Is the use of biodegradable devices in the operative treatment of avulsion fractures of fingers, the so-called mallet finger advantageous? A feasibility study with meniscus arrows.

PURPOSE: Treatment of Mallet fingers or fractures remains a controversial topic. No evident preference can be distilled from the reports of the clinical results obtained by conservative treatment with splints and internal fixation. If operative treatment is indicated, several techniques can be used. However, each technique has disadvantages like the risk of comminution of the fragment, the risk of infection and necrosis, a demanding operative technique and-or the necessity of removing the metallic devices. This can be avoided by the use of biodegradable devices. The purpose of this feasibility study was to evaluate the outcome of internal fixation of a Mallet fracture with a biodegradable device, the Meniscus Arrow((R)). METHODS: We treated nine consecutive patients with a Mallet fracture by fixation of the fragment with a biodegradable Meniscus Arrow((R)), at this moment the smallest device available, with an average operation time of 14 minutes. RESULTS: Postoperatively, no complications were found. All patients were satisfied by the results after surgery, with a restored range of motion in the distal interphalangeal joint as previously and good alignment with full consolidation of all fractures at radiological evaluation. CONCLUSIONS: The operative treatment of bony mallet fingers with the Meniscus Arrow((R)) is a fast procedure without complications in our prospective series of nine patients and without the need of a second operation to remove the implant.

The use of biodegradables in the treatment of osteochondritis dissecans of the knee: fiction or future?

The use of biodegradable fixation devices in the operative treatment of osteochondritis dissecans of the knee could avoid a second operation for removal of the hardware, but what are the disadvantages? Seven osteochondritis dissecans lesions, non-displaced in four adult knees and in one adolescent knee and displaced in two knees of adolescents, were treated by drilling and stabilisation with biodegradable pins, resulting in primary consolidation in the five non-displaced lesions and failure in the two detached lesions. However, two detached fragments in adults, primarily fixed with one metallic compression screw and three biodegradable pins both consolidated. In another adult patient, the fixation with two compression screws failed. A study of the available literature and the results of our limited experience seem to indicate that the primary operative treatment of choice of a non-detached osteochondritis dissecans lesion is drilling and fixation with biodegradable pins. However, if this regimen fails or in patients with a detached lesion, one metallic screw and a few additional biodegradable pins appear to constitute the best method of fixation. The use of biodegradable screws is still hazardous, because of the long degradation time and subsequent risk of erosion of the opposite cartilage and tissue reaction. Other resurfacing options are available for failures or fragmented or non-vital lesions.

The use of Marlex mesh in patients with generalized peritonitis and multiple organ system failure.

Patients with generalized peritonitis form a rather threatened group, with a high mortality and risk of complications which increases when multiple organ failure develops. In 20 patients with this condition, the laparotomy wound was closed without tension using a Marlex mesh prosthesis, after surgical treatment of the underlying illness and drainage of the abdominal cavity. The mortality was lower than expected, according to data from the literature; also, pulmonary complications, residual abscesses and wound dehiscence occurred less frequently. This method seems to be a valuable contribution to the complex treatment of these patients.