. // The Journal of foot and ankle surgery. 2002. V.41(1). P.6-15.
30. Ciccone W.J., Motz C., Bentley C., Tasto J.P. Bioabsorbable implants in orthopaedics: new developments and clinical applications. // The Journal of the American Academy of Orthopaedic Surgeons. 2001. V.9(5). P.280-288.
31. Manninen M.J., Päivärinta U., Taurio R., Törmälä P., Suuro- nen R., Räihä J., Rokkanen P., Pätiälä H. Polylactide screws in the fixation of olecranon osteotomies. A mechanical study in sheep. // Acta orthopaedica Scandinavica. 1992. V.63(4). P.437-442.
32. Рюди Т., Бакли Р., Моран К. AO-принципы лечения переломов (в двух томах). Русскоязычное второе дополненное и переработанное издание. Перевод с английского. // Берлин. Васса-Медиа. 2013. Том 1 С.1-8, 32-46, 212-226
33. Шаповалов В.М., Хоминец В.В., Михайлов С.В. Основы внутреннего остеосинтеза. // М.: ГЭОТАР-Медиа. 2009.- 240 с.
34. Väänänen P., Nurmi J.T., Lappalainen R., Jank S. Fixation properties of a biodegradable "free-form" osteosynthesis plate with screws with cut-off screw heads: biomechanical evaluation over 26 weeks. // Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, Endodntics. 2009. V.107(4). P.462-8.
35. Агаджанян В.В., Пронских А.А., Демина В.А., Гомзяк В.И., Седуш Н.Г., Чвалун С.Н. Биодеградируемые импланты в ортопедии и травматологии. Наш первый опыт. // Политравма. 2016. №.4. С.85-93.
36. Jainandunsing J.S., van der Elst M., van der Werken C.C. Bioresorbable fixation devices for musculoskeletal injuries in adults. // Cochrane Database System Review. 2005 V.2. P.1-9.
Review
For citations:
Golubev V.G., Starostenkov A.N. OPERATIVE TECHNIQUE FEATURES IN APPLICATION OF BIOABSORBABLE IMPLANTS FOR LIMB FRACTURES TREATMENT. Surgical practice (Russia). 2017;(2):5-13. (In Russ.)
Views:
481
Email this article 