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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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Baldini M, Coppa V, Falcioni D, Cusano G, Massetti D, Marinelli M, Gigante AP. Resorbable magnesium screws for fixation of medial epicondyle avulsion fractures in skeletally immature patients: A comparison with Kirschner wires. J Child Orthop 2023; 17:499-501. [PMID: 37799316 PMCID: PMC10549691 DOI: 10.1177/18632521231192470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Affiliation(s)
- Marco Baldini
- Department of Clinical and Molecular Science, Clinical Orthopedics, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
- Azienda Sanitaria Territoriale Pesaro Urbino, Ortopedia e Traumatologia, Pesaro, Italy
| | - Valentino Coppa
- Clinic of Adult and Paediatric Orthopedic, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Danya Falcioni
- Clinic of Adult and Paediatric Orthopedic, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Giuseppe Cusano
- Department of Clinical and Molecular Science, Clinical Orthopedics, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Daniele Massetti
- Divisione di Ortopedia e Traumatologia, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Mario Marinelli
- Clinic of Adult and Paediatric Orthopedic, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Antonio Pompilio Gigante
- Department of Clinical and Molecular Science, Clinical Orthopedics, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
- Clinic of Adult and Paediatric Orthopedic, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, Ancona, Italy
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Rehm A, Clegg R, Linardatou Novak P, Ashby E. Resorbable magnesium screws for fixation of medial epicondyle avulsion fractures in skeletally immature patients: A comparison with Kirschner wires. J Child Orthop 2023; 17:497-498. [PMID: 37799314 PMCID: PMC10549692 DOI: 10.1177/18632521231192466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Affiliation(s)
- Andreas Rehm
- Department of Paediatric Orthopaedics, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Rachael Clegg
- Department of Paediatric Orthopaedics, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | | | - Elizabeth Ashby
- Department of Paediatric Orthopaedics, Cambridge University Hospitals NHS Trust, Cambridge, UK
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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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Baldini M, Coppa V, Falcioni D, Cusano G, Massetti D, Marinelli M, Gigante AP. Resorbable magnesium screws for fixation of medial epicondyle avulsion fractures in skeletally immature patients: A comparison with Kirschner wires. J Child Orthop 2022; 16:481-487. [PMID: 36483654 PMCID: PMC9723866 DOI: 10.1177/18632521221136100] [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] [Received: 06/23/2022] [Accepted: 10/08/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Displaced medial epicondyle fractures are treated with open reduction and internal fixation with K-wires or screws. Rates of implant prominence, failure, or non-union reported are considerable. Magnesium screws have demonstrated biocompatibility, osteoconductivity, and high pull-out strength. The aim of this study was to compare surgical fixation of medial epicondyle fracture using resorbable magnesium Herbert screws to K-wires, in skeletally immature patients. METHODS A retrospective analysis was performed from January 2015 to April 2020. Inclusion criteria were as follows displaced medial epicondyle fracture, <15 years, and absence of concomitant ipsilateral upper limb fractures. Two consecutive cohorts based on fixation device were made: Group A (wires) and Group B (magnesium screws). Alignment, pain, range of motion, Mayo Elbow Performance Score, and radiological healing were assessed. RESULTS A total of 27 patients were included: 15 in Group A and 12 in Group B. Groups were comparable for age and sex. Mean follow-up was higher in Group A (38.73 ± 3.15 vs 26.18 ± 4.85 months; p < 0.001). No significant differences were observed regarding range of motion, alignment, pain, and Mayo Elbow Performance Score, with excellent results in both groups. Two patients in Group A developed a deep wound pin site infection requiring antibiotics. X-rays revealed three cases of non-union in Group A and one in Group B, all of them asymptomatic. No patient required a second surgical procedure. CONCLUSION Open reduction and internal fixation of medial epicondyle fractures with magnesium screws showed comparable results to a widely accepted procedure such as the use of K-wires, potentially with a lower incidence of non-union and infection. No adverse reactions were recorded. LEVEL OF EVIDENCE level III.
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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,Marco Baldini, Clinical Orthopedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Via Tronto, 10/A, 60126 Ancona, Italy. Emails: ;
| | - Valentino Coppa
- Clinic of Adult and Paediatric Orthopedic, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Danya Falcioni
- Clinic of Adult and Paediatric Orthopedic, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Giuseppe Cusano
- Clinical Orthopedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Daniele Massetti
- Divisione di Ortopedia e Traumatologia, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Mario Marinelli
- Clinic of Adult and Paediatric Orthopedic, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, 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 Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, Ancona, Italy
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Waelti SL, Markart S, Willems EP, Fischer T, Dietrich TJ, Ditchfield M, Matissek C, Krebs T. Radiographic features of magnesium-based bioabsorbable screw resorption in paediatric fractures. Pediatr Radiol 2022; 52:2368-2376. [PMID: 35606529 DOI: 10.1007/s00247-022-05383-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/28/2022] [Accepted: 04/13/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Resorption of magnesium-based alloy bioabsorbable screws produces hydrogen gas, which can be mistaken as a sign of infection and may affect the physis or fixed bone fragment. OBJECTIVE We evaluated the temporal and spatial occurrence of gas and the occurrence of a breakage of the fixed bone fragment or screw following magnesium screw fixation. MATERIALS AND METHODS Radiographs of paediatric patients treated with magnesium screws were retrospectively reviewed. Temporal occurrence and distribution of gas in the bone, the physis and soft tissues, breakage of the screw or fixed bone fragment and joint effusion were assessed. RESULTS One hundred and three radiographs in 35 paediatric patients were reviewed (mean age: 10.6 years). Follow-up ranged from 1 to 730 days. Gas in the bone increases up to week 5, remains constant up to week 16 and then decreases. Gas in soft tissues, intra-articular gas and joint effusions gradually reduce over time. In 1/23 (4.3%) patients with an open physis, gas intrusion into the physis occurred. Breakage of the bone fragment fixated by the screw was observed in 4/35 (11.4%) patients within the first 6 weeks. Screw breakage was observed in 16/35 (45.7%) patients, with a median time to first detection of 300 days. CONCLUSION Gas bubbles in bone and soft tissue are normal findings in the context of screw resorption and should not be confused with soft-tissue infection or osteomyelitis. Gas is rarely visible in the physis. Breakage of the fixed bone fragment and/or screw can occur.
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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.
| | - 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
| | - 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
| | - Michael Ditchfield
- Department of Diagnostic Imaging, Monash Children's Hospital, Monash Health, Clayton, Australia
| | - Christoph Matissek
- Department of Paediatric Surgery, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Thomas Krebs
- Department of Paediatric Surgery, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
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Rehm A, Granger L, Kobezda T, Ong JC. Letter to the Editor: "Fixation of Unstable Osteochondritis Dissecans Lesions and Displaced Osteochondral Fragments Using New Biodegradable Magnesium Pins in Adolescents". Cartilage 2022; 13:19476035221098874. [PMID: 35819015 PMCID: PMC9280822 DOI: 10.1177/19476035221098874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Andreas Rehm
- Cambridge University Hospitals NHS Foundation Trust Ringgold Standard Institution–Paediatric Orthopaedics, Cambridge, UK,Andreas Rehm, Cambridge University Hospitals NHS Foundation Trust Ringgold Standard Institution–Paediatric Orthopaedics, Hills Road, Cambridge CB3 9JG, UK.
| | - Luke Granger
- Cambridge University Hospitals NHS Foundation Trust Ringgold Standard Institution–Paediatric Orthopaedics, Cambridge, UK
| | - Tamás Kobezda
- Cambridge University Hospitals NHS Foundation Trust Ringgold Standard Institution–Paediatric Orthopaedics, Cambridge, UK
| | - Joshua C.Y. Ong
- Cambridge University Hospitals NHS Foundation Trust Ringgold Standard Institution–Paediatric Orthopaedics, Cambridge, UK
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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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Rehm A, Granger L, Ong JCY, Ashby E. "Safety and performance of biodegradable magnesium-based implants in children and adolescents". Injury 2022; 53:2380-2381. [PMID: 35031106 DOI: 10.1016/j.injury.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/02/2022] [Indexed: 02/02/2023]
Affiliation(s)
- Andreas Rehm
- Consultant Paediatric Orthopaedic Surgeon, Department of Paediatric Orthopaedics, Paediatric Division, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom.
| | - Luke Granger
- Higher Orthopaedic Trainee, Department of Paediatric Orthopaedics, Paediatric Division, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom.
| | - Joshua C Y Ong
- Higher Orthopaedic Trainee, Department of Paediatric Orthopaedics, Paediatric Division, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom.
| | - Elizabeth Ashby
- Consultant Paediatric Orthopaedic Surgeon, Department of Paediatric Orthopaedics, Paediatric Division, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom.
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A Systematic Review and Network Meta-Analysis of Biomedical Mg Alloy and Surface Coatings in Orthopedic Application. Bioinorg Chem Appl 2022; 2022:4529520. [PMID: 35399618 PMCID: PMC8991394 DOI: 10.1155/2022/4529520] [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: 01/17/2022] [Accepted: 02/19/2022] [Indexed: 12/15/2022] Open
Abstract
Magnesium alloys have great application prospects as ideal bone implant materials. However, their poor corrosion resistance limits their clinical orthopedic application. Surface modification promotes the corrosion resistance of magnesium. Conversion coatings, such as calcium phosphate (Ca-P) coating, microarc oxidation (MAO) treatment, and fluoride (FLU) treatment, have been extensively investigated in in vivo studies. This systematic review and network meta-analysis compared the influence of different conversion coatings on bone repair, material properties, and systemic host response in orthopedic applications. Using the PICOS model, the inclusion criteria for biodegradable magnesium and its alloys were determined for in vivo studies. Four databases were used. The standard and weight mean differences with 95% confidence intervals were used to analyze new bone formation and degradation rate. Network structure and forest plots were created, and ranking probabilities were estimated. The risk of bias and quality of evidence were assessed using SYRCLE, CERQual, and GRADE tools. In the qualitative analysis, 43 studies were selected, and the evaluation of each outcome indicator was not entirely consistent from article to article. In the quantitative analysis, 21 articles were subjected to network meta-analysis, with 16 articles on implant degradation and 8 articles for new bone formation. Additionally, SUCRA indicated that Ca-P coating exhibited the highest corrosion resistance, followed by FLU treatment. MAO demonstrated the best capability for new bone formation, followed by Ca-P coating. Ca-P coating exhibited the highest overall performance. To conclude, coated Mg can promote better new bone formation than bare Mg and has considerable biocompatibility. Ca-P-coated Mg and MAO-coated Mg have the greatest potential to significantly promote corrosion resistance and bone regeneration, respectively. The findings of this study will provide a theoretical basis for the investigation of composite coatings and guidance for the orthopedic application of Mg bone implants.
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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: 6] [Impact Index Per Article: 3.0] [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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Rehm A, Kobezda T, Ong JCY, Ashby E. "Changes in the management of pediatric medial humeral epicondyle fractures with and without associated elbow dislocation." Scherer S, Dietzel M, Jordan N, Tsiflikas I, Kirschner HJ, Fuchs J, Lieber J. Injury 2021;52:2257-2264. Injury 2022; 53:1297-1298. [PMID: 34876257 DOI: 10.1016/j.injury.2021.11.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 11/24/2021] [Indexed: 02/02/2023]
Affiliation(s)
- Andreas Rehm
- Consultant Paediatric Orthopaedic Surgeon, Department of Paediatric Orthopaedics, Paediatric Division, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom.
| | - Tamás Kobezda
- Higher Orthopaedic Trainee, Department of Paediatric Orthopaedics, Paediatric Division, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom.
| | - Joshua C Y Ong
- Higher Orthopaedic Trainee, Department of Paediatric Orthopaedics, Paediatric Division, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom.
| | - Elizabeth Ashby
- Consultant Paediatric Orthopaedic Surgeon, Department of Paediatric Orthopaedics, Paediatric Division, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom.
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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 2022; 16:77-80. [PMID: 35615388 PMCID: PMC9124917 DOI: 10.1177/18632521221080032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Marco Baldini
- Clinical Orthopedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Ancona, Italy,Marco Baldini, Clinical Orthopedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Via Tronto, 10/A, 60126 Ancona, Italy.
| | - Valentino Coppa
- Clinic of Adult and Paediatric Orthopedic, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Danya Falcioni
- Clinic of Adult and Paediatric Orthopedic, Azienda Ospedaliero 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
- Clinic of Adult and Paediatric Orthopedic, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona, 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 Ospedaliero Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
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Rehm A, Granger L, Ashby E. Use of resorbable magnesium screws in children: systematic review of the literature and short-term follow-up from our series. J Child Orthop 2022; 16:75-76. [PMID: 35615391 PMCID: PMC9124913 DOI: 10.1177/18632521221080026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Andreas Rehm
- Andreas Rehm, Cambridge University Hospitals NHS Trust, Hills Road, Cambridge CB2 0QQ, UK.
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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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