OSTEOSYNTHESIS OF THE METACARPAL BONE WITH BIOABSORBABLE MATERIALS: A CASE REPORTS
Background. Recent advances in biomaterial technology make it possible to produce easy-to-handle implants for osteosynthesis with ultra-high strenght and excellent biocompatibility. Biomechanical studies have shown that fixation rigidity achieved with self-reinforced (SR) pins, screws and miniplates is comparable with that of metallic fixation methods. Internal fixation by means of bioabsorbable plates, screws, and pins can be used to stabilize some fractures of small bones in the hand.
We report our experience with three cases where internal fixation with a SR (poly-L/DL-lactide 70/30; SR-P (L/DL) LA 70/30, BioSorbTMFX) miniplates and screws was carried out for stabilization of a metacarpal shaft fracture and thumb replantation.
Conclusions. After bone healing is complete, metallic osteosynthesis devices become unnecessary or can even be harmful. Metallic implant-related long-term complications and secondary removal operation are avoided by using of bioabsorbable osteosynthesis devices for metacarpal bones osteosynthesis.
Stern PJ. Fractures of the metacarpals and phalanges. In: GreenDP, Hotchkiss RN, Pederson WC. Greens operative hand surgery. 4th ed. Philadelphia: Churchill Livingstone 1999: 711–71.
Page SM, Stern PJ, Cincinnati O. Complications and range of motion following plate fixation of metacarpal and phalangeal fractures. J Hand Surg 1998; 23A: 827–32.
Stern PJ, Wieser MJ, Reilly DG. Complications of plate fixation in the hand skeleton. Clin Orthop 1987; 214: 59–65.
Fambrough RA, Green DP. Tendon rupture as a complication of screw fixation in fractures in the hand. A case report. J Bone Joint Surg 1979; 61A: 781– 2.
Wong-Chung J, Quinlan W. Rupture of extensor pollicis longus following fixation of a distal radius fracture. Injury 1989; 20: 375–6.
Rokkanen PU, Böstman O, Hirvensalo E et al. Bioabsorbable fixation in orthopaedic surgery and traumatology. Biomaterials 2000; 21: 2607–13.
Ashammakhi N, Peltoniemi H, Waris E et al. Developments in craniomaxillofacial surgery: use of self-reinforced bioabsorbable osteofixation devices. Plast Reconstr Surg 2001; 108: 167–80.
Böstman O, Pihlajamäki H. Adverse tissue reactions to bioabsorbable fixation devices. Clin Orthop 2000; 371: 216–27.
Törmälä P. Biodegradable self-reinforced composite materials; Manufacturing structure and mechanical properties. Clin Mater 1992; 10: 29–34.
Vasenius J, Vainionpää S, Vihtonen K, Mäkelä A, Rokkanen P, Mero M, Törmälä P. Comparison of in vitro hydrolysis, subcutaneous and intramedullary implantation to evaluate the strength retention of absorbable osteosynthesis implants. Biomaterials 1990; 11: 501–4.
Majola A, Vainionpää S, Mikkola HM, Törmälä P, Rokkanen P. Absorbable self-reinforced polylactide (SR-PLA) composite rods for fracture fixation: strength and strength retention in the bone and subcutaneous tissue of rabbits. J Mater Sci Mater Med 1992; 3: 43–7.
Päivärinta U, Böstman O, Majola A, Toivonen T, Törmälä P, Rokkanen P. Intraosseous cellular response to biodegradable fracture fixation screws made of polyglycolide or polylactide. Arch Orthop Trauma Surg 1993; 112: 71–4.
Black D, Mann RJ, Constine R, Daniels AU. Comparison of internal fixation techniques in metacarpal fractures. J Hand Surg 1985; 10A: 466–72.
Firoozbakhsh KK, Moneim MS, Howey T, Castaneda E, Pirela-Cruz MA. Comparative fatigue strength and stability of metacarpal internal fixation techniques. J Hand Surg 1993; 18A: 1059–68.
Prevel CD, McCarty M, Katona T, Moore K, Jackson JR, Eppley BL, Sood R. Comparative biomechanical stability of titanium bone fixation systems in metacarpal fractures. Ann Plast Surg 1995; 35: 6–14.
Waris E, Ashammakhi N, Raatikainen T, Törmälä P, Santavirta S, Konttinen Y. Self-reinforced bioabsorbable versus metallic fixation systems for metacarpal and phalangeal fractures: a biomechanical study. J Hand Surg 2002; 27 A: 902–9.
Paavolainen P, Karaharju E, Slätis P, Ahonen J, Holmström T. Effect of rigid plate fixation on structure and mineral content of cortical bone. Clin Orthop 1978; 136: 287–93.
Novak E, Spanio S, Mijatovic D, Orozim Z, Pekarovic J. Bioabsorbable fixation in hand surgery. In: 4th Croatian congress of plastic, reconstructive and aesthetic surgery. Zagreb 25.–28. 9. 2002.
Jukkala-Partio K, Partio EK, Helevirta P, Pohjonen T, Törmälä P, Rokkanen P. Treatment of subcapital femoral neck fractures with bioabsorbable or metallic screw fixation. A preliminary report. Ann Chir Gynaecol 2000; 89: 45–52.
Jukkala-Partio K, Partio EK, Hirvensalo E, Rokkanen P. Absorbable fixation of femoral head fractures. A prospective study of six cases. Ann Chir Gynaecol 1998; 87: 44–8.
Pelto-Vasenius K, Hirvensalo E, Böstman O, Rokkanen P. Fixation of scaphoid delayd union and non-union with absorbable polyglycolide pin or Herbert screw. Consolidation and functional results. Arch Orthop Trauma Surg 1995; 114: 347–51.
The Author transfers to the Publisher (Zdravniški vestnik/Slovenian Medical Journal) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Zdravniški vestnik/Slovenian Medical Journal) has the right to transfer the rights, acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.