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Herzog P, Rendenbach C, Turostowski M, Ellinghaus A, Prates Soares A, Heiland M, Duda GN, Schmidt-Bleek K, Fischer H. Titanium versus plasma electrolytic oxidation surface-modified magnesium miniplates in a forehead secondary fracture healing model in sheep. Acta Biomater 2024; 185:98-110. [PMID: 39002920 DOI: 10.1016/j.actbio.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 07/02/2024] [Accepted: 07/05/2024] [Indexed: 07/15/2024]
Abstract
Magnesium as a biodegradable material offers promising results in recent studies of different maxillo-facial fracture models. To overcome adverse effects caused by the fast corrosion of pure magnesium in fluid surroundings, various alloys, and surface modifications are tested in animal models. In specified cases, magnesium screws already appeared for clinical use in maxillofacial surgery. The present study aims to compare the bone healing outcome in a non-load-bearing fracture scenario of the forehead in sheep when fixed with standard-sized WE43 magnesium fixation plates and screws with plasma electrolytic oxidation (PEO) surface modification in contrast to titanium osteosynthesis. Surgery was performed on 24 merino mix sheep. The plates and screws were explanted en-bloc with the surrounding tissue after four and twelve weeks. The outcome of bone healing was investigated with micro-computed tomography, histological, immunohistological, and fluorescence analysis. There was no significant difference between groups concerning the bone volume, bone volume/ total volume, and newly formed bone in volumetric and histological analysis at both times of investigation. The fluorescence analysis revealed a significantly lower signal in the magnesium group after one week, although there was no difference in the number of osteoclasts per mm2. The magnesium group had significantly fewer vessels per mm2 in the healing tissue. In conclusion, the non-inferiority of WE43-based magnesium implants with PEO surface modification was verified concerning fracture healing under non-load-bearing conditions in a defect model. STATEMENT OF SIGNIFICANCE: Titanium implants, the current gold standard of fracture fixation, can lead to adverse effects linked to the implant material and often require surgical removal. Therefore, degradable metals like the magnesium alloy WE43 with plasma electrolytic oxidation (PEO) surface modification gained interest. Yet, miniplates of this alloy with PEO surface modification have not been examined in a fracture defect model of the facial skeleton in a large animal model. This study shows, for the first time, the non-inferiority of magnesium miniplates compared to titanium miniplates. In radiological and histological analysis, bone healing was undisturbed. Magnesium miniplates can reduce the number of interventions for implant removal, thus reducing the risk for the patient and minimizing the costs.
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Affiliation(s)
- Paulina Herzog
- Charité - Universitätsmedizin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Carsten Rendenbach
- Charité - Universitätsmedizin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Marta Turostowski
- Charité - Universitätsmedizin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Agnes Ellinghaus
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Ana Prates Soares
- Charité - Universitätsmedizin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Max Heiland
- Charité - Universitätsmedizin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Georg N Duda
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Katharina Schmidt-Bleek
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Heilwig Fischer
- Charité - Universitätsmedizin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; Charité - Universitätsmedizin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Center for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; Berlin Institute of Health at Charité -Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Charitéplatz 1, 10117 Berlin, Germany
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Riyaz S, Sun Y, Helmholz H, Medina TP, Medina OP, Wiese B, Will O, Albaraghtheh T, Mohamad FH, Hövener JB, Glüer CC, Römer RW. Inflammatory response toward a Mg-based metallic biomaterial implanted in a rat femur fracture model. Acta Biomater 2024; 185:41-54. [PMID: 38969080 DOI: 10.1016/j.actbio.2024.06.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 06/20/2024] [Accepted: 06/26/2024] [Indexed: 07/07/2024]
Abstract
The immune system plays an important role in fracture healing, by modulating the pro-inflammatory and anti-inflammatory responses occurring instantly upon injury. An imbalance in these responses can lead to adverse outcomes, such as non-union of fractures. Implants are used to support and stabilize complex fractures. Biodegradable metallic implants offer the potential to avoid a second surgery for implant removal, unlike non-degradable implants. However, considering our dynamic immune system it is important to conduct in-depth studies on the immune response to these implants in living systems. In this study, we investigated the immune response to Mg and Mg-10Gd in vivo in a rat femur fracture model with external fixation. In vivo imaging using liposomal formulations was used to monitor the fluorescence-related inflammation over time. We combine ex vivo methods with our in vivo study to evaluate and understand the systemic and local effects of the implants on the immune response. We observed no significant local or systemic effects in the Mg-10Gd implanted group compared to the SHAM and Mg implanted groups over time. Our findings suggest that Mg-10Gd is a more compatible implant material than Mg, with no adverse effects observed in the early phase of fracture healing during our 4-week study. STATEMENT OF SIGNIFICANCE: Degradable metallic implants in form of Mg and Mg-10Gd intramedullary pins were assessed in a rat femur fracture model, alongside a non-implanted SHAM group with special respect to the potential to induce an inflammatory response. This pre-clinical study combines innovative non-invasive in vivo imaging techniques associated with multimodal, ex vivo cellular and molecular analytics. The study contributes to the development and evaluation of degradable biometals and their clinical application potential. The study results indicate that Mg-10Gd did not exhibit any significant harmful effects compared to the SHAM and Mg groups.
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Affiliation(s)
- Sana Riyaz
- Helmholtz-Zentrum hereon GmbH, Institute of Metallic Biomaterials, Max-Planck-Straße 1, Geesthacht 21502, Germany.
| | - Yu Sun
- Helmholtz-Zentrum hereon GmbH, Institute of Metallic Biomaterials, Max-Planck-Straße 1, Geesthacht 21502, Germany
| | - Heike Helmholz
- Helmholtz-Zentrum hereon GmbH, Institute of Metallic Biomaterials, Max-Planck-Straße 1, Geesthacht 21502, Germany.
| | - Tuula Penate Medina
- Section Biomedical Imaging, Department of Radiology and Neuroradiology University Hospital Schleswig-Holstein Campus Kiel, Kiel University, Am Botanischen Garten 14, 24118 Kiel, Germany; Institute for Experimental Cancer Research, Kiel University, 24105 Kiel, Germany
| | - Oula Penate Medina
- Section Biomedical Imaging, Department of Radiology and Neuroradiology University Hospital Schleswig-Holstein Campus Kiel, Kiel University, Am Botanischen Garten 14, 24118 Kiel, Germany; Institute for Experimental Cancer Research, Kiel University, 24105 Kiel, Germany; Lonza Netherlands B.V., 6167 RB Geleen, the Netherlands
| | - Björn Wiese
- Helmholtz-Zentrum hereon GmbH, Institute of Metallic Biomaterials, Max-Planck-Straße 1, Geesthacht 21502, Germany
| | - Olga Will
- Section Biomedical Imaging, Department of Radiology and Neuroradiology University Hospital Schleswig-Holstein Campus Kiel, Kiel University, Am Botanischen Garten 14, 24118 Kiel, Germany
| | - Tamadur Albaraghtheh
- Helmholtz-Zentrum hereon GmbH, Institute of Metallic Biomaterials, Max-Planck-Straße 1, Geesthacht 21502, Germany; Helmholtz-Zentrum hereon GmbH, Institute of Surface Science, Max-Planck-Straße 1, Geesthacht 21502, Germany
| | - Farhad Haj Mohamad
- Section Biomedical Imaging, Department of Radiology and Neuroradiology University Hospital Schleswig-Holstein Campus Kiel, Kiel University, Am Botanischen Garten 14, 24118 Kiel, Germany
| | - Jan-Bernd Hövener
- Section Biomedical Imaging, Department of Radiology and Neuroradiology University Hospital Schleswig-Holstein Campus Kiel, Kiel University, Am Botanischen Garten 14, 24118 Kiel, Germany
| | - Claus Christian Glüer
- Section Biomedical Imaging, Department of Radiology and Neuroradiology University Hospital Schleswig-Holstein Campus Kiel, Kiel University, Am Botanischen Garten 14, 24118 Kiel, Germany
| | - Regine Willumeit Römer
- Helmholtz-Zentrum hereon GmbH, Institute of Metallic Biomaterials, Max-Planck-Straße 1, Geesthacht 21502, Germany
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Kim WS, Oh MJ, Park MS, Sung KH. Comparison of surgical outcomes between bioabsorbable and metal screw fixation for distal tibial physeal fracture in children and adolescent. INTERNATIONAL ORTHOPAEDICS 2024:10.1007/s00264-024-06284-4. [PMID: 39183229 DOI: 10.1007/s00264-024-06284-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 08/14/2024] [Indexed: 08/27/2024]
Abstract
PURPOSE This study aimed to compare the surgical outcomes between bioabsorbable and metal screw fixation for distal tibial physeal fracture in children and adolescents, radiographically and clinically. METHODS This study included consecutive 67 children and adolescents who underwent open reduction and internal fixation using metal or bioabsorbable screws for the distal tibia physeal fracture. All patients underwent preoperative radiographs, three-dimensional computed tomography scans, and postoperative follow-up teleradiogram. Patients were divided into metal (N = 40) and bioabsorbable groups (N = 27). We compared the surgical outcomes between the two groups in terms of clinical and radiographic outcomes, length of hospital stays, and medical cost. RESULTS Follow-up duration were significantly longer in the metal group than that in the bioabsorbable group. There was no significant difference in the incidence of growth arrest after surgery and the scores of the Oxford Ankle and Foot Questionnaire between the two groups. However, the total hospital stay was significantly longer in the metal group (5.2 ± 4.8 days) compared to the bioabsorbable group (2.6 ± 0.5 days). Medical costs were significantly higher in the bioabsorbable group than in the metal group with a difference of 397 US dollars. CONCLUSIONS The use of bioabsorbable screws exhibited therapeutic effects equivalent to that of metal screws for pediatric distal tibia physeal fractures regarding clinical and radiological outcomes. Moreover, it had the advantage of avoiding the need for repeated general anesthesia and secondary operation for implant removal. Therefore, the use of bioabsorbable screws may be a favourable surgical option for treating pediatric fractures.
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Affiliation(s)
- Woo Sub Kim
- Department of Orthopaedic Surgery, Myongji Hospital, Hanyang University College of Medicine, Goyang, Gyeonggi, Korea
| | - Min Joon Oh
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Seongnam, Gyeonggi, 13620, Korea
| | - Moon Seok Park
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Seongnam, Gyeonggi, 13620, Korea
| | - Ki Hyuk Sung
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Seongnam, Gyeonggi, 13620, Korea.
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Fang C, Premchand AXR, Park DH, Toon DH. Peri-articular elbow fracture fixations with magnesium implants and a review of current literature: A case series. World J Orthop 2024; 15:215-229. [PMID: 38596190 PMCID: PMC10999966 DOI: 10.5312/wjo.v15.i3.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/11/2024] [Accepted: 02/02/2024] [Indexed: 03/15/2024] Open
Abstract
BACKGROUND In recent years, the use of Magnesium alloy implants have gained renewed popularity, especially after the first commercially available Conformité Européenne approved Magnesium implant became available (MAGNEZIX® CS, Syntellix) in 2013. AIM To document our clinical and radiographical outcomes using magnesium implants in treating peri-articular elbow fractures. METHODS Our paper was based on a retrospective case series design. Intra-operatively, a standardized surgical technique was utilized for insertion of the magnesium implants. Post - operatively, clinic visits were standardized and physical exam findings, functional scores, and radiographs were obtained at each visit. All complications were recorded. RESULTS Five patients with 6 fractures were recruited (2 coronoid, 3 radial head and 1 capitellum). The mean patient age and length of follow up was 54.6 years and 11 months respectively. All fractures healed, and none exhibited loss of reduction or complications requiring revision surgery. No patient developed synovitis of the elbow joint or suffered electrolytic reactions when titanium implants were used concurrently. CONCLUSION Although there is still a paucity of literature available on the subject and further studies are required, magnesium implants appear to be a feasible tool for fixation of peri-articular elbow fractures with promising results in our series.
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Affiliation(s)
- Christopher Fang
- Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, National Healthcare Group, Singapore 768828, Singapore
| | - Antony Xavier Rex Premchand
- Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, National Healthcare Group, Singapore 768828, Singapore
| | - Derek Howard Park
- Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, National Healthcare Group, Singapore 768828, Singapore
| | - Dong Hao Toon
- Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, National Healthcare Group, Singapore 768828, Singapore
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Waelti SL, Fandak J, Markart S, Willems EP, Wildermuth S, Fischer T, Dietrich TJ, Matissek C, Krebs T. Prospective evaluation of ultrasound features of magnesium-based bioabsorbable screw resorption in pediatric fractures. Eur Radiol 2024; 34:1556-1566. [PMID: 37658140 DOI: 10.1007/s00330-023-10091-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 05/27/2023] [Accepted: 07/04/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE Bioabsorbable magnesium-based alloy screws release gas upon resorption. The resulting findings in the adjacent soft tissues and joints may mimic infection. The aim of the study was to evaluate the ultrasound (US) findings in soft tissues and joints during screw resorption. METHODS Prospectively acquired US studies from pediatric patients treated with magnesium screws were evaluated for screw head visibility, posterior acoustic shadowing, twinkling artifact, foreign body granuloma, gas (soft tissue, intra-articular), alterations of the skin and subcutaneous fat, perifascial fluid, localized fluid collections, hypervascularization, and joint effusion. RESULTS Sixty-six US studies of 28 pediatric patients (nfemale = 9, nmale = 19) were included. The mean age of the patients at the time of surgery was 10.84 years; the mean time between surgery and ultrasound was 128.3 days (range = 6-468 days). The screw head and posterior acoustic shadowing were visible in 100% of the studies, twinkling artifact in 6.1%, foreign body granuloma in 92.4%, gas locules in soft tissue in 100% and intra-articular in 18.2%, hyperechogenicity of the subcutaneous fat in 90.9%, cobblestoning of the subcutaneous fat in 24.2%, loss of normal differentiation between the epidermis/dermis and the subcutaneous fat in 57.6%, localized fluid collection in 9.9%, perifascial fluid in 12.1%, hypervascularization in 27.3%, and joint effusion in 18.2%. CONCLUSION US findings in pediatric patients treated with magnesium screws strongly resemble infection, but are normal findings in the setting of screw resorption. CLINICAL RELEVANCE STATEMENT Bioabsorbable magnesium-based alloy screws release gas during resorption. The resulting US findings in the adjacent soft tissues and joints in pediatric patients may mimic infection, but are normal findings. KEY POINTS • Bioabsorbable magnesium-based alloy screws release gas upon resorption. • The resulting ultrasound findings in children's soft tissues and joints closely resemble those of soft tissue infection or osteosynthesis-associated infection. • Be familiar with these ultrasound findings in order to avoid inadvertently misdiagnosing a soft tissue infection or osteosynthesis-associated infection.
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Affiliation(s)
- Stephan L Waelti
- Department of Radiology and Nuclear Medicine, Children's Hospital of Eastern Switzerland, Claudiusstrasse 6, 9006, St. Gallen, Switzerland.
- Department of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
| | - Jozef Fandak
- Department of Radiology and Nuclear Medicine, Children's Hospital of Eastern Switzerland, Claudiusstrasse 6, 9006, St. Gallen, Switzerland
- Department of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Stefan Markart
- Department of Radiology and Nuclear Medicine, Children's Hospital of Eastern Switzerland, Claudiusstrasse 6, 9006, St. Gallen, Switzerland
- Department of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Erik P Willems
- Clinical Trials Unit, Biostatistics, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Simon Wildermuth
- Department of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Tim Fischer
- Department of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Tobias J Dietrich
- Department of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Christoph Matissek
- Department of Pediatric Surgery, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Thomas Krebs
- Department of Pediatric Surgery, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
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Giordano V, Rodrigues A, Voelcker L, Alves G, Pires RE, Freitas A, Mariolani JR, Belangero WD. Is just one screw really enough? Single- versus double-screw in the medial malleolus in supination-external rotation ankle fractures: A comparative biomechanical study using partially threaded cancellous screws. Injury 2024; 55:111175. [PMID: 37926664 DOI: 10.1016/j.injury.2023.111175] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 10/24/2023] [Accepted: 10/29/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE The aim of this study is to investigate stiffness and the maximum load to failure values of single- and double-screw fixation of oblique medial malleolus fractures using partially threaded cancellous screws. Our hypothesis is that single-screw fixation of medial malleolus fractures after SER injuries provides similar stiffness when compared with double-screw fixation. DESIGN Biomechanical study. METHODS Twelve composite polyurethane synthetic right distal tibiae were used in the experiment. Oblique fractures of the medial malleolus were created with a band saw using a custom-made osteotomy guide to standardize the cuts in all models. Bone models were randomly separated into two groups and fixed with one (n = 6) or two (n = 6) 4.0 mm partially threaded cancellous screws placed perpendicular to the fracture line. These were tested by applying an offset axial tension at 10 mm/minute up to maximum load displacement, defined as subsidence of the medial malleolus fragment. Maximum load to failure was determined for the groups at the point where the curve ceased to be linear and suffered an inflection. Force versus displacement curves were obtained and recorded. The student's t-test for independent samples was used to compare stiffness (N / mm) and maximum load (N) between experimental groups, with a p value of < 0.05. RESULTS There were no significant differences in stiffness (p = 0.290) and maximum load (p = 0.191) among the two fixation constructs. Mean stiffness was 62.26 (±SD 21.11) N/mm for double-screw fixation group and 48.24 (±SD 22.40) N/mm for single-screw fixation group. Mean maximum load was 387.83 (±SD 115.78) N for double-screw fixation group and 306.64 (±SD 81.97) N for single-screw fixation group. CONCLUSION Fixation with one 4.0 mm partially threaded cancellous screw was not shown to be biomechanically inferior to fixation with two 4.0 mm partially threaded cancellous screws in an oblique fracture of the medial malleolus, supporting previous clinical studies that have shown that one screw is sufficient for fractures of the medial malleolus.
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Affiliation(s)
- Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro, Brazil; Clínica São Vicente, Rede D'or São Luiz, Rio de Janeiro, Brazil.
| | - Aliny Rodrigues
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro, Brazil
| | - Luiza Voelcker
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro, Brazil
| | - Gabriel Alves
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro, Brazil
| | - Robinson Esteves Pires
- Departamento do Aparelho Locomotor, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | | | - José Ricardo Mariolani
- Laboratório de Biomateriais em Ortopedia (LABIMO), Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil
| | - William Dias Belangero
- Laboratório de Biomateriais em Ortopedia (LABIMO), Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil; Departamento de Ortopedia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil
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Carter TH, Oliver WM, Bell KR, Graham C, Duckworth AD, White TO. Operative vs Nonoperative Management of Unstable Medial Malleolus Fractures: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2351308. [PMID: 38236603 PMCID: PMC10797457 DOI: 10.1001/jamanetworkopen.2023.51308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 11/21/2023] [Indexed: 01/19/2024] Open
Abstract
Importance Unstable ankle fractures are routinely managed operatively. However, because of soft tissue and implant-related complications, recent literature has reported on the nonoperative management of well-reduced medial malleolus fractures after fibular stabilization, but with limited evidence supporting the routine application. Objective To assess the superiority of internal fixation of well-reduced (displacement ≤2 mm) medial malleolus fractures compared with nonfixation after fibular stabilization. Design, Setting, and Participants This superiority, pragmatic, parallel, prospective randomized clinical trial was conducted from October 1, 2017, to August 31, 2021. A total of 154 adult participants (≥16 years) with a closed, unstable bimalleolar or trimalleolar ankle fracture requiring surgery at an academic major trauma center in the UK were assessed. Exclusion criteria included injuries with no medial-sided fracture, open fractures, neurovascular injury, and the inability to comply with follow-up. Data analysis was performed in July 2022 and confirmed in September 2023. Interventions Once the lateral (and where appropriate, posterior) malleolus had been fixed and satisfactory intraoperative reduction of the medial malleolus fracture was confirmed by the operating surgeon, participants were randomly allocated to fixation (n = 78) or nonfixation (n = 76) of the medial malleolus. Main Outcome and Measure Olerud-Molander Ankle Score (OMAS) 1 year after randomization (range, 0-100 points, with 0 indicating worst possible outcome and 100 indicating best possible outcome). Results Among 154 randomized participants (mean [SD] age, 56.5 [16.7] years; 119 [77%] female), 144 (94%) completed the trial. At 1 year, the median OMAS was 80.0 (IQR, 60.0-90.0) in the fixation group compared with 72.5 (IQR, 55.0-90.0) in the nonfixation group (P = .17). Complication rates were comparable. Significantly more patients in the nonfixation group developed a radiographic nonunion (20% vs 0%; P < .001), with 8 of 13 clinically asymptomatic; 1 patient required surgical reintervention for this. Fracture type and reduction quality appeared to influence fracture union and patient outcome. Conclusions and Relevance In this randomized clinical trial comparing internal fixation of well-reduced medial malleolus fractures with nonfixation, after fibular stabilization, fixation was not superior according to the primary outcome. However, 1 in 5 patients developed a radiographic nonunion after nonfixation, and although the reintervention rate to manage this was low, the future implications are unknown. These results support selective nonfixation of anatomically reduced medial malleolar fractures after fibular stabilization. Trial Registration ClinicalTrials.gov Identifier: NCT03362229.
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Affiliation(s)
- Thomas H. Carter
- Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - William M. Oliver
- Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Katrina R. Bell
- Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Catriona Graham
- Edinburgh Clinical Research Facility, Western General Hospital, Edinburgh, United Kingdom
| | - Andrew D. Duckworth
- Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Timothy O. White
- Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
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Labmayr V, Suljevic O, Sommer NG, Schwarze UY, Marek RL, Brcic I, Foessl I, Leithner A, Seibert FJ, Herber V, Holweg PL. Mg-Zn-Ca Alloy (ZX00) Screws Are Resorbed at a Mean of 2.5 Years After Medial Malleolar Fracture Fixation: Follow-up of a First-in-humans Application and Insights From a Sheep Model. Clin Orthop Relat Res 2024; 482:184-197. [PMID: 37603369 PMCID: PMC10723859 DOI: 10.1097/corr.0000000000002799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 07/05/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND In the ongoing development of bioresorbable implants, there has been a particular focus on magnesium (Mg)-based alloys. Several Mg alloys have shown promising properties, including a lean, bioresorbable magnesium-zinc-calcium (Mg-Zn-Ca) alloy designated as ZX00. To our knowledge, this is the first clinically tested Mg-based alloy free from rare-earth elements or other elements. Its use in medial malleolar fractures has allowed for bone healing without requiring surgical removal. It is thus of interest to assess the resorption behavior of this novel bioresorbable implant. QUESTIONS/PURPOSES (1) What is the behavior of implanted Mg-alloy (ZX00) screws in terms of resorption (implant volume, implant surface, and gas volume) and bone response (histologic evaluation) in a sheep model after 13 months and 25 months? (2) What are the radiographic changes and clinical outcomes, including patient-reported outcome measures, at a mean of 2.5 years after Mg-alloy (ZX00) screw fixation in patients with medial malleolar fractures? METHODS A sheep model was used to assess 18 Mg-alloy (ZX00) different-length screws (29 mm, 24 mm, and 16 mm) implanted in the tibiae and compared with six titanium-alloy screws. Micro-CT was performed at 13 and 25 months to quantify the implant volume, implant surface, and gas volume at the implant sites, as well as histology at both timepoints. Between July 2018 and October 2019, we treated 20 patients with ZX00 screws for medial malleolar fractures in a first-in-humans study. We considered isolated, bimalleolar, or trimalleolar fractures potentially eligible. Thus, 20 patients were eligible for follow-up. However, 5% (one patient) of patients were excluded from the analysis because of an unplanned surgery for a pre-existing osteochondral lesion of the talus performed 17 months after ZX00 implantation. Additionally, another 5% (one patient) of patients were lost before reaching the minimum study follow-up period. Our required minimum follow-up period was 18 months to ensure sufficient time to observe the outcomes of interest. At this timepoint, 10% (two patients) of patients were either missing or lost to follow-up. The follow-up time was a mean of 2.5 ± 0.6 years and a median of 2.4 years (range 18 to 43 months). RESULTS In this sheep model, after 13 months, the 29-mm screws (initial volume: 198 ± 1 mm 3 ) degraded by 41% (116 ± 6 mm 3 , mean difference 82 [95% CI 71 to 92]; p < 0.001), and after 25 months by 65% (69 ± 7 mm 3 , mean difference 130 [95% CI 117 to 142]; p < 0.001). After 13 months, the 24-mm screws (initial volume: 174 ± 0.2 mm 3 ) degraded by 51% (86 ± 21 mm 3 , mean difference 88 [95% CI 52 to 123]; p = 0.004), and after 25 months by 72% (49 ± 25 mm 3 , mean difference 125 [95% CI 83 to 167]; p = 0.003). After 13 months, the 16-mm screws (initial volume: 112 ± 5 mm 3 ) degraded by 57% (49 ± 8 mm 3 , mean difference 63 [95% CI 50 to 76]; p < 0.001), and after 25 months by 61% (45 ± 10 mm 3 , mean difference 67 [95% CI 52 to 82]; p < 0.001). Histologic evaluation qualitatively showed ongoing resorption with new bone formation closely connected to the resorbing screw without an inflammatory reaction. In patients treated with Mg-alloy screws after a mean of 2.5 years, the implants were radiographically not visible in 17 of 18 patients and the bone had homogenous texture in 15 of 18 patients. No clinical or patient-reported complications were observed. CONCLUSION In this sheep model, Mg-alloy (ZX00) screws showed a resorption to one-third of the original volume after 25 months, without eliciting adverse immunologic reactions, supporting biocompatibility during this period. Mg-alloy (ZX00) implants were not detectable on radiographs after a mean of 2.5 years, suggesting full resorption, but further studies are needed to assess environmental changes regarding bone quality at the implantation site after implant resorption. CLINICAL RELEVANCE The study demonstrated successful healing of medial malleolar fractures using bioresorbable Mg-alloy screws without clinical complications or revision surgery, resulting in pain-free ankle function after 2.5 years. Future prospective studies with larger samples and extended follow-up periods are necessary to comprehensively assess the long-term effectiveness and safety of ZX00 screws, including an exploration of limitations when there is altered bone integrity, such as in those with osteoporosis. Additional use of advanced imaging techniques, such as high-resolution CT, can enhance evaluation accuracy.
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Affiliation(s)
- Viktor Labmayr
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Omer Suljevic
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | | | - Uwe Yacine Schwarze
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
- Department of Dentistry and Oral Health, Division of Oral Surgery and Orthodontics, Medical University of Graz, Graz, Austria
| | - Romy Linda Marek
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Iva Brcic
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Ines Foessl
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Franz Josef Seibert
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Valentin Herber
- Department of Dentistry and Oral Health, Division of Oral Surgery and Orthodontics, Medical University of Graz, Graz, Austria
- Department of Oral Surgery, University Center for Dental Medicine, University of Basel, Basel, Switzerland
| | - Patrick Lukas Holweg
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
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9
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Elad A, Pul L, Rider P, Rogge S, Witte F, Tadić D, Mijiritsky E, Kačarević ŽP, Steigmann L. Resorbable magnesium metal membrane for sinus lift procedures: a case series. BMC Oral Health 2023; 23:1006. [PMID: 38097992 PMCID: PMC10722874 DOI: 10.1186/s12903-023-03695-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/22/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND The purpose of this case series was to demonstrate the use of a magnesium membrane for repairing the perforated membrane in both direct and indirect approaches, as well as its application in instances where there has been a tear of the Schneiderian membrane. CASE PRESENTATION The case series included four individual cases, each demonstrating the application of a magnesium membrane followed by bone augmentation using a mixture of xenograft and allograft material in the sinus cavity. In the first three cases, rupture of Schneiderian membrane occurred as a result of tooth extraction, positioning of the dental implant, or as a complication during the procedure. In the fourth case, Schneiderian membrane was perforated as a result of the need to aspirate a polyp in the maxillary sinus. In case one, 10 mm of newly formed bone is visible four months after graft placement. Other cases showed between 15 and 20 mm of newly formed alveolar bone. No residual magnesium membrane was seen on clinical inspection. The vertical and horizontal augmentations proved stable and the dental implants were placed in the previously grafted sites. CONCLUSION Within the limitations of this case series, postoperative clinical examination, and panoramic and CBCT images demonstrated that resorbable magnesium membrane is a viable material for sinus lift and Schneiderian membrane repair. The case series showed successful healing and formation of new alveolar bone with separation of the oral cavity and maxillary sinus in four patients.
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Affiliation(s)
| | - Luka Pul
- Department of Dental Medicine, Faculty of Dental Medicine and Health Osijek, J.J. Strossmayer University of Osijek, Crkvena 21, 31 000, Osijek, Croatia
| | | | - Svenja Rogge
- Botiss Biomaterials GmbH, 15806, Zossen, Germany
| | - Frank Witte
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité-Universitätsmedizin Berlin, Aßmannshauser Straße, 4-6, 14197, Berlin, Germany
| | - Dražen Tadić
- Botiss Biomaterials GmbH, 15806, Zossen, Germany
| | - Eitan Mijiritsky
- Department of Head and Neck and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, The Sackler Faculty of Medicine, Tel-Aviv University, 6139001, Tel Aviv, Israel
| | - Željka Perić Kačarević
- Botiss Biomaterials GmbH, 15806, Zossen, Germany.
- Department of Anatomy, Histology, Embryology, Pathology Anatomy and Pathology Histology, Faculty of Dental Medicine and Health Osijek, J.J. Strossmayer University of Osijek, Crkvena 21, 31 000, Osijek, Croatia.
| | - Larissa Steigmann
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, MA, USA
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10
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Frosecchi M. Horizontal and Vertical Defect Management with a Novel Degradable Pure Magnesium Guided Bone Regeneration (GBR) Membrane-A Clinical Case. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2009. [PMID: 38004058 PMCID: PMC10672872 DOI: 10.3390/medicina59112009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/03/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023]
Abstract
Background and objectives: In guided bone regeneration (GBR), large defects comprising both horizontal and vertical components usually require additional mechanical support to stabilize the augmentation and preserve the bone volume. This additional support is usually attained by using non-resorbable materials. A recently developed magnesium membrane presents the possibility of providing mechanical support whilst being completely resorbable. The aim of this case report was to describe the application and outcome of the magnesium membrane in combination with a collagen pericardium membrane for GBR. Materials and methods: A 74 year old, in an otherwise good general health condition, was presented with stage 2 grade A periodontitis and an impacted canine. After extraction of the impacted canine, a defect was created with both vertical and horizontal components. The defect was augmented using the magnesium membrane to create a supportive arch to the underlying bone graft and a collagen pericardium membrane was placed on top to aid with the soft tissue closure. Results: Upon reentry at 8 months, complete resorption of the magnesium devices was confirmed as there were no visible remnants remaining. A successful augmentation outcome had been achieved as the magnesium membrane in combination with the collagen membrane had maintained the augmented bone well. Two dental implants could be successfully placed in the healed augmentation. Conclusions: In this case, the magnesium membrane in combination with a collagen pericardium membrane presented a potentially viable alternative treatment to titanium meshes or titanium-reinforced membranes for the augmentation of a defect with both horizontal and vertical components that is completely resorbable. It was demonstrated that it is possible to attain a good quality and quantity of bone using a resorbable system that has been completely resorbed by the time of reentry.
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Affiliation(s)
- Massimo Frosecchi
- Department of Surgical and Diagnostic Sciences (DISC), University of Genoa, 16132 Genoa, Italy
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11
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Coheña-Jiménez M, Prieto-Domínguez R, Pérez-Belloso AJ, Muriel-Sánchez JM, Gómez-Carrión Á, Montaño-Jiménez P. Comparison of Resorbable and Non-Resorbable Osteosynthesis Material in Hallux Surgery: A Systematic Review. Life (Basel) 2023; 13:2018. [PMID: 37895399 PMCID: PMC10608219 DOI: 10.3390/life13102018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 10/02/2023] [Accepted: 10/04/2023] [Indexed: 10/29/2023] Open
Abstract
There are various pathologies that involve the hallux, among which hallux valgus is the most common. When conservative treatment fails, it is necessary to resort to a surgical approach. The fixation elements for osteotomies in the hallux are usually composed of metallic materials; however, today, there are numerous resorbable materials that offer numerous advantages over conventional materials. In this article, the objective is to analyze the scientific evidence through the systematic analysis of the existing literature in relation to the effectiveness of resorbable versus non-resorbable osteosynthesis material in the surgical correction of hallux deformities and compare the complications as well as the patient satisfaction and quality of life between both fixation methods. A systematic review of the literature available in the PubMed, EMBASE, Web of Science and Scopus databases and 10 studies were included. The documents were chosen following the eligibility and exclusion criteria, including experimental and observational studies evaluated with the Jadad and Newcastle-Ottawa methodological quality scale, respectively. Data were extracted from valid studies for the review, and the variables functionality, pain, angular corrections, complications, satisfaction and quality of life were observed. In conclusion, there is limited scientific evidence regarding the effectiveness of resorbable versus non-resorbable osteosynthesis material in the surgical correction of hallux deformities. All observed variables are similar regardless of the surgical technique and osteosynthesis material used.
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Affiliation(s)
- Manuel Coheña-Jiménez
- Podiatry Department, University of Seville, 41009 Seville, Spain; (M.C.-J.); (R.P.-D.); (P.M.-J.)
| | - Raquel Prieto-Domínguez
- Podiatry Department, University of Seville, 41009 Seville, Spain; (M.C.-J.); (R.P.-D.); (P.M.-J.)
| | - Ana Juana Pérez-Belloso
- Podiatry Department, University of Seville, 41009 Seville, Spain; (M.C.-J.); (R.P.-D.); (P.M.-J.)
| | | | | | - Pedro Montaño-Jiménez
- Podiatry Department, University of Seville, 41009 Seville, Spain; (M.C.-J.); (R.P.-D.); (P.M.-J.)
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12
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Martinez DC, Dobkowska A, Marek R, Ćwieka H, Jaroszewicz J, Płociński T, Donik Č, Helmholz H, Luthringer-Feyerabend B, Zeller-Plumhoff B, Willumeit-Römer R, Święszkowski W. In vitro and in vivo degradation behavior of Mg-0.45Zn-0.45Ca (ZX00) screws for orthopedic applications. Bioact Mater 2023; 28:132-154. [PMID: 37250863 PMCID: PMC10209338 DOI: 10.1016/j.bioactmat.2023.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/26/2023] [Accepted: 05/09/2023] [Indexed: 05/31/2023] Open
Abstract
Magnesium (Mg) alloys have become a potential material for orthopedic implants due to their unnecessary implant removal, biocompatibility, and mechanical integrity until fracture healing. This study examined the in vitro and in vivo degradation of an Mg fixation screw composed of Mg-0.45Zn-0.45Ca (ZX00, in wt.%). With ZX00 human-sized implants, in vitro immersion tests up to 28 days under physiological conditions, along with electrochemical measurements were performed for the first time. In addition, ZX00 screws were implanted in the diaphysis of sheep for 6, 12, and 24 weeks to assess the degradation and biocompatibility of the screws in vivo. Using scanning electron microscopy (SEM) coupled with energy dispersive X-ray spectroscopy (EDX), micro-computed tomography (μCT), X-ray photoelectron spectroscopy (XPS), and histology, the surface and cross-sectional morphologies of the corrosion layers formed, as well as the bone-corrosion-layer-implant interfaces, were analyzed. Our findings from in vivo testing demonstrated that ZX00 alloy promotes bone healing and the formation of new bone in direct contact with the corrosion products. In addition, the same elemental composition of corrosion products was observed for in vitro and in vivo experiments; however, their elemental distribution and thicknesses differ depending on the implant location. Our findings suggest that the corrosion resistance was microstructure-dependent. The head zone was the least corrosion-resistant, indicating that the production procedure could impact the corrosion performance of the implant. In spite of this, the formation of new bone and no adverse effects on the surrounding tissues demonstrated that the ZX00 is a suitable Mg-based alloy for temporary bone implants.
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Affiliation(s)
- Diana C. Martinez
- Biomaterials Group, Materials Design Division, Faculty of Materials Science and Engineering, Warsaw University of Technology, Wołoska 141, 02-507, Warsaw, Poland
| | - Anna Dobkowska
- Biomaterials Group, Materials Design Division, Faculty of Materials Science and Engineering, Warsaw University of Technology, Wołoska 141, 02-507, Warsaw, Poland
| | - Romy Marek
- Department of Orthopedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Hanna Ćwieka
- Institute of Metallic Biomaterials, Helmholtz-Zentrum Hereon GmbH, 21502, Geesthacht, Germany
| | - Jakub Jaroszewicz
- Biomaterials Group, Materials Design Division, Faculty of Materials Science and Engineering, Warsaw University of Technology, Wołoska 141, 02-507, Warsaw, Poland
| | - Tomasz Płociński
- Biomaterials Group, Materials Design Division, Faculty of Materials Science and Engineering, Warsaw University of Technology, Wołoska 141, 02-507, Warsaw, Poland
| | - Črtomir Donik
- Department of Physics and Chemistry of Materials, Institute of Metals and Technology, University of Ljubljana, Lepi Pot 11, SI-1000, Ljubljana, Slovenia
| | - Heike Helmholz
- Institute of Metallic Biomaterials, Helmholtz-Zentrum Hereon GmbH, 21502, Geesthacht, Germany
| | | | - Berit Zeller-Plumhoff
- Institute of Metallic Biomaterials, Helmholtz-Zentrum Hereon GmbH, 21502, Geesthacht, Germany
| | - Regine Willumeit-Römer
- Institute of Metallic Biomaterials, Helmholtz-Zentrum Hereon GmbH, 21502, Geesthacht, Germany
| | - Wojciech Święszkowski
- Biomaterials Group, Materials Design Division, Faculty of Materials Science and Engineering, Warsaw University of Technology, Wołoska 141, 02-507, Warsaw, Poland
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13
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Ben Amara H, Martinez DC, Shah FA, Loo AJ, Emanuelsson L, Norlindh B, Willumeit-Römer R, Plocinski T, Swieszkowski W, Palmquist A, Omar O, Thomsen P. Magnesium implant degradation provides immunomodulatory and proangiogenic effects and attenuates peri-implant fibrosis in soft tissues. Bioact Mater 2023; 26:353-369. [PMID: 36942009 PMCID: PMC10024189 DOI: 10.1016/j.bioactmat.2023.02.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 02/01/2023] [Accepted: 02/14/2023] [Indexed: 03/17/2023] Open
Abstract
Implants made of magnesium (Mg) are increasingly employed in patients to achieve osteosynthesis while degrading in situ. Since Mg implants and Mg2+ have been suggested to possess anti-inflammatory properties, the clinically observed soft tissue inflammation around Mg implants is enigmatic. Here, using a rat soft tissue model and a 1-28 d observation period, we determined the temporo-spatial cell distribution and behavior in relation to sequential changes of pure Mg implant surface properties and Mg2+ release. Compared to nondegradable titanium (Ti) implants, Mg degradation exacerbated initial inflammation. Release of Mg degradation products at the tissue-implant interface, culminating at 3 d, actively initiated chemotaxis and upregulated mRNA and protein immunomodulatory markers, particularly inducible nitric oxide synthase and toll-like receptor-4 up to 6 d, yet without a cytotoxic effect. Increased vascularization was demonstrated morphologically, preceded by high expression of vascular endothelial growth factor. The transition to appropriate tissue repair coincided with implant surface enrichment of Ca and P and reduced peri-implant Mg2+ concentration. Mg implants revealed a thinner fibrous encapsulation compared with Ti. The detailed understanding of the relationship between Mg material properties and the spatial and time-resolved cellular processes provides a basis for the interpretation of clinical observations and future tailoring of Mg implants.
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Affiliation(s)
- Heithem Ben Amara
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Diana C. Martinez
- Biomaterials Group, Materials Design Division, Faculty of Materials Science and Engineering, Warsaw University of Technology, Warsaw, Poland
| | - Furqan A. Shah
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Johansson Loo
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lena Emanuelsson
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Birgitta Norlindh
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Tomasz Plocinski
- Biomaterials Group, Materials Design Division, Faculty of Materials Science and Engineering, Warsaw University of Technology, Warsaw, Poland
| | - Wojciech Swieszkowski
- Biomaterials Group, Materials Design Division, Faculty of Materials Science and Engineering, Warsaw University of Technology, Warsaw, Poland
| | - Anders Palmquist
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Omar Omar
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Peter Thomsen
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Corresponding author. Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg Box 412, SE-405 30, Gothenburg, Sweden.
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14
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Waelti SL, Wildermuth S, Willems EP, Fischer T, Dietrich TJ, Leschka S, Matissek C, Krebs T, Markart S. Prospective Evaluation of Magnetic Resonance Imaging Features of Magnesium-Based Alloy Screw Resorption in Pediatric Fractures. J Clin Med 2023; 12:jcm12083016. [PMID: 37109351 PMCID: PMC10141748 DOI: 10.3390/jcm12083016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The resorption of magnesium-based alloy bioabsorbable screws results in the release of hydrogen gas, which can mimic infection and enter the growth plate. The screw itself and the released gas may also affect image quality. OBJECTIVE The evaluation of magnetic resonance imaging (MRI) findings during the most active phase of screw resorption is the objective, with particular focus on the growth plate and to assess for the presence of metal-induced artifacts. MATERIAL AND METHODS In total, 30 prospectively acquired MRIs from 17 pediatric patients with fractures treated with magnesium screws were assessed for the presence and distribution of intraosseous, extraosseous, and intra-articular gas; gas within the growth plate; osteolysis along the screw; joint effusion; bone marrow edema; periosteal reaction; soft tissue edema; and metal-induced artifacts. RESULTS Gas locules were found in the bone and soft tissues in 100% of the examinations, intra-articular in 40%, and in 37% of unfused growth plates. Osteolysis and the periosteal reaction were present in 87%, bone marrow edema in 100%, soft tissue edema in 100%, and joint effusion in 50% of examinations. Pile-up artifacts were present in 100%, and geometric distortion in 0% of examinations. Fat suppression was not significantly impaired in any examination. CONCLUSIONS Gas and edema in the bone and soft tissues are normal findings during the resorption of magnesium screws and should not be misinterpreted as infection. Gas can also be detected within growth plates. MRI examinations can be performed without metal artifact reduction sequences. Standard fat suppression techniques are not significantly affected.
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Affiliation(s)
- Stephan L Waelti
- Department of Radiology and Nuclear Medicine, Children's Hospital of Eastern Switzerland, 9006 St. Gallen, Switzerland
- Department of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland
| | - Simon Wildermuth
- Department of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland
| | - Erik P Willems
- Clinical Trials Unit, Biostatistics, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland
| | - Tim Fischer
- Department of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland
| | - Tobias J Dietrich
- Department of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland
| | - Sebastian Leschka
- Department of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland
| | - Christoph Matissek
- Department of Pediatric Surgery, Children's Hospital of Eastern Switzerland, 9006 St. Gallen, Switzerland
| | - Thomas Krebs
- Department of Pediatric Surgery, Children's Hospital of Eastern Switzerland, 9006 St. Gallen, Switzerland
| | - Stefan Markart
- Department of Radiology and Nuclear Medicine, Children's Hospital of Eastern Switzerland, 9006 St. Gallen, Switzerland
- Department of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland
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15
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Okutan B, Schwarze UY, Berger L, Martinez DC, Herber V, Suljevic O, Plocinski T, Swieszkowski W, Santos SG, Schindl R, Löffler JF, Weinberg AM, Sommer NG. The combined effect of zinc and calcium on the biodegradation of ultrahigh-purity magnesium implants. BIOMATERIALS ADVANCES 2023; 146:213287. [PMID: 36669235 DOI: 10.1016/j.bioadv.2023.213287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 12/15/2022] [Accepted: 01/09/2023] [Indexed: 01/13/2023]
Abstract
Magnesium (Mg)-based implants are promising candidates for orthopedic interventions, because of their biocompatibility, good mechanical features, and ability to degrade completely in the body, eliminating the need for an additional removal surgery. In the present study, we synthesized and investigated two Mg-based materials, ultrahigh-purity ZX00 (Mg-Zn-Ca; <0.5 wt% Zn and <0.5 wt% Ca, in wt%; Fe-content <1 ppm) and ultrahigh-purity Mg (XHP-Mg, >99.999 wt% Mg; Fe-content <1 ppm), in vitro and in vivo in juvenile healthy rats to clarify the effect of the alloying elements Zn and Ca on mechanical properties, microstructure, cytocompatibility and degradation rate. Potential differences in bone formation and bone in-growth were also assessed and compared with state-of-the-art non-degradable titanium (Ti)-implanted, sham-operated, and control (non-intervention) groups, using micro-computed tomography, histology and scanning electron microscopy. At 6 and 24 weeks after implantation, serum alkaline phosphatase (ALP), calcium (Ca), and Mg level were measured and bone marrow stromal cells (BMSCs) were isolated for real-time PCR analysis. Results show that ZX00 implants have smaller grain size and superior mechanical properties than XHP-Mg, and that both reveal good biocompatibility in cytocompatibilty tests. ZX00 homogenously degraded with an increased gas accumulation 12 and 24 weeks after implantation, whereas XHP-Mg exhibited higher gas accumulation already at 2 weeks. Serum ALP, Ca, and Mg levels were comparable among all groups and both Mg-based implants led to similar relative expression levels of Alp, Runx2, and Bmp-2 genes at weeks 6 and 24. Histologically, Mg-based implants are superior for new bone tissue formation and bone in-growth compared to Ti implants. Furthermore, by tracking the sequence of multicolor fluorochrome labels, we observed higher mineral apposition rate at week 2 in both Mg-based implants compared to the control groups. Our findings suggest that (i) ZX00 and XHP-Mg support bone formation and remodeling, (ii) both Mg-based implants are superior to Ti implants in terms of new bone tissue formation and osseointegration, and (iii) ZX00 is more favorable due to its lower degradation rate and moderate gas accumulation.
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Affiliation(s)
- Begüm Okutan
- Department of Orthopedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria.
| | - Uwe Y Schwarze
- Department of Orthopedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria; Department of Dentistry and Oral Health, Division of Oral Surgery and Orthodontics, Medical University of Graz, Billrothgasse 4, 8010 Graz, Austria.
| | - Leopold Berger
- Laboratory of Metal Physics and Technology, Department of Materials, ETH Zurich, Vladimir-Prelog-Weg 4, 8093 Zurich, Switzerland.
| | - Diana C Martinez
- Department of Materials Science and Engineering, Warsaw University of Technology, Woloska 141, 02-507 Warsaw, Poland.
| | - Valentin Herber
- Department of Dentistry and Oral Health, Division of Oral Surgery and Orthodontics, Medical University of Graz, Billrothgasse 4, 8010 Graz, Austria; Department of Oral Surgery, University Center for Dental Medicine, University of Basel, Mattenstrasse 40, 4058 Basel, Switzerland.
| | - Omer Suljevic
- Department of Orthopedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria.
| | - Tomasz Plocinski
- Department of Materials Science and Engineering, Warsaw University of Technology, Woloska 141, 02-507 Warsaw, Poland.
| | - Wojciech Swieszkowski
- Department of Materials Science and Engineering, Warsaw University of Technology, Woloska 141, 02-507 Warsaw, Poland.
| | - Susana G Santos
- i3S - Instituto de Investigação e Inovação em Saúde, and INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Rua Alfredo Allen 208, Porto 4200-135, Portugal.
| | - Rainer Schindl
- Gottfried Schatz Research Center, Biophysics, Medical University of Graz, Neue Stiftingtalstrasse 6, 8010 Graz, Austria.
| | - Jörg F Löffler
- Laboratory of Metal Physics and Technology, Department of Materials, ETH Zurich, Vladimir-Prelog-Weg 4, 8093 Zurich, Switzerland.
| | - Annelie M Weinberg
- Department of Orthopedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria.
| | - Nicole G Sommer
- Department of Orthopedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria.
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16
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Haslhofer DJ, Gotterbarm T, Klasan A. High Complication Rate and High Percentage of Regressing Radiolucency in Magnesium Screw Fixation in 18 Consecutive Patients. J Pers Med 2023; 13:jpm13020357. [PMID: 36836591 PMCID: PMC9960705 DOI: 10.3390/jpm13020357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
(1) Background: Magnesium-based implants use has become a research focus in recent years. Radiolucent areas around inserted screws are still worrisome. The objective of this study was to investigate the first 18 patients treated using MAGNEZIX® CS screws. (2) Methods: This retrospective case series included all 18 consecutive patients treated using MAGNEZIX® CS screws at our Level-1 trauma center. Radiographs were taken at 3-, 6- and 9-month follow-ups. Osteolysis, radiolucency and material failure were assessed, as were infection and revision surgery. (3) Results: Most patients (61.1%) had surgery in the shoulder region. Radiolucency regressed from 55.6% at 3-month follow-ups to 11.1% at 9-month follow-ups. Material failure occurred in four patients (22.22%) and infection occurred in two patients, yielding a 33.33% complication rate. (4) Conclusion: MAGNEZIX® CS screws demonstrated a high percentage of radiolucency that regressed and seems to be clinically irrelevant. The material failure rate and infection rate require further research.
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Affiliation(s)
- David J. Haslhofer
- Department for Orthopedics and Traumatology, Med Campus III, Kepler University Hospital Linz, Krankenhausstrasse 9, 4020 Linz, Austria
- Faculty of Medicine, Johannes Kepler University Linz, Altenbergerstrasse 69, 4040 Linz, Austria
- Correspondence:
| | - Tobias Gotterbarm
- Department for Orthopedics and Traumatology, Med Campus III, Kepler University Hospital Linz, Krankenhausstrasse 9, 4020 Linz, Austria
- Faculty of Medicine, Johannes Kepler University Linz, Altenbergerstrasse 69, 4040 Linz, Austria
| | - Antonio Klasan
- Faculty of Medicine, Johannes Kepler University Linz, Altenbergerstrasse 69, 4040 Linz, Austria
- Department for Orthopedics and Traumatology, AUVA Graz, Göstinger Straße 24, 8020 Graz, Austria
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17
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Open-porous magnesium-based scaffolds withstand in vitro corrosion under cyclic loading: A mechanistic study. Bioact Mater 2023; 19:406-417. [PMID: 35574056 PMCID: PMC9062748 DOI: 10.1016/j.bioactmat.2022.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/10/2022] [Accepted: 04/13/2022] [Indexed: 01/05/2023] Open
Abstract
The successful application of magnesium (Mg) alloys as biodegradable bone substitutes for critical-sized defects may be comprised by their high degradation rate resulting in a loss of mechanical integrity. This study investigates the degradation pattern of an open-porous fluoride-coated Mg-based scaffold immersed in circulating Hanks' Balanced Salt Solution (HBSS) with and without in situ cyclic compression (30 N/1 Hz). The changes in morphological and mechanical properties have been studied by combining in situ high-resolution X-ray computed tomography mechanics and digital volume correlation. Although in situ cyclic compression induced acceleration of the corrosion rate, probably due to local disruption of the coating layer where fatigue microcracks were formed, no critical failures in the overall scaffold were observed, indicating that the mechanical integrity of the Mg scaffolds was preserved. Structural changes, due to the accumulation of corrosion debris between the scaffold fibres, resulted in a significant increase (p < 0.05) in the material volume fraction from 0.52 ± 0.07 to 0.47 ± 0.03 after 14 days of corrosion. However, despite an increase in fibre material loss, the accumulated corrosion products appear to have led to an increase in Young's modulus after 14 days as well as lower third principal strain (εp3) accumulation (−91000 ± 6361 με and −60093 ± 2414 με after 2 and 14 days, respectively). Therefore, this innovative Mg scaffold design and composition provide a bone replacement, capable of sustaining mechanical loads in situ during the postoperative phase allowing new bone formation to be initially supported as the scaffold resorbs. First report on in vitro cyclic loading of MgF2 coated open-porous Mg scaffolds in HBSS simulating 2–3 months in humans. Fluoride-coating slows down corrosion under cyclic loading in vitro. Entangled scaffold structure accumulates local corrosion debris which keeps the mechanical integrity over 14 days in vitro.
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18
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Drobyshev A, Komissarov A, Redko N, Gurganchova Z, Statnik ES, Bazhenov V, Sadykova I, Miterev A, Romanenko I, Yanushevich O. Bone Remodeling Interaction with Magnesium Alloy Implants Studied by SEM and EDX. MATERIALS (BASEL, SWITZERLAND) 2022; 15:7529. [PMID: 36363121 PMCID: PMC9657747 DOI: 10.3390/ma15217529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/25/2022] [Accepted: 10/25/2022] [Indexed: 06/16/2023]
Abstract
The development direction of bioresorbable fixing structures is currently very relevant because it corresponds to the priority areas in worldwide biotechnology development. Magnesium (Mg)-based alloys are gaining high levels of attention due to their promising potential use as the basis for fixating structures. These alloys can be an alternative to non-degradable metal implants in orthopedics, maxillofacial surgery, neurosurgery, and veterinary medicine. In our study, we formulated a Mg-2Zn-2Ga alloy, prepared pins, and analyzed their biodegradation level based on SEM (scanning electron microscopy) and EDX (energy-dispersive X-ray analysis) after carrying out an experimental study on rats. We assessed the resorption parameters 1, 3, and 6 months after surgery. In general, the biodegradation process was characterized by the systematic development of newly formed bone tissue. Our results showed that Mg-2Zn-2Ga magnesium alloys are suitable for clinical applications.
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Affiliation(s)
- Alexey Drobyshev
- Laboratory of Medical Bioresorption and Bioresistance, Moscow State University of Medicine and Dentistry, 127473 Moscow, Russia
| | - Alexander Komissarov
- Laboratory of Medical Bioresorption and Bioresistance, Moscow State University of Medicine and Dentistry, 127473 Moscow, Russia
- Laboratory of Hybrid Nanostructured Materials, National University of Science and Technology “MISiS”, 119049 Moscow, Russia
| | - Nikolay Redko
- Laboratory of Medical Bioresorption and Bioresistance, Moscow State University of Medicine and Dentistry, 127473 Moscow, Russia
| | - Zaira Gurganchova
- Laboratory of Medical Bioresorption and Bioresistance, Moscow State University of Medicine and Dentistry, 127473 Moscow, Russia
| | - Eugene S. Statnik
- HSM Laboratory, Center for Energy Science and Technology, Skoltech, 121205 Moscow, Russia
| | - Viacheslav Bazhenov
- Casting Department, National University of Science and Technology “MISiS”, 119049 Moscow, Russia
| | - Iuliia Sadykova
- HSM Laboratory, Center for Energy Science and Technology, Skoltech, 121205 Moscow, Russia
| | - Andrey Miterev
- Laboratory of Medical Bioresorption and Bioresistance, Moscow State University of Medicine and Dentistry, 127473 Moscow, Russia
| | - Igor Romanenko
- Laboratory of Medical Bioresorption and Bioresistance, Moscow State University of Medicine and Dentistry, 127473 Moscow, Russia
| | - Oleg Yanushevich
- Laboratory of Medical Bioresorption and Bioresistance, Moscow State University of Medicine and Dentistry, 127473 Moscow, Russia
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19
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Swierstra BA, van Enst WA. The prognosis of ankle fractures: a systematic review. EFORT Open Rev 2022; 7:692-700. [PMID: 36287098 PMCID: PMC9619393 DOI: 10.1530/eor-22-0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The aim of this study was to update the scientific evidence for ankle fracture prognosis by addressing radiographic osteoarthritis, time course and prognostic factors. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were included if they were randomized controlled trials, controlled trials or observational studies, including case series and case-control studies investigating radiologically confirmed osteoarthritis in adults with a classified ankle fracture, treated with or without surgery, with a minimum follow-up of 1 year. Also included were studies examining prognostic factors predicting radiologically confirmed osteoarthritis. Tibial plafond and talus fractures were excluded. Thirty-four studies were included examining 3447 patients. Extracted data included study type, inclusion and exclusion criteria, age, number of patients, number of fractures according to the author-reported classification method, radiological osteoarthritis, follow-up period, prognostic factors, and treatment. Severe heterogeneity was visible in the analyses (I2 > 90%), reflecting clinical heterogeneity possibly arising from the presence of osteoarthritis at baseline, the classifications used for the fractures and for osteoarthritis. The incidence of osteoarthritis was 25% (95% CI: 18–32) and 34% (95% CI: 23–45) for more severe fractures with involvement of the posterior malleolus. The severity of the trauma, as reflected by the fracture classification, was the most important prognostic factor for the development of radiographic osteoarthritis, but there is also a risk with simpler injuries. The period within which osteoarthritis develops or becomes symptomatic with an indication for treatment could not be specified.
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Affiliation(s)
| | - W Annefloor van Enst
- Medical Guidelines, Amsterdam, The Netherlands,Correspondence should be addressed to W A van Enst;
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20
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Espiritu J, Berangi M, Yiannakou C, Silva E, Francischello R, Kuehne A, Niendorf T, Könneker S, Willumeit-Römer R, Seitz JM. Evaluating metallic artefact of biodegradable magnesium-based implants in magnetic resonance imaging. Bioact Mater 2022; 15:382-391. [PMID: 35386351 PMCID: PMC8958470 DOI: 10.1016/j.bioactmat.2021.11.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/12/2021] [Accepted: 11/28/2021] [Indexed: 11/13/2022] Open
Abstract
Magnesium (Mg) implants have shown to cause image artefacts or distortions in magnetic resonance imaging (MRI). Yet, there is a lack of information on how the degradation of Mg-based implants influences the image quality of MRI examinations. In this study, Mg-based implants are analysed in vitro, ex vivo, and in the clinical setting for various magnetic field strengths with the aim to quantify metallic artefact behaviour. In vitro corroded Mg-based screws and a titanium (Ti) equivalent were imaged according to the ASTM F2119. Mg-based and Ti pins were also implanted into rat femurs for different time points and scanned to provide insights on the influence of soft and hard tissue on metallic artefact. Additionally, MRI data of patients with scaphoid fractures treated with CE-approved Mg-based compression screws (MAGNEZIX®) were analysed at various time points post-surgery. The artefact production of the Mg-based material decreased as implant material degraded in all settings. The worst-case imaging scenario was determined to be when the imaging plane was selected to be perpendicular to the implant axis. Moreover, the Mg-based implant outperformed the Ti equivalent in all experiments by producing lower metallic artefact (p < 0.05). This investigation demonstrates that Mg-based implants generate significantly lower metallic distortion in MRI when compared to Ti. Our positive findings suggest and support further research into the application of Mg-based implants including post-operative care facilitated by MRI monitoring of degradation kinetics and bone/tissue healing processes. Mg-based implants produce lower metallic artefact than Ti in MRI. Metallic artefact production of Mg reduces as degradation increases. Mg implants provide sufficient visualisation in MRI for better postoperative care.
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Affiliation(s)
| | - Mostafa Berangi
- MRI.TOOLS GmbH, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany.,Berlin Ultrahigh Field Facility (B.U.F.F.), Max-Delbrueck Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | | | - Eduarda Silva
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Roberto Francischello
- Chemistry and Industrial Chemistry Department, Università di Pisa, Via Moruzzi 13, Pisa, Italy.,Fondazione Toscana Gabriele Monasterio, Via Moruzzi 1, Pisa, Italy
| | | | - Thoralf Niendorf
- MRI.TOOLS GmbH, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany.,Berlin Ultrahigh Field Facility (B.U.F.F.), Max-Delbrueck Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Sören Könneker
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
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21
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Paiva JCC, Oliveira L, Vaz MF, Costa-de-Oliveira S. Biodegradable Bone Implants as a New Hope to Reduce Device-Associated Infections-A Systematic Review. Bioengineering (Basel) 2022; 9:409. [PMID: 36004934 PMCID: PMC9405200 DOI: 10.3390/bioengineering9080409] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/28/2022] [Accepted: 08/10/2022] [Indexed: 11/24/2022] Open
Abstract
Bone fractures often require fixation devices that frequently need to be surgically removed. These temporary implants and procedures leave the patient more prone to developing medical device-associated infections, and osteomyelitis associated with trauma is a challenging complication for orthopedists. In recent years, biodegradable materials have gained great importance as temporary medical implant devices, avoiding removal surgery. The purpose of this systematic review was to revise the literature regarding the use of biodegradable bone implants in fracture healing and its impact on the reduction of implant-associated infections. The systematic review followed the PRISMA guidelines and was conducted by searching published studies regarding the in vivo use of biodegradable bone fixation implants and its antibacterial activity. From a total of 667 references, 23 studies were included based on inclusion and exclusion criteria. Biodegradable orthopedic implants of Mg-Cu, Mg-Zn, and Zn-Ag have shown antibacterial activity, especially in reducing infection burden by MRSA strains in vivo osteomyelitis models. Their ability to prevent and tackle implant-associated infections and to gradually degrade inside the body reduces the need for a second surgery for implant removal, with expectable gains regarding patients' comfort. Further in vivo studies are mandatory to evaluate the efficiency of these antibacterial biodegradable materials.
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Affiliation(s)
- José C. C. Paiva
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Luís Oliveira
- DPS—Product Systems Development, INEGI—Institute of Science and Innovation in Mechanical and Industrial Engineering, 4200-465 Porto, Portugal
| | - Maria Fátima Vaz
- IDMEC—Instituto Superior Técnico, Universidade de Lisboa, 1499-002 Lisboa, Portugal
- Departamento de Engenharia Mecânica, Instituto Superior Técnico, Universidade de Lisboa, 1499-002 Lisboa, Portugal
| | - Sofia Costa-de-Oliveira
- Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Center for Health Technology and Services Research—CINTESIS@RISE, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
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22
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Kačarević ŽP, Rider P, Elad A, Tadic D, Rothamel D, Sauer G, Bornert F, Windisch P, Hangyási DB, Molnar B, Kämmerer T, Hesse B, Bortel E, Bartosch M, Witte F. Biodegradable magnesium fixation screw for barrier membranes used in guided bone regeneration. Bioact Mater 2022; 14:15-30. [PMID: 35310352 PMCID: PMC8892133 DOI: 10.1016/j.bioactmat.2021.10.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/25/2021] [Accepted: 10/25/2021] [Indexed: 12/29/2022] Open
Abstract
An ideal fixation system for guided bone (GBR) regeneration in oral surgery must fulfil several criteria that includes the provision of adequate mechanical fixation, complete resorption when no longer needed, complete replacement by bone, as well as be biocompatible and have a good clinical manageability. For the first time, a biodegradable magnesium fixation screw made of the magnesium alloy WZM211 with a MgF2 coating has been designed and tested to fulfill these criteria. Adequate mechanical fixation was shown for the magnesium fixation screw in several benchtop tests that directly compared the magnesium fixation screw with an equivalent polymeric resorbable device. Results demonstrated slightly superior mechanical properties of the magnesium device in comparison to the polymeric device even after 4 weeks of degradation. Biocompatibility of the magnesium fixation screw was demonstrated in several in vitro and in vivo tests. Degradation of the magnesium screw was investigated in in vitro and in vivo tests, where it was found that the screw is resorbed slowly and completely after 52 weeks, providing adequate fixation in the early critical healing phase. Overall, the magnesium fixation screw demonstrates all of the key properties required for an ideal fixation screw of membranes used in guided bone regeneration (GBR) surgeries. The first comprehensive report on experimental data for a biodegradable metallic fixation pin for use in oral surgery is presented. Results demonstrated superior mechanical properties of the Mg fixation pin in comparison to the polymeric pin even after 4 weeks of degradation. The MgF2 coated Mg pin made of alloy WZM211 has a slow corrosion rate with a service time of 4 weeks and is fully resorped at 52 weeks after implantation.
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Affiliation(s)
- Željka Perić Kačarević
- Department of Anatomy Histology, Embryology, Pathology Anatomy and Pathology Histology, Faculty of Dental Medicine and Health, University of Osijek, Osijek, 31000, Croatia
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité – Universitätsmedizin Berlin, Aßmannshauser Straße 4–6, 14197, Berlin, Germany
- Botiss Biomaterials AG, Ullsteinstrasse 108, 12109, Berlin, Germany
| | - Patrick Rider
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité – Universitätsmedizin Berlin, Aßmannshauser Straße 4–6, 14197, Berlin, Germany
- Botiss Biomaterials AG, Ullsteinstrasse 108, 12109, Berlin, Germany
| | - Akiva Elad
- Botiss Biomaterials AG, Ullsteinstrasse 108, 12109, Berlin, Germany
| | - Drazen Tadic
- Botiss Biomaterials AG, Ullsteinstrasse 108, 12109, Berlin, Germany
| | - Daniel Rothamel
- CMF Surgery, Johannes BLA Hospital, Mönchengladbach, Germany
| | - Gerrit Sauer
- CMF Surgery, Johannes BLA Hospital, Mönchengladbach, Germany
| | | | - Peter Windisch
- Department of Periodontology, Semmelweis University, Budapest, Hungary
| | | | - Balint Molnar
- Department of Periodontology, Semmelweis University, Budapest, Hungary
| | - Till Kämmerer
- University Hospital Munich, Department of Dermatology and Allergy, Frauenlobstr. 9-11, 80337, Munich, Germany
| | | | - Emely Bortel
- Xploraytion GmbH, Bismarkstrasse 11, Berlin, Germany
| | - Marco Bartosch
- Biotrics Bioimplants AG, Ullsteinstrasse 108, 12109, Berlin, Germany
| | - Frank Witte
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité – Universitätsmedizin Berlin, Aßmannshauser Straße 4–6, 14197, Berlin, Germany
- Biotrics Bioimplants AG, Ullsteinstrasse 108, 12109, Berlin, Germany
- Corresponding author. Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité – Universitätsmedizin Berlin, Assmannshauser Straße 4–6, 14197, Berlin, Germany.
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23
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Anderson T, Lee J, Johnston P, Torreggiani W, Ryan M. Magnesium implants in orthopaedic surgery create a diagnostic conundrum: A radiology case series and literature review. Ir J Med Sci 2022:10.1007/s11845-022-03071-1. [PMID: 35768653 DOI: 10.1007/s11845-022-03071-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 06/11/2022] [Indexed: 11/30/2022]
Abstract
During a routine post-operative orthopaedic radiograph reading session, repeated unusual radiographic soft tissue and bone appearances became evident. It was discovered that these patients had received biodegradable magnesium implants which have recently been introduced into orthopaedic clinical practice. To the untrained eye, the combination of peri-metallic bone resorption with associated soft tissue gas, could easily be mistaken for post-operative infection. The aim of this study is to properly characterise the radiographic post-operative appearances of biodegradable magnesium orthopaedic hardware. We retrospectively evaluated radiographs of all patients who underwent magnesium screw implantation for fractures over a 6 month period. Four patients, mean age of 9.75 (range: 6-15) years who underwent magnesium screw fixation following fracture were included in the study. Follow up duration was 100 days (range: 75-122) with a mean of 2.5 postoperative radiographs being performed per patient during this period. All cases demonstrated post-operative peri-metallic radiolucency which developed around the magnesium screws on x-ray, which subsequently resorbed over time. Peri-metallic soft tissue gas was observed in all patients. In two cases, magnesium implants fractured. As the use of biodegradable metal implants becomes more common, it is important for radiologists to be aware of their imaging characteristics. Prior to reporting a case, it would be prudent to know if biodegradable screws have been utilised and whether there exists a clinical concern for post-operative infection in patients with these particular implants, in which case it would be critical not to dismiss peri-prosthetic radiolucencies and soft tissue gas as merely a sequela of the natural metal degradation process.
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Affiliation(s)
- Toni Anderson
- Radiology Department, Tallaght University Hospital, Dublin 24, Dublin, Ireland.
| | - Jennifer Lee
- Radiology Department, Tallaght University Hospital, Dublin 24, Dublin, Ireland
| | - Philip Johnston
- Radiology Department, Tallaght University Hospital, Dublin 24, Dublin, Ireland
| | - William Torreggiani
- Radiology Department, Tallaght University Hospital, Dublin 24, Dublin, Ireland
| | - Martin Ryan
- Radiology Department, Tallaght University Hospital, Dublin 24, Dublin, Ireland
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24
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Bobe K, Willbold E, Haupt M, Reebmann M, Morgenthal I, Andersen O, Studnitzky T, Nellesen J, Tillmann W, Vogt C, Vano-Herrera K, Witte F. Biodegradable open-porous scaffolds made of sintered magnesium W4 and WZ21 short fibres show biocompatibility in vitro and in long-term in vivo evaluation. Acta Biomater 2022; 148:389-404. [PMID: 35691561 DOI: 10.1016/j.actbio.2022.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 05/27/2022] [Accepted: 06/01/2022] [Indexed: 11/26/2022]
Abstract
Open-porous scaffolds made of W4 and WZ21 fibres were evaluated to analyse their potential as an implant material. WZ21 scaffolds without any surface modification or coating, showed promising mechanical properties which were comparable to the W4 scaffolds tested in previous studies. Eudiometric testing results were dependent on the experimental setup, with corrosion rates differing by a factor of 3. Cytotoxicity testing of WZ21 showed sufficient cytocompatibility. The corrosion behavior of the WZ21 scaffolds in different cell culture media are indicating a selective dealloying of elements from the magnesium scaffold by different solutions. Long term in-vivo studies were using 24 W4 scaffolds and 12 WZ21 scaffolds, both implanted in rabbit femoral condyles. The condyles and important inner organs were explanted after 6, 12 and 24 weeks and analyzed. The in-vivo corrosion rate of the WZ21 scaffolds calculated by microCT-based volume loss was up to 49 times slower than the in-vitro corrosion rate based on weight loss. Intramembranous bone formation within the scaffolds of both alloys was revealed, however a low corrosion rate and formation of gas cavities at initial time points were also detected. No systemic or local toxicity could be observed. Investigations by μ-XRF did not reveal accumulation of yttrium in the neighboring tissue. In summary, the magnesium scaffold´s performance is biocompatible, but would benefit from a surface modification, such as a coating to obtain lower the initial corrosion rates, and hereby establish a promising open-porous implant material for load-bearing applications. STATEMENT OF SIGNIFICANCE: Magnesium is an ideal temporary implant material for non-load bearing applications like bigger bone defects, since it degrades in the body over time. Here we developed and tested in vitro and in a rabbit model in vivo degradable open porous scaffolds made of sintered magnesium W4 and WZ21 short fibres. These scaffolds allow the ingrowth of cells and blood vessels to promote bone healing and regeneration. Both fibre types showed in vitro sufficient cytocompatibility and proliferation rates and in vivo, no systemic toxicity could be detected. At the implantation site, intramembranous bone formation accompanied by ingrowth of supplying blood vessels within the scaffolds of both alloys could be detected.
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Affiliation(s)
- Katharina Bobe
- Laboratory for Biomechanics and Biomaterials, Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Straße 1-7, Hannover 30625, Germany
| | - Elmar Willbold
- Laboratory for Biomechanics and Biomaterials, Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Straße 1-7, Hannover 30625, Germany.
| | - Maike Haupt
- Laboratory for Biomechanics and Biomaterials, Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Straße 1-7, Hannover 30625, Germany
| | - Mattias Reebmann
- Laboratory for Biomechanics and Biomaterials, Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Straße 1-7, Hannover 30625, Germany
| | - Ingrid Morgenthal
- Fraunhofer Institute for Manufacturing Technology and Advanced Materials IFAM, Branch Lab Dresden, Winterbergstraße 28, Dresden 01277, Germany
| | - Olaf Andersen
- Fraunhofer Institute for Manufacturing Technology and Advanced Materials IFAM, Branch Lab Dresden, Winterbergstraße 28, Dresden 01277, Germany
| | - Thomas Studnitzky
- Fraunhofer Institute for Manufacturing Technology and Advanced Materials IFAM, Branch Lab Dresden, Winterbergstraße 28, Dresden 01277, Germany
| | - Jens Nellesen
- Institute of Materials Engineering, Technische Universität Dortmund, Leonhard-Euler-Straße 2, Dortmund 44227, Germany
| | - Wolfgang Tillmann
- Institute of Materials Engineering, Technische Universität Dortmund, Leonhard-Euler-Straße 2, Dortmund 44227, Germany
| | - Carla Vogt
- Institute for Analytical Chemistry, University of Mining and Technology, Leipziger Straße 29, Freiberg 09599, Germany
| | - Kelim Vano-Herrera
- Deutsches Institut für Kautschuktechnologie, Eupener Straße 33, Hannover 30519, Germany
| | - Frank Witte
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Dental Materials and Biomaterial Research, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Aßmannshauser Straße 4-6, Berlin 14197, Germany
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25
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Cordunianu MA, Antoniac I, Niculescu M, Paltanea G, Raiciu AD, Dura H, Forna N, Carstoc ID, Cristea MB. Treatment of Knee Osteochondral Fractures. Healthcare (Basel) 2022; 10:healthcare10061061. [PMID: 35742112 PMCID: PMC9222836 DOI: 10.3390/healthcare10061061] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/31/2022] [Accepted: 06/07/2022] [Indexed: 11/16/2022] Open
Abstract
Osteochondral lesions (OCLs) that are frequently encountered in skeletally immature and adult patients are more common than once thought, and their incidence rate is rising. These lesions can appear in many synovial joints of the body, such as the shoulder, elbow, hip, and ankle, occurring most often in the knee. The term osteochondral lesion includes a vast spectrum of pathologies such as osteochondritis dissecans, osteochondral defects, osteochondral fractures, and osteonecrosis of the subchondral bone. When considering this, the term osteochondral fracture is preserved only for an osteochondral defect that combines disruption of the articular cartilage and subchondral bone. These fractures commonly occur after sports practice and are associated with acute lateral patellar dislocations. Many of these lesions are initially diagnosed by plain radiographs; however, a computed tomography (CT) scan or magnetic resonance imaging (MRI) can add significant value to the diagnosis and treatment. Treatment methods may vary depending on the location and size of the fracture, fragment instability, and skeletal maturity. The paper reports a 14-year-old boy case with an osteochondral fracture due to sports trauma. The medical approach involved an arthrotomy of the knee, drainage of the hematoma, two Kirschner wires (K-wires) for temporary fixation to restructure anatomic alignment, and a titanium Herbert screw fixing the fracture permanently. The patient had a favorable postoperative outcome with no residual pain, adequate knee stability, and a normal range of motion. The mobility of the knee was fully recovered.
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Affiliation(s)
- Mihai Alexandru Cordunianu
- Faculty of Medicine, Titu Maiorescu University, 67A Gheorghe Petrascu, RO-031593 Bucharest, Romania; (M.A.C.); (M.N.)
| | - Iulian Antoniac
- Faculty of Material Science and Engineering, University Politehnica of Bucharest, RO-060042 Bucharest, Romania;
- Academy of Romanian Scientists, RO-050094 Bucharest, Romania
| | - Marius Niculescu
- Faculty of Medicine, Titu Maiorescu University, 67A Gheorghe Petrascu, RO-031593 Bucharest, Romania; (M.A.C.); (M.N.)
| | - Gheorghe Paltanea
- Faculty of Electrical Engineering, University Politehnica of Bucharest, RO-060042 Bucharest, Romania
- Correspondence: (G.P.); (H.D.)
| | | | - Horatiu Dura
- Faculty of Medicine, Lucian Blaga University of Sibiu, RO-550169 Sibiu, Romania;
- Correspondence: (G.P.); (H.D.)
| | - Norin Forna
- Department of Orthopedics and Traumatology, Gr. T. Popa University of Medicine and Pharmacy, RO-700115 Iasi, Romania;
| | - Ioana Dana Carstoc
- Faculty of Medicine, Lucian Blaga University of Sibiu, RO-550169 Sibiu, Romania;
| | - Mihai Bogdan Cristea
- Department of Morphological Sciences, Carol Davila University of Medicine and Pharmacy, RO-020021 Bucharest, Romania;
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Potential bioactive coating system for high-performance absorbable magnesium bone implants. Bioact Mater 2022; 12:42-63. [PMID: 35087962 PMCID: PMC8777287 DOI: 10.1016/j.bioactmat.2021.10.034] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 10/21/2021] [Accepted: 10/21/2021] [Indexed: 12/11/2022] Open
Abstract
Magnesium alloys are considered the most suitable absorbable metals for bone fracture fixation implants. The main challenge in absorbable magnesium alloys is their high corrosion/degradation rate that needs to be controlled. Various coatings have been applied to magnesium alloys to slow down their corrosion rates to match their corrosion rate to the regeneration rate of the bone fracture. In this review, a bioactive coating is proposed to slow down the corrosion rate of magnesium alloys and accelerate the bone fracture healing process. The main aim of the bioactive coatings is to enhance the direct attachment of living tissues and thereby facilitate osteoconduction. Hydroxyapatite, collagen type I, recombinant human bone morphogenetic proteins 2, simvastatin, zoledronate, and strontium are six bioactive agents that show high potential for developing a bioactive coating system for high-performance absorbable magnesium bone implants. In addition to coating, the substrate itself can be made bioactive by alloying magnesium with calcium, zinc, copper, and manganese that were found to promote bone regeneration. Bioactive-coated magnesium implant could accelerate bone fracture healing time to match with magnesium degradation. Hydroxyapatite, collagen type I, recombinant human bone morphogenetic proteins 2, simvastatin, zoledronate, and strontium are high potential bioactive coating materials. The incorporation of Ca, Zn, Cu, Sr, and Mn in Mg base-metal could further enhance bone formation.
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Radiolucent zones of biodegradable magnesium-based screws in children and adolescents-a radiographic analysis. Arch Orthop Trauma Surg 2022; 143:2297-2305. [PMID: 35352154 DOI: 10.1007/s00402-022-04418-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 03/05/2022] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Albeit the implantation of magnesium-based biodegradable implants can avoid a second surgery for implant removal, the postoperative occurrence of radiolucent zones around these implants based on corrosion processes has not been previously investigated in children and adolescents. We sought to characterize the distinct temporal and spatial dynamics for magnesium-based implants based on standard clinical routine radiographs. MATERIALS AND METHODS We retrospectively analyzed 29 patients, treated with magnesium-based compression screws (MAGNEZIX® CS 2.7 mm, CS 3.2 mm, CSC 4.8 mm; Syntellix AG) for fracture fixation, osteotomy, or osteochondral refixation. During a follow-up examination, the clinical and functional status was evaluated. Based on digital radiographs, the ratio of the area of the radiolucent zone and that of the screw was evaluated to assess implant degradation at two follow-up visits (i.e., after 6-8 weeks and 12-24 weeks). RESULTS In 29 patients (16/29 females, 14.03 ± 2.13 years), a total of 57 implants were evaluated that were used for osteotomy (n = 13, screws n = 26), fracture fixation (n = 9, screws n = 18), or osteochondral refixation (n = 7, screws n = 13). All patients healed without complications and regained full function. Radiolucent zones were observed in 27/29 patients at the first follow-up, with significantly decreased ratios at the second follow-up (2.10 ± 0.55 vs 1.64 ± 0.60, p = 0.0006). Regression analyses were performed to assess the temporal dynamics of radiolucent zones and revealed significant logarithmic developments for the 2.7 mm and 3.2 mm screws, marked by a strong ratio decrease during the first weeks and an almost complete disappearance after approximately 100 days and 200 days, respectively. In contrast, the ceramic-coated 4.8 mm screws presented a significant linear and slower decrease of radiolucent zones. CONCLUSION Radiolucent zones are a common phenomenon in the course of implant degradation. However, they represent a self-limiting phenomenon. Remarkably, neither implant failure nor affected implant function is noted in this context. Yet, the microstructural changes accompanying the presence of radiolucent zones remain to be analyzed by three-dimensional high-resolution imaging.
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Making Hardware Removal Unnecessary by Using Resorbable Implants for Osteosynthesis in Children. CHILDREN 2022; 9:children9040471. [PMID: 35455515 PMCID: PMC9031809 DOI: 10.3390/children9040471] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/08/2022] [Accepted: 03/21/2022] [Indexed: 11/30/2022]
Abstract
Introduction: Following osteosynthesis, children generally require a second surgery to remove the hardware. This becomes unnecessary, by using resorbable implants. Limiting the number of required surgeries and their associated risks, this technique provides critical aspects of minimally invasive surgery. This review focuses on resorbable implants for osteosynthesis for the treatment of fractures in children and discusses their clinical features. Method: We provide an overview of the two most common technologies used in resorbable osteosynthesis materials: polymer- and magnesium-based alloys. Clinical examples of osteosynthesis are presented using polymer-based ActivaTM products and magnesium-based Magnezix® products. Results: Polymer-based implants demonstrate surgical safety and efficacy. Due to their elasticity, initial placement of polymer-based products may demonstrate technical challenges. However, stability is maintained over the course of healing. While maintaining good biocompatibility, the rate of polymer-resorption may be controlled by varying the composition of polyesters and copolymers. Similarly, magnesium-based implants demonstrate good mechanical stability and resorption rates, while these characteristics may be controlled by varying alloy components. One of the significant shortcomings of magnesium is that metabolism results in the production of hydrogen gas. Both technologies provide equally good results clinically and radiographically, when compared to non-resorbable implants. Conclusion: Resorbable osteosynthesis materials demonstrate similar therapeutic results as conventional materials for osteosynthesis. Resorbable implants may have the potential to improve patient outcomes, by sparing children a second surgery for hardware removal.
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Magnesium-Based Alloys Used in Orthopedic Surgery. MATERIALS 2022; 15:ma15031148. [PMID: 35161092 PMCID: PMC8840615 DOI: 10.3390/ma15031148] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 01/27/2022] [Accepted: 01/29/2022] [Indexed: 02/04/2023]
Abstract
Magnesium (Mg)-based alloys have become an important category of materials that is attracting more and more attention due to their high potential use as orthopedic temporary implants. These alloys are a viable alternative to nondegradable metals implants in orthopedics. In this paper, a detailed overview covering alloy development and manufacturing techniques is described. Further, important attributes for Mg-based alloys involved in orthopedic implants fabrication, physiological and toxicological effects of each alloying element, mechanical properties, osteogenesis, and angiogenesis of Mg are presented. A section detailing the main biocompatible Mg-based alloys, with examples of mechanical properties, degradation behavior, and cytotoxicity tests related to in vitro experiments, is also provided. Special attention is given to animal testing, and the clinical translation is also reviewed, focusing on the main clinical cases that were conducted under human use approval.
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Hug U, Fiumedinisi F, Roos J, Pallaver A, Bodmer E, Liechti R. Torque load on biodegradable magnesium screws during intramedullary insertion into a metacarpal bone – a biomechanical study. HAND SURGERY & REHABILITATION 2022; 41:341-346. [DOI: 10.1016/j.hansur.2022.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/25/2022] [Accepted: 01/29/2022] [Indexed: 11/16/2022]
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Kozakiewicz M, Gabryelczak I, Bielecki-Kowalski B. Clinical Evaluation of Magnesium Alloy Osteosynthesis in the Mandibular Head. MATERIALS 2022; 15:ma15030711. [PMID: 35160655 PMCID: PMC8836973 DOI: 10.3390/ma15030711] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/11/2022] [Accepted: 01/16/2022] [Indexed: 02/01/2023]
Abstract
Titanium alloys are used in skeletal surgery. However, once bone union is complete, such fixation material becomes unnecessary or even harmful. Resorbable magnesium materials have been available for several years (WE43 alloy). The aim of this study was to clinically compare magnesium versus titanium open reduction and rigid fixations in mandible condylar heads. Ten patients were treated for fractures of the mandibular head with magnesium headless compression screws (2.3 mm in diameter), and 11 patients were included as a reference group with titanium screws (1.8 mm in diameter) with similar construction. The fixation characteristics (delay, time, and number of screws), distant anatomical results (mandibular ramus height loss, monthly loss rate, and relative loss of reconstructed ramus height), basic functional data (mandibular movements, facial nerve function, and cutaneous perception) and the influence of the effects of the injury (fracture type, fragmentation, occlusion, additional fractures, and associated diseases) on the outcome were evaluated. The long-term results of treatment were evaluated after 18 months. Treatment results similar to those of traditional titanium fixation were found with magnesium screws. Conclusions: Resorbable metal screws can be a favored option for osteosynthesis because surgical reentry can be avoided. These materials provide proper and stable treatment results.
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Li C, Lv H, Du Y, Zhu W, Yang W, Wang X, Wang J, Chen W. Biologically modified implantation as therapeutic bioabsorbable materials for bone defect repair. Regen Ther 2021; 19:9-23. [PMID: 35024389 PMCID: PMC8732753 DOI: 10.1016/j.reth.2021.12.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/08/2021] [Accepted: 12/20/2021] [Indexed: 12/26/2022] Open
Abstract
For decades, researches have concentrated on the mechanical properties, biodegradation, and biocompatibility of implants used in the therapy of large size bone defect. In vivo studies demonstrate that bioabsorbable bone substitute materials can reduce the risk of common symptoms such as inflammation and osteonecrosis caused by bio-inert materials after long-term implantation. Several organic, inorganic, and composite materials have been approved for clinical application, based on their unique characteristics and advantages. Although some artificial bioabsorbable bone substitute materials have been used for years, there are still some disadvantages existing, such as low mechanical strength, high brittleness, and low degradation rate. Therefore, novel bioabsorbable composite materials biomaterials have been developed for bone defect repair. In this review, we provide an overview of the development of artificial bioabsorbable bone substitute materials and highlight the advantages and disadvantages. Furthermore, recent advances in bioabsorbable bone substitute materials used in bone defect repair are outlined. Finally, we discuss current challenges and further developments in the clinical application of bioabsorbable bone substitute materials.
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Affiliation(s)
- Chao Li
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang 050051, PR China,Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, No.139 Ziqiang Road, Shijiazhuang 050051, PR China,NHC Key Laboratory of Intelligent Orthopaedic Equipment, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang 050051, PR China
| | - Hongzhi Lv
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang 050051, PR China,Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, No.139 Ziqiang Road, Shijiazhuang 050051, PR China,NHC Key Laboratory of Intelligent Orthopaedic Equipment, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang 050051, PR China
| | - Yawei Du
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai 200025, PR China
| | - Wenbo Zhu
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang 050051, PR China,Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, No.139 Ziqiang Road, Shijiazhuang 050051, PR China,NHC Key Laboratory of Intelligent Orthopaedic Equipment, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang 050051, PR China
| | - Weijie Yang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang 050051, PR China,Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, No.139 Ziqiang Road, Shijiazhuang 050051, PR China,NHC Key Laboratory of Intelligent Orthopaedic Equipment, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang 050051, PR China
| | - Xiumei Wang
- State Key Laboratory of New Ceramics and Fine Processing, School of Materials Science and Engineering, Tsinghua University, No.30 Shuangqing Road, Beijing 100084, PR China
| | - Juan Wang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang 050051, PR China,Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, No.139 Ziqiang Road, Shijiazhuang 050051, PR China,NHC Key Laboratory of Intelligent Orthopaedic Equipment, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang 050051, PR China,Corresponding author. No.139 Ziqiang Road, Shjiazhuang 050051, PR China. Fax: +86-311-87023626.
| | - Wei Chen
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang 050051, PR China,Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, No.139 Ziqiang Road, Shijiazhuang 050051, PR China,NHC Key Laboratory of Intelligent Orthopaedic Equipment, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang 050051, PR China,Corresponding author. No.139 Ziqiang Road, Shjiazhuang 050051, PR China. Fax: +86-311-87023626.
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Sonnow L, Ziegler A, Pöhler GH, Kirschner MH, Richter M, Cetin M, Unal M, Kose O. Alterations in magnetic resonance imaging characteristics of bioabsorbable magnesium screws over time in humans: a retrospective single center study. Innov Surg Sci 2021; 6:105-113. [PMID: 35224178 PMCID: PMC8826160 DOI: 10.1515/iss-2021-0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/04/2021] [Indexed: 11/28/2022] Open
Abstract
Objectives This study aimed to examine the alterations in magnetic resonance imaging (MRI) characteristics of bioabsorbable magnesium (Mg) screws over time in a single center study in humans. Methods Seventeen patients who underwent medial malleolar (MM) fracture or osteotomy fixation using bioabsorbable Mg screws and had at least one postoperative MRI were included in this retrospective study. Six of them had more than one MRI in the postoperative period and were subject of the artifact reduction measurements. 1.5T or 3T MRI scans were acquired in different periods in each patient. The size and extent of the artifact were assessed independently by two experienced radiologists both quantitatively (distance measurement) and qualitatively (Likert scale). Results In the quantitative measurements of the six follow-up patients the screw’s signal loss artifact extent significantly decreased over the time, regardless of the MRI field strength (p<0.001). The mean artifact reduction was 0.06 mm (95% confidence interval [CI]: 0.05–0.07) for proton density weighted [PDw] and 0.04 mm (95% CI: 0.03–0.05) for T1 weighted (T1w) sequences per week. The qualitative assessments similarly showed significant artifact reduction in all MRI sequences. Different imaging findings, like bone marrow edema (BME), liquid collections, and gas formation were reported. The overall inter-reader agreement was high (κ=0.88, p<0.001). Conclusions The time-dependent artifact reduction of Mg screws in postoperative controls might indicate the expected self-degradation of the Mg implants. In addition, different MRI findings were reported, which are characteristic of Mg implants. Further MRI studies are required to get a better understanding of Mg imaging properties.
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Affiliation(s)
- Lena Sonnow
- Department of Diagnostic and Interventional Radiology , Hannover Medical School , Hannover , Germany
| | - Andreas Ziegler
- Medizincampus Davos , Davos , Switzerland
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal , Pietermaritzburg , South Africa
- Department of Cardiology , University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Gesa H. Pöhler
- Department of Diagnostic and Interventional Radiology , Hannover Medical School , Hannover , Germany
| | | | | | - Mustafa Cetin
- Department of Radiology , Antalya Education and Research Hospital , Antalya , Turkey
| | - Melih Unal
- Department of Orthopedics and Traumatology , Antalya Education and Research Hospital , Antalya , Turkey
| | - Ozkan Kose
- Department of Orthopedics and Traumatology , Antalya Education and Research Hospital , Antalya , Turkey
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Polat O, Toy S, Kibar B. Surgical outcomes of scaphoid fracture osteosynthesis with magnesium screws. Jt Dis Relat Surg 2021; 32:721-728. [PMID: 34842105 PMCID: PMC8650676 DOI: 10.52312/jdrs.2021.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/31/2021] [Indexed: 11/25/2022] Open
Abstract
Objectives
This study aims to evaluate the mid-term functional and radiological outcomes of magnesium-based screws in the treatment of scaphoid fractures. Patients and methods
Between February 2015 and February 2018, a total of 21 patients (18 males, 3 females; mean age: 28.5±5.8 years; range, 19 to 39 years) with acute scaphoid waist fractures who underwent fracture fixation with biologically degradable magnesium-based compression screws were retrospectively analyzed. Fractures were classified according to the Herbert and Fisher classification. The absence of pain on palpation and painless active range of motion were accepted as the signs of union. Results
The mean follow-up was 43.3±5.3 (range, 36 to 52) months. According to the Herbert and Fisher classification, nine patients had type B1 and 12 patients had type B2 scaphoid fractures. Union was achieved in all cases. The mean time to union was 11.2±1.5 (range, 9 to 14) weeks. The mean grip strength, flexion, and extension were 43.57°, 73.57°, and 76.43°, respectively. The grip strength, pinch strength, and range of motion of the operated side were evaluated at the final follow-up visit and compared with the contralateral side (control group). No complication occurred. Any screw was not removed. Conclusion
Magnesium-based compression screws can be safely used for acute scaphoid fractures considering their favorable functional and radiological results.
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Affiliation(s)
- Oktay Polat
- Ağrı Eğitim ve Araştırma Hastanesi, Ortopedi ve Travmatoloji Kliniği, 04200 Ağrı, Türkiye.
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Stürznickel J, Delsmann MM, Jungesblut OD, Stücker R, Knorr C, Rolvien T, Kertai M, Rupprecht M. Safety and performance of biodegradable magnesium-based implants in children and adolescents. Injury 2021; 52:2265-2271. [PMID: 33775413 DOI: 10.1016/j.injury.2021.03.037] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/15/2021] [Indexed: 02/02/2023]
Abstract
AIMS Biodegradable magnesium-based alloy implants represent a promising option in orthopedic surgery, as the clinical outcomes have been reported to be comparable to those of titanium implants and no surgical interventions are required for removal. To date, little is known about the results of the use of these implants in children and adolescents. Therefore, the aim of the present study was to analyze the safety and performance of these implants in children and adolescents. PATIENTS AND METHODS Eighty-nine patients treated with magnesium-based implants for fracture stabilization, osteotomy and osteochondral refixation were analyzed; 38 were treated by osteosynthesis; 18, osteotomy; and 33, osteochondral refixation. The mean follow-up duration was 8.2 months (range, 1.5-30 months). Clinical and radiographical follow-up examinations were performed at 4-8 weeks and 3-6 months, respectively, to evaluate implant performance and osseous consolidation. RESULTS Clinical outcomes were rated as good to very good in all patients. Radiolucent zones were apparent after surgery in all patients but were noted to decrease in size during the follow-up period. Revision surgery was necessary in 1 of 89 patients who had a highly unstable osteochondritis dissecans lesion of the knee. None of the magnesium-based implants required surgical removal. CONCLUSION Magnesium-based implants in children and adolescents results in good clinical outcomes when used for fracture stabilization, osteotomy and osteochondral defect refixation. Future studies are needed to further analyze the significance of the transient appearance and temporal development of radiolucent zones in the growing skeleton as well as the long-term performance of these implants.
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Affiliation(s)
- Julian Stürznickel
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maximilian M Delsmann
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Oliver D Jungesblut
- Department of Pediatric Orthopaedics, Children's Hospital Hamburg-Altona, Hamburg, Germany; Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ralf Stücker
- Department of Pediatric Orthopaedics, Children's Hospital Hamburg-Altona, Hamburg, Germany; Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Knorr
- Department of Pediatric Surgery, Klinik St. Hedwig, University Medical Center Regensburg, Regensburg, Germany
| | - Tim Rolvien
- Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Kertai
- Department of Pediatric Surgery, Klinik St. Hedwig, University Medical Center Regensburg, Regensburg, Germany.
| | - Martin Rupprecht
- Department of Pediatric Orthopaedics, Children's Hospital Hamburg-Altona, Hamburg, Germany; Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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In Vivo Imaging of Biodegradable Implants and Related Tissue Biomarkers. Polymers (Basel) 2021; 13:polym13142348. [PMID: 34301105 PMCID: PMC8309526 DOI: 10.3390/polym13142348] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/12/2021] [Indexed: 01/10/2023] Open
Abstract
Non-invasive longitudinal imaging of osseointegration of bone implants is essential to ensure a comprehensive, physical and biochemical understanding of the processes related to a successful implant integration and its long-term clinical outcome. This study critically reviews the present imaging techniques that may play a role to assess the initial stability, bone quality and quantity, associated tissue remodelling dependent on implanted material, implantation site (surrounding tissues and placement depth), and biomarkers that may be targeted. An updated list of biodegradable implant materials that have been reported in the literature, from metal, polymer and ceramic categories, is provided with reference to the use of specific imaging modalities (computed tomography, positron emission tomography, ultrasound, photoacoustic and magnetic resonance imaging) suitable for longitudinal and non-invasive imaging in humans. The advantages and disadvantages of the single imaging modality are discussed with a special focus on preclinical imaging for biodegradable implant research. Indeed, the investigation of a new implant commonly requires histological examination, which is invasive and does not allow longitudinal studies, thus requiring a large number of animals for preclinical testing. For this reason, an update of the multimodal and multi-parametric imaging capabilities will be here presented with a specific focus on modern biomaterial research.
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Baldini M, Coppa V, Falcioni D, Senigagliesi E, Marinelli M, Gigante AP. Use of resorbable magnesium screws in children: systematic review of the literature and short-term follow-up from our series. J Child Orthop 2021; 15:194-203. [PMID: 34211595 PMCID: PMC8223084 DOI: 10.1302/1863-2548.15.210004] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 04/06/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Biodegradable implants are of major interest in orthopaedics, especially in the skeletally immature population. Magnesium (Mg) implants are promising for selected surgical procedure in adults, but evidence is lacking. Thus, the aim of this study is to analyze the safety and efficacy of resorbable Mg screw in different orthopaedic procedures in skeletally immature patients. In addition, we present a systematic review of the current literature on the clinical use of Mg implants. METHODS From 2018 until the writing of this manuscript, consecutive orthopaedic surgical procedures involving the use of Mg screws performed at our centre in patients < 15 years of age were retrospectively reviewed. In addition, a systematic review of the literature was performed in the main databases. We included clinical studies conducted on humans, using Mg-alloy implants for orthopaedic procedures. RESULTS A total of 14 patients were included in this retrospective analysis. Mean age at surgery was 10.8 years (sd 2.4), mean follow-up was 13.8 months (sd 7.5). Healing was achieved in all the procedures, with no implant-related adverse reaction. No patients required any second surgical procedure. The systematic review evidenced 20 clinical studies, 19 of which conducted on an adult and one including paediatric patients. CONCLUSION Evidence on resorbable Mg implants is low but promising in adults and nearly absent in children. Our series included apophyseal avulsion, epiphyseal fractures, osteochondritis dissecans, displaced osteochondral fragment and tendon-to-bone fixation. Mg screws guaranteed stable fixation, without implant failure, with good clinical and radiological results and no adverse events. LEVEL OF EVIDENCE IV - Single cohort retrospective analysis with systematic review.
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Affiliation(s)
- Marco Baldini
- Clinical Orthopedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Valentino Coppa
- Clinical Orthopedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Danya Falcioni
- Clinic of Adult and Paediatric Orthopedic, Azienda Ospedal-iero-Universitaria, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Elisa Senigagliesi
- Clinical Orthopedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Mario Marinelli
- Clinical Orthopedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Antonio Pompilio Gigante
- Clinical Orthopedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
- Clinic of Adult and Paediatric Orthopedic, Azienda Ospedal-iero-Universitaria, Ospedali Riuniti di Ancona, Ancona, Italy
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Bonithon R, Kao AP, Fernández MP, Dunlop JN, Blunn GW, Witte F, Tozzi G. Multi-scale mechanical and morphological characterisation of sintered porous magnesium-based scaffolds for bone regeneration in critical-sized defects. Acta Biomater 2021; 127:338-352. [PMID: 33831571 DOI: 10.1016/j.actbio.2021.03.068] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/11/2021] [Accepted: 03/31/2021] [Indexed: 12/19/2022]
Abstract
Magnesium (Mg) and its alloys are very promising degradable, osteoconductive and osteopromotive materials to be used as regenerative treatment for critical-sized bone defects. Under load-bearing conditions, Mg alloys must display sufficient morphological and mechanical resemblance to the native bone they are meant to replace to provide adequate support and enable initial bone bridging. In this study, unique highly open-porous Mg-based scaffolds were mechanically and morphologically characterised at different scales. In situ X-ray computed tomography (XCT) mechanics, digital volume correlation (DVC), electron microscopy and nanoindentation were combined to assess the influence of material properties on the apparent (macro) mechanics of the scaffold. The results showed that Mg exhibited a higher connected structure (38.4mm-3 and 6.2mm-3 for Mg and trabecular bone (Tb), respectively) and smaller spacing (245µm and 629µm for Mg and Tb, respectively) while keeping an overall appropriate porosity of 55% in the range of trabecular bone (30-80%). This fully connected and highly porous structure promoted lower local strain compared to the trabecular bone structure at material level (i.e. -22067 ± 8409µε and -40120 ± 18364µε at 6% compression for Mg and trabecular bone, respectively) and highly ductile mechanical behaviour at apparent level preventing premature scaffold failure. Furthermore, the Mg scaffolds exceeded the physiological strain of bone tissue generated in daily activities such as walking or running (500-2000µε) by one order of magnitude. The yield stress was also found to be close to trabecular bone (2.06MPa and 6.67MPa for Mg and Tb, respectively). Based on this evidence, the study highlights the overall biomechanical suitability of an innovative Mg-based scaffold design to be used as a treatment for bone critical-sized defects. STATEMENT OF SIGNIFICANCE: Bone regeneration remains a challenging field of research where different materials and solutions are investigated. Among the variety of treatments, biodegradable magnesium-based implants represent a very promising possibility. The novelty of this study is based on the characterisation of innovative magnesium-based implants whose structure and manufacturing have been optimised to enable the preservation of mechanical integrity and resemble bone microarchitecture. It is also based on a multi-scale approach by coupling high-resolution X-ray computed tomography (XCT), with in situ mechanics, digital volume correlation (DVC) as well as nano-indentation and electron-based microscopy imaging to define how degradable porous Mg-based implants fulfil morphological and mechanical requirements to be used as critical bone defects regeneration treatment.
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Herber V, Okutan B, Antonoglou G, Sommer NG, Payer M. Bioresorbable Magnesium-Based Alloys as Novel Biomaterials in Oral Bone Regeneration: General Review and Clinical Perspectives. J Clin Med 2021; 10:jcm10091842. [PMID: 33922759 PMCID: PMC8123017 DOI: 10.3390/jcm10091842] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 02/07/2023] Open
Abstract
Bone preservation and primary regeneration is a daily challenge in the field of dental medicine. In recent years, bioresorbable metals based on magnesium (Mg) have been widely investigated due to their bone-like modulus of elasticity, their high biocompatibility, antimicrobial, and osteoconductive properties. Synthetic Mg-based biomaterials are promising candidates for bone regeneration in comparison with other currently available pure synthetic materials. Different alloys based on Mg were developed to fit clinical requirements. In parallel, advances in additive manufacturing offer the possibility to fabricate experimentally bioresorbable metallic porous scaffolds. This review describes the promising clinical results of resorbable Mg-based biomaterials for bone repair in osteosynthetic application and discusses the perspectives of use in oral bone regeneration.
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Affiliation(s)
- Valentin Herber
- Department of Dentistry and Oral Health, Division of Oral Surgery and Orthodontics, Medical University of Graz, Billrothgasse 4, 8010 Graz, Austria; (G.A.); (M.P.)
- Department of Orthopaedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5/6, 8036 Graz, Austria; (B.O.); (N.G.S.)
- Correspondence:
| | - Begüm Okutan
- Department of Orthopaedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5/6, 8036 Graz, Austria; (B.O.); (N.G.S.)
| | - Georgios Antonoglou
- Department of Dentistry and Oral Health, Division of Oral Surgery and Orthodontics, Medical University of Graz, Billrothgasse 4, 8010 Graz, Austria; (G.A.); (M.P.)
| | - Nicole G. Sommer
- Department of Orthopaedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5/6, 8036 Graz, Austria; (B.O.); (N.G.S.)
| | - Michael Payer
- Department of Dentistry and Oral Health, Division of Oral Surgery and Orthodontics, Medical University of Graz, Billrothgasse 4, 8010 Graz, Austria; (G.A.); (M.P.)
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