Absorbable screw internal fixation: Complications and prevention measures

doi:10.3969/j.issn.2095-4344.2013.09.013

Abstract

Abstract:

BACKGROUND: In some special parts of limbs, absorbable screws instead of metal screws have obtained good fixation effects, but, a few complications also appear. The causes and prevention measures of complications of absorbable screws have been reported less in literature.
OBJECTIVE: To analyze the incidence, causes and prevention measures of complications of absorbable screw internal fixation.
METHODS: A total of 113 cases treated with 236 absorbable screw or rod internal fixation were studied retrospectively. Among the 113 cases, limb fractures occurred in 92 cases and ligament reconstructions in 21 cases. Excepted for four cases of tibial shaft fractures, the rest cases of limb fractures were cancellous bone fractures near the joints.
RESULTS AND CONCLUSION: All the patients were followed-up for 12-48 months with an average of 20 months, the total incidence of complications was 10.6%.The fixation failure occurred in five cases (failure rate 4.4%), that was related with inappropriate choice of indications, osteoporosis, over-tapping and too early or excessive activity after operation. Among the five cases of fixation failure, displacement lighter in three cases and displacement significant in two cases. Local adverse reactions occurred in seven cases (6.2% incidence rate), that was mainly related with material composition, perforation of joint, too much outside exposure of screws. Among the seven cases of local adverse reactions, mild in two cases (1.8%) and severe in five cases (4.4%); early reactions in four cases (3.5%) and late phase reactions in three cases (2.7%). Complications of absorbable screws internal fixation are related with the material composition, poor choice of indication, failure to regulate the standard operation and too early or excessive activity after operation, as well as other factors.

Key words: bone and joint implants, orthopedic implants, absorbable screws, metal plate, internal fixation, humeral condylar fracture, radius bone head, olecranon, patella fractures, complication, fixation failure, adverse reaction

CLC Number:

R318

Xu Ke-lin, Yin Qu-dong, Gu San-jun, Sun Zhen-zhong, Shou Kui-shui. Absorbable screw internal fixation: Complications and prevention measures[J]. Chinese Journal of Tissue Engineering Research, 2013, 17(9): 1605-1610.

Figures/Tables 3

References

[1] Kim SH, Lee YH, Chung SW, et al. Outcomes for four-part proximal humerus fractures treated with a locking compression plate and an autologous iliac bone impaction graft. Injury. 2012;43(10):1724-1731.

[2] Ye T, Chen A, Yuan W, et al. Management of grade III open dislocated ankle fractures: combined internal fixation with bioabsorbable screws/rods and external fixation. J Am Podiatr Med Assoc. 2011;101(4):307-315.

[3] Tang J, Guo WC, Hu JF, et al. Zhonghua Linchuang Yishi Zazhi(Dianziban). 2012;6(3):203-204. 唐谨,郭卫春,胡金凤,等.可吸收螺钉在骨科的应用及研究[J].中华临床医师杂志(电子版),2012,6(3):203-204.

[4] Zhao L, Wang LM, Jiang CZ, et al. Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu. 2007;11(1):175-175. 赵磊,王黎明,蒋纯志,等.新型内固定材料可吸收螺钉治疗髌骨骨折的应用特点[J].中国组织工程研究与临床康复,2007,11(1): 175-175.

[5] Rouleau DM,Laflamme GY,Berry GK,et al.Proximal humerus fracturestreated by percutaneous locking plate internal fixation. Orthop Traumatol SurgRes. 2009;95(1):56-62.

[6] Zhang J, Ebraheim N, Lausé GE, et al. A comparison of absorbable screws and metallic plates in treating calcaneal fractures: a prospective randomized trial. J Trauma Acute Care Surg. 2012;72(2):E106-110.

[7] Hu YL, Yuan WQ, Wang LF, et al. Nanfang Yike Daxue Xuebao. 2010;30(10):2360-2362. 扈延龄,袁万青,王兰风,等.PDLLA吸收螺钉和金属螺钉治疗下胫腓联合分离的前瞻性对照研究[J].南方医科大学学报,2010, 30(10):2360-2362.

[8] Chen YM, Huang JH, Li Q, et al. Linchuang Guke Zazhi. 2012;15(1):20-20. 陈优民,黄际河,李群,等.可吸收螺钉结合可吸收线张力带内固定治疗肱骨大结节骨折[J].临床骨科杂志,2012,15(1):20-20.

[9] Agarwal S, Gupta A, Grevious M, et al.Use of resorbable implants for mandibular fixation: a systematic review. J Craniofac Surg.2009;20(2):331-339.

[10] Givissis PK, Stavridis SI, Papagelopoulos PJ, et al.Delayed foreign-body reaction to absorbable implants in metacarpal fracture treatment. Clin Orthop Relat Res.2010;468(12):3377- 3383.

[11] Pihlajamäki H, Böstman O, Tynninen O, et al.Long-term tissue response to bioabsorbable poly-L-lactide and metallic screws: an experimental study.Bone.2006;39(4):932-937.

[12] Liu WX, Xia RG, Shi HP. Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu. 2008;12(4):135-137. 刘闻欣,夏荣刚,施慧鹏.应用可吸收螺钉生物学特点指导髌骨骨折患者术后康复[J].中国组织工程研究与临床康复,2008,12(4): 135-137.

[13] Zhao L, Wang LM, Jiang CZ, et al. Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu. 2007;11(01):175. 赵磊,王黎明,蒋纯志,等.新型内固定材料可吸收螺钉治疗髌骨骨折的应用特点[J].中国组织工程研究与临床康复,2007,11(01): 175.

[14] Mosier-Laclair S, Pike H, Pomeroy G. Intraosseous bioabsorbable poly-L-lactic acid screw presenting as a late foreign-body reaction: a case report.Plast Reconstr Surg. 2006;117(7):2347-2360.

[15] Landes CA, Ballon A, Roth C.Maxillary and mandibular osteosyntheses with PLGA and P(L/DL)LA implants: a 5-year inpatient biocompatibility and degradation experience. Plast Reconstr Surg.2006.117(7):2347-2360.

[16] Zuo W, Liang XJ. Zhongguo Xiufu Chongjian Waike Zazhi. 2008;22(4):507-509. 左伟,梁宪军.可吸收螺钉治疗青壮年股骨头骨折[J].中国修复重建外科杂志,2008,22(4):507-509.

[17] Sun JG, Wang YH, Nie JH, et al. Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu. 2007;11(16):3168-3169. 孙建国,王银河,缪继华,等.自身增强可吸收螺钉在松质骨部位骨折固定的效果评价[J].中国组织工程研究与临床康复,2007, 11(16):3168-3169.

[18] Givissis PK，Stavridis SI,Papagelopoulos PJ,et al. Delayed foreign-body reaction to absorbable implants in metacarpal fracture treatment.Clin Orthop Relat Res.2010;468(12): 3377-3383.

[19] Yang AQ, Cheng XM, Wang JD, et al. Zhonghua Chuangshang Zazhi. 2006;22(7):506-509. 杨安群,程学明,王进东,等.可吸收螺钉和金属内固定治疗胫骨平台骨折疗效比较[J].中华创伤杂志,2006,22(7):506-509.

[20] Zhang SQ, Liu AQ, Xiao DM, et al. Zhongguo Guy u Guanjie Sunshang Zazhi. 2006;21(11):68-69. 张世权,刘安庆,肖德明,等.可吸收螺钉治疗踝关节骨折并发症分析[J].中国骨与关节损伤杂志,2006,21(11):68-69.

[21] Böstman OM. Osteoarthritis of the ankle after foreign-body reaction to absorbable pins and screws: a three to nine year follow up study.J Bone Joint Surg Br.1998;80(2):333-338.

[22] Böstman OM, Pihlajamäki HK.Adverse tissue reactions to bioabsorbable fixation devices.Foot Ankle Int.2001;22(3): 247-251.

[23] Hall MP, Hergan DM, Sherman OH.Early fracture of a bioabsorbable tibial interference screw after ACL reconstruction with subsequent chondral injury.Orthopedics. 2009;32(3):208.

[24] Baums MH, Zelle BA, Schultz W, et al.Intraarticular migration of a broken biodegradable interference screw after anterior cruciate ligament reconstruction.Knee Surg Sports Traumatol Arthrosc.2006;14(9):865-868.

[25] Scioscia TN, Giffin JR, Allen CR, et al.Potential complication of bioabsorbable screw fixation for osteochondritis dissecans of the knee.Arthroscopy.2001;17(2):E7.

[26] Al-Sukhun J, Penttilä H, Ashammakhi N. Orbital stress analysis: part III: biomechanics of orbital blowout fracture repair using bioresorbable poly-L/DL-lactide (P[L/DL]LA 70:30) implant. J Craniofac Surg. 2011;22(4):1299-1303.

[27] Meara DJ, Knoll MR, Holmes JD, et al. Fixation of Le Fort I osteotomies with poly-DL-lactic acid mesh and ultrasonic welding--a new technique. J Oral Maxillofac Surg. 2012;70(5): 1139-1144.

[28] ] Lu SS, Xiaong JW, Zhu CH, et al. Shiyong Linchuang Yixue(Jiangxi). 2011;12(10):45-46. 卢水生,熊军委,祝长华,等.关节部位骨折可吸收螺钉的应用[J].实用临床医学(江西),2011,12(10):45-46.

[29] Weppe F, Magnussen RA, Lustig S, et al. A biomechanical evaluation of bicortical metal screw fixation versus absorbable interference screw fixation after coracoid transfer for anterior shoulder instability. Arthroscopy. 2011;27(10):1358-1363.

[30] Brunton LM, Wittstadt RA. Thumb carpometacarpal arthroplasty using an absorbable interference screw for flexor carpi radialis ligament reconstruction. J Trauma Acute Care Surg. 2012;72(2):E106-110.