Bioabsorbable fixation in orthopaedic surgery and traumatology

Bioabsorbable internal fixation devices were introduced clinically in the t reatment of fractures and osteotomies of the extremities at the Department of Orthopaedics and Traumatology, Helsinki University, in 1984. Since Novem ber 5, 1984, a total of 3200 patients were managed using bone or ligament f ixation devices made of self-reinforced (matrix and fibres of the same poly mer) bioabsorbable alpha-hydroxy polyesters. The devices used included cyli ndrical rods, screws, tacks, plugs, arrows, and wires. The most common indi cation for the use of bioabsorbable implants was the displaced malleolar fr acture of the ankle. Transphyseal fixation with small-diameter, mainly poly glycolide pins was used in children. The postoperative clinical course was uneventful in more than 90% of the patients. The complications included bac terial wound infection in 4% and failure of fixation in 4%. In one-fifth of the latter cases, however, re-operation was not necessary. The occurrence of non-infectious foreign-body reactions two to three months postoperativel y has been observed in 2% of the patients operated in the last few years wi th polyglycolide implants but none of the patients managed with polylactide implants. This inflammatory tissue response often required aspiration with a needle but did not influence the functional or radiologic result of the treatment. Owing to the biodegradability of these internal fixation devices , implant removal procedures were avoided. This results in financial benefi ts and psychological advantages. Bioabsorbable implants can also be used in open fractures and infection operations. (C) 2000 Elsevier Science Ltd. Al l rights reserved.