Arch Hand Microsurg.  2023 Dec;28(4):267-274. 10.12790/ahm.23.0037.

The usefulness of bioabsorbable magnesium implants in addition to metal plates in the treatment of complex distal radius fractures

• An KY
• Park TG
• Kim YJ

• KMID: 2548598
• DOI: http://doi.org/10.12790/ahm.23.0037

Abstract

Purpose
The aim of this study was to determine whether normal plating yields comparable outcomes to plating using additional bioabsorbable screws or wires for complex distal radial fractures.
Methods
Among 80 patients with complex distal radius fractures treated between January 2018 and March 2021, 45 were studied retrospectively and divided into two groups as follows: group A (n=23) received a plate, and group B (n=22) received a plate with a bioresorbable screw or wire. Radiological studies evaluated the period of bone union, radial length, inclination, and resorption of the bioresorbable screws or wires after surgery. The Disabilities of the Arm, Shoulder, and Hand (DASH) score was examined for clinical evaluation, and complications were compared between the two groups.
Results
The two groups showed similar distributions in sex, age, injury mechanism, diabetes mellitus, smoking, and mean follow-up period; however, there were no statistically significant differences in the period of bone union and maintenance of reduction (radial length, inclination, and volar tilt). The DASH score averaged 14.8 and 13.2 points in groups A and B, respectively, showing no significant difference in complications (nonunion, malunion, infection, and arthritis).
Conclusion
Regardless of the use of additional bioresorbable screws or wires, reduction in distal radius fractures in both groups yielded good results. Plating with additional bioresorbable screws or wires may be a suitable fixation method to compensate for the shortcomings of metal implants in complex distal radius fractures.

Keyword

Distal radius fracture; Bioabsorbable screw; Bioabsorbable wire

Figure

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  Fig. 1. Flow chart of patients with radius fractures. In total, 232 patients with distal radius fractures were enrolled, and two groups appropriate for the goals of this study were selected as the study subjects: group A, internal fixation with a plate only (n=23) and group B, bioresorbable implant (n=22).

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  Fig. 2. A 74-year-old female patient in group B (bioresorbable implant). (A, B) Preoperative simple radiology. (C, D) Postoperative radiology using internal fixation with a plate and absorbable implant for a distal radius fracture. (A, C) Anteroposterior view, (B, D) lateral view.

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  Fig. 3. Bioresorbable implant used in this study (Resomet; U&I Corp., Seoul, Korea). (A) Bioresorbable screw, (B) bioresorbable wire.

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  Fig. 4. A 74-year-old female patient in group B (bioresorbable implant). Intraoperative radiology using internal fixation with plate and absorbable implant for distal radius fracture (A, lateral view; B, anteroposterior view).

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  Fig. 5. A 74-year-old female patient in group B (bioresorbable implant). Intraoperative clinical photograph using internal fixation with plate and absorbable implant for distal radius fracture.

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  Fig. 6. A 74-year-old female patient in group B (bioresorbable implant). Postoperative computed tomography (A, coronal view; B, sagittal view) shows that the patient’s status is well maintained without complications.

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  Fig. 7. An 80-year-old female patient. Postoperative clinical photograph (A, coronal view; B, sagittal view) showing internal fixation with plate and external Kirschner-wire fixation for a distal radius fracture.

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  Fig. 8. An 80-year-old female patient. Postoperative clinical radiology showing internal fixation with a plate and external Kirschner-wire fixation for a distal radius fracture (A, anteroposterior view; B, lateral view).

Reference

References

1. Chung MY, Rhi WS, Chung JY, Koo SH, Jeun SY, Chae YH. Treatment of Colles’ fracture with percutaneous pinning. J Korean Orthop Assoc. 1995; 30:1440–6.

2. Athanasiou KA, Agrawal CM, Barber FA, Burkhart SS. Orthopaedic applications for PLA-PGA biodegradable polymers. Arthroscopy. 1998; 14:726–37.

3. Tornetta P 3rd, Spoo JE, Reynolds FA, Lee C. Overtightening of the ankle syndesmosis: is it really possible? J Bone Joint Surg Am. 2001; 83:489–92.

4. Choo JT, Lai SH, Tang CQ, Thevendran G. Magnesium-based bioabsorbable screw fixation for hallux valgus surgery: a suitable alternative to metallic implants. Foot Ankle Surg. 2019; 25:727–32.

5. Schaller B, Matthias Burkhard JP, Chagnon M, Beck S, Imwinkelried T, Assad M. Fracture healing and bone remodeling with human standard-sized magnesium versus polylactide-co-glycolide plate and screw systems using a mini-swine craniomaxillofacial osteotomy fixation model. J Oral Maxillofac Surg. 2018; 76:2138–50.

6. Nellans KW, Kowalski E, Chung KC. The epidemiology of distal radius fractures. Hand Clin. 2012; 28:113–25.

7. Choi HC, Lee JY, Jung JY, Park IJ, Chung YG. Radiologic results in accordance with the number of distal locking screws in volar plate fixation for distal radius fractures. J Korean Soc Surg Hand. 2014; 19:124–9.

8. Gummesson C, Atroshi I, Ekdahl C. The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire: longitudinal construct validity and measuring self-rated health change after surgery. BMC Musculoskelet Disord. 2003; 4:11.

9. Van Nortwick SS, Yao J, Ladd AL. Titanium integration with bone, welding, and screw head destruction complicating hardware removal of the distal radius: report of 2 cases. J Hand Surg Am. 2012; 37:1388–92.

10. Kim KY, Jung DE. Treatment of unstable Colles’ fracture. J Korean Orthop Assoc. 1986; 21:869–76.

11. Lichtman DM, Bindra RR, Boyer MI, et al. Treatment of distal radius fractures. J Am Acad Orthop Surg. 2010; 18:180–9.

12. Lill CA, Goldhahn J, Albrecht A, Eckstein F, Gatzka C, Schneider E. Impact of bone density on distal radius fracture patterns and comparison between five different fracture classifications. J Orthop Trauma. 2003; 17:271–8.

13. Prommersberger KJ, Fernandez DL. Nonunion of distal radius fractures. Clin Orthop Relat Res. 2004; (419):51–6.

14. Mehling I, Müller LP, Delinsky K, Mehler D, Burkhart KJ, Rommens PM. Number and locations of screw fixation for volar fixed-angle plating of distal radius fractures: biomechanical study. J Hand Surg Am. 2010; 35:885–91.

15. Moss DP, Means KR Jr, Parks BG, Forthman CL. A biomechanical comparison of volar locked plating of intra-articular distal radius fractures: use of 4 versus 7 screws for distal fixation. J Hand Surg Am. 2011; 36:1907–11.

16. Zhou H, Liang B, Jiang H, Deng Z, Yu K. Magnesium-based biomaterials as emerging agents for bone repair and regeneration: from mechanism to application. J Magnes Alloys. 2021; 9:779–804.

17. Luthringer BJ, Feyerabend F, Willumeit-Römer R. Magnesium-based implants: a mini-review. Magnes Res. 2014; 27:142–54.

18. Windhagen H, Radtke K, Weizbauer A, et al. Biodegradable magnesium-based screw clinically equivalent to titanium screw in hallux valgus surgery: short term results of the first prospective, randomized, controlled clinical pilot study. Biomed Eng Online. 2013; 12:62.

19. Hoffmann R, Krettek C, Hetkämper A, Haas N, Tscherne H. Osteosynthesis of distal radius fractures with biodegradable fracture rods: results of two years follow-up. Unfallchirurg. 1992; 95:99–105.

20. Pietrzak WS, Sarver D, Verstynen M. Bioresorbable implants: practical considerations. Bone. 1996; 19(1 Suppl):109S–119S.