Redisplacement after ankle osteosynthesis with absorbable implants.

A total of 1202 fractures of the ankle were treated with absorbable implants made of polyglycolide/polylactide copolymer or self-reinforced polyglycolide and/or self-reinforced polylactide between November 5, 1984, and January 12, 1994. A redisplacement after fixation was diagnosed in 30 patients (2.5%). The redisplacement occurred in 8 of 934 (0.9%) simple ankle fractures and in 22 of 268 (8.2%) severer ankle fractures. A breakage or loosening of the absorbable implant was verified at reoperation in 8 cases and was suspected in another 9. A technical failure was the main reason in 13 cases. A reoperation was performed for 25 patients. The absorbable implants seem to provide a secure fixation in the majority of ankle fractures, but the use of these implants showed unsatisfactory results in unstable and comminuted fractures.

Osteolytic changes after polyglycolide pin fixation in chevron osteotomy.

Absorbable polyglycolide pins were used for fixation of 94 chevron osteotomies in 70 patients at the Department of Orthopaedics and Traumatology, Helsinki University Central Hospital, between 1986 and 1992. Postoperative osteolytic changes around the degrading pin occurred in 21 of 94 (22%) metatarsal heads. In 17 of 21 metatarsal heads, polydioxanone-coated polyglycolide pins were used. This type of pin has not been used since 1988. At follow-up, 16 of 21 osteolytic changes resolved completely and four partially resolved. In the remaining one, the osteolytic area remained visible after 6 years. Cystic changes in the metatarsal head, not attributable to the location of the absorbable implants, occurred in seven (7.4%) metatarsal heads and avascular necrosis of the entire metatarsal head in one (1.1%). Foreign body reaction occurred in six (6.3%) metatarsal heads and wound infection in three (3.2%) metatarsal heads. No association was observed between osteolytic changes and foreign body reaction or infection. Osteolysis in patients receiving polyglycolide implants only require observation, because associated symptoms with the radiographic findings are transient.

Absorbable pins in the treatment of hand fractures.

Open reduction and internal fixation with absorbable devices was used to treat 32 fractures of the hand at our department. The clinical results were reviewed in 20 patients with an average follow-up of 4.5 years. There were 17 metacarpal fractures, 12 phalangeal and three carpal fractures. Thirty fractures were intra-articular. Subjectively 15 of the 20 patients indicated their satisfaction with the outcome of the treatment. Redisplacement of fixation occurred in two Bennett's fractures. A minor redisplacement was observed in one comminuted and in one noncomminuted phalangeal intra-articular fracture. A foreign-body reaction occurred in two patients with a Bennett's fracture and in one with a trapezoid fracture. A wound infection occurred in one patient with a Bennett's fracture and in one patient with a phalangeal fracture. The use of absorbable implants showed promising results in the intra-articular fractures of metacarpal and phalangeal bones with the exception of the Bennett's fractures, where the outcome was less favourable. The number of patients in the study was limited and for a more definitive conclusion a larger series of fractures of the hand should be analysed.

Absorbable implants in the treatment of distal humeral fractures in adolescents and adults.

Between 1986 and 1994, 57 consecutive patients with a distal humeral fracture were treated operatively using absorbable implants, 15 of them were treated by combining absorbable pins or screws with metallic implants. According to the AO/ASIF system, there were 13 Type A, 21 Type B and 10 Type C fractures. Thirteen patients were lost to follow-up. The clinical outcome was reviewed in 44 patients with an average follow-up time of 4.6 years. The functional results by Broberg and Morrey were excellent or good in 36 (81%), fair in three (6,8%) and poor in five (11,2%) patients. Twenty-nine (66%) patients indicated their satisfaction with the outcome of the treatment. The elderly had more severely unstable fractures and more unfavourable results than younger patients. A postoperative redisplacement was seen in 11 (25%) patients and infection in seven (16%) patients. An abacterial foreign-body reaction occurred in four (9,1%) patients. The results were favourable in the noncomminuted epicondylar and condylar fractures of the distal humerus as well as in the humeral capitellum fractures. The results were unsatisfactory in the comminuted intraaticular distal humeral fractures.

Fixation of scaphoid delayed union and non-union with absorbable polyglycolide pin or Herbert screw. Consolidation and functional results.

Internal fixation with an absorbable polyglycolide pin or a Herbert screw was used to treat 34 patients with ununited and delayed union of fractures of the carpal scaphoid. The late clinical result could be reviewed in 14 patients in the polyglycolide group and 10 in the Herbert group with an average follow-up time of 68 and 58 months, respectively. The rate of union was 64% in the polyglycolide group and 60% in the Herbert group. The functional outcome was better in the Herbert group than in the polyglycolide group. A transient local abacterial tissue reaction occurred in 5 of 20 (25%) patients in the polyglycolide group. Two Herbert screws were removed due to penetration of the screw into the radial cartilage. The complication rate was relatively high with both methods. The polyglycolide pin results were unsatisfactory in this study, and thus we do not recommend their use in delayed union of and ununited scaphoid fractures.