Resorbable plate-screw systems: clinical applications (original) (raw)
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Use of Resorbable Plate and Screws in Pediatric Craniofacial Reconstructive Surgery
Jurnal Plastik Rekonstruksi, 2013
Latar Belakang: Mengevaluasi dua pasien anak dengan sindrom kelainan kraniofasial yang menjalani operasi rekonstruksi kraniofasial dengan menggunakan sistem resorbable plate-screw, yang telah diklaim sebagai material fiksasi biodegradabel dan keuntungan mereka seperti resistensi biomekanik yang memadahi, waktu tinggal lebih lama, eliminasi melalui rute fisiologis tanpa menimbulkan reaksi benda asing dan/ atau sekuel signifikan. Pasien dan Metode: Sistem resorbable plate-screw digunakan pada dua pasien anak yang menjalani prosedur rekonstruksi kraniofasial yaitu bilateral fronto-orbital advancement dan segmental right orbita (four wall box) osteotomy, dievaluasi keberhasilannya. Hasil: Pada kedua pasien didapatkan hasil fiksasi yang memadahi, tetapi komplikasi infeksi terjadi pada pasien yang menjalani segmental right orbita osteotomy yaitu timbul lokal abses pada insisi frontomedial dan subsilier. Setelah dilakukan insisi drainase dan pemberian antibiotik selama tujuh hari didapatkan infeksi mereda. Ringkasan: Kopolimer resorbabel berisi derivat poliester dari L-lactid dan asam glikolat merupakan materi fiksasi yang ideal digunakan pada operasi rekonstruksi kraniofasial pada anak dan memiliki keunggulan seperti resistensi biomekanik yang memadahi melawan tarikan dan tekanan pada awal periode pasca operasi, waktu tinggal lebih lama dan eliminasi dari tubuh melalui rute fisiologis tanpa menimbulkan reaksi benda asing. Kata kunci : Craniofacial surgery, resorbable plate screw Background: To evaluate two pediatric patients with syndromic craniofacial anomaly that underwent craniofacial reconstructive surgery using resorbable plate-screw systems which have been claimed as biodegradable fixation materials and used in craniofacial reconstructive procedures owing to their advantages such as adequate biomechanical resistance, longer dwelling time, elimination through physiological routes without causing any foreign body reaction and/or significant sequale. Patient and Method: Resorbable plate-screw systems used in 2 patiens for craniofacial reconstructive procedures such as bilateral fronto-orbital advancement and segmental right orbita (four wall box) osteotomy were evaluated as for their efficacy. Result: Adequate fixation was obtained in both patient, but Infection complication was seen in segmental right orbita osteotomy patient that appear localized abcess formation on subciliary incision and fronto medial insicion. After drainage insicion and antibiotic administration for 1 week, the infection was relieved. Summary: Owing to resorbable copolymer which contain a polyester derivate of L-lactidc and glycolic acid are ideal fixation materials used favourably in pediatric craniofacial reconstructive surgery and have further advantages such as adequate biomechanical resistance against distraction and compression forces in the early postoperative period, longer dwelling time and elimination from the body through physiological routes without causing any foreign body reaction.
New resorbable bone fixation. Biomaterials in craniomaxillofacial surgery: present and future
European Journal of Plastic Surgery, 2004
Metallic implants have been extensively used for osteofixation in craniomaxillofacial surgery (CMF). Although they are mainly inert, the disadvantage of not being resorbable remains. Advances in biomaterials technology led to the development of resorbable polymers composed by monomeric units that are naturally present in the body. Among them are polylactide (PLA), polyglycolide (PGA) and their copolymers [PLGA and P(L/ DL)LA]. After in-depth studies of the structure of these materials, the self-reinforced (SR) technology has merged to solve their mechanical limitations. SR is based on reinforcing elements within the same material, increasing their strength. Ultra-high strength implants were then manufactured by the SR technique. In CMF surgery, SR devices have been used for over 10 years without reported complications. As advantages, SR devices have shown to be biocompatible, reliable, easily handled, and to have favorable degradation properties. At present, copolymeric SR devices [P(L/DL)LA, BioSorb FX, and PLGA, BioSorb PDX] represent an advance in the clinical application of absorbable devices in CMF surgery. The aim of this review is to give an overall understanding of the ultimate advances in biomaterial research for CMF reconstruction, with emphasis in self-reinforced resorbable devices. We also intend to give insight into new devices, such as SR, tacks and their applicability.
Resorbable versus titanium plates for orthognathic surgery
Cochrane Database Syst Rev, 2007
Background Recognition of some of the limitations of titanium plates and screws used for the fixation of bones has led to the development of plates manufactured from bioresorbable materials. Whilst resorbable plates appear to offer clinical advantages over metal plates in orthognathic surgery, concerns remain about the stability of fixation and the length of time required for their degradation and the possibility of foreign body reactions.
National Journal of Maxillofacial Surgery, 2013
Rigid internal fixation with metallic materials is a standard technique, in use for the last 35 years and performed to align bone segments during healing periods. First osteosynthesis plate was described by Sir William Lane [1] over a hundred years ago. Rigid fixation methods have till now, relied almost exclusively upon metallic components because of their high strength and contourability. However, there are inherent drawbacks associated with metallic devices, as susceptibity to corrosion, need to remove these plates/screws due to factors like infection, stress shielding, plate palpability, temperature sensitivity; interference with advanced imaging technique, [2] possible growth restrictions and implant migration in pediatric population and problem in patients who have to be irradiated as they may cause backscatter. [3] In an effort to overcome the disadvantages of metallic osteofixation devices, various biodegradable polymers have been developed. [4] The advantages of biodegradable osteosynthesis devices include the gradual transference of physiological forces to the healing bone, the reduced
Use of biodegradable plates and screws in the treatment of pediatric facial bone fractures
Egyptian Journal of Oral & Maxillofacial Surgery, 0
Background Pediatric patients with facial fractures are a unique challenge in terms of their treatment planning, which is different from that of adult patients. Early literature has advocated conservative closed management of pediatric facial fractures to prevent complications. However, recent advances in treatment have enabled us to use biodegradable plates and screws, which overcome the limitations of metallic plates. Aim This study was conducted to evaluate the effectiveness of Inion CPS biodegradable plates and screws on pediatric facial fractures. Patients and methods The study was conducted on 30 pediatric patients with maxillofacial fractures requiring open reduction and internal fixation. Fractures with infection and comminuted fractures were excluded. Patients were aged 3–12 years, 18 boys and 12 girls, with different types of trauma: 12 patients had suffered falls, 12 patients had middle cerebral artery (MCA), four patients had sports-related fracture; and two patients had assaultrelated fractures. The site of fracture was different: 18 patients had mandibular fractures, four patients had zygomatic complex fractures, four patients had orbital fractures, two patients had maxillary fractures (one isolated and the other with mandibular fracture), and one patient had frontal bone and sinus fractures (anterior wall). Fractures were plated with a biodegradable system (Inion CPS) using standard plating principles. Postoperative complications were assessed. Results Satisfactory reduction was obtained in all patients, as judged from the position of the fracture segments in 24-h postoperative radiographs compared with all subsequently obtained images. The undisturbed reduction was considered as a marker of the stable fixation provided by the bioresorbable system. The screw holes visible as radiolucencies on the radiograph were also seen to maintain their position throughout the period of follow-up. Conclusion In our study, we concluded that the use of Inion bioresorbable plates is effective in the treatment of facial fracture in pediatric patients. There was no complication and no growth disturbance in the follow-up period, which proves that bioresorbable plates provide stable fixation in children. Our data support the use of bioresorbable plate fixation in pediatric craniofacial surgery as a means of avoiding the potential and well-documented problems associated with rigid metal fixation.
Bioresorbable Plates and Screws for Clinical Applications: A Review
Journal of Healthcare Engineering, 2012
Bioresorbable implants are being widely used for fracture fixation in orthopaedic surgery and the market is expanding rapidly worldwide. Bioresorbable materials slowly dissolve in the human body, such that a second operation to remove the synthetic material is not needed. Bioresorbable implants have expanded the armamentarium of the surgeon, especially in the field of sports medicine. Interference screws, plates, pins, suture anchors, meniscal repair implants, and simple fracture fixation implants are the most commonly used resorbable implants for anterior cruciate ligament reconstruction, shoulder surgery, meniscal repair, and fracture care. However, many clinicians continue to rely on metal fixation, mainly due to the high mechanical strength and to the complications reported with some of the available resorbable implant materials. The goal of the present paper is to present an overview on the available resorbable materials and their applications with a particular focus on new developments and trends in the field.
Background Recognition of some of the limitations of titanium plates and screws used for the fixation of bones has led to the development of plates manufactured from bioresorbable materials. Whilst resorbable plates appear to offer clinical advantages over metal plates in orthognathic surgery, concerns remain about the stability of fixation and the length of time required for their degradation and the possibility of foreign body reactions. This review compares the use of titanium versus bioresorbable plates in orthognathic surgery and is an update of the Cochrane Review first published in 2007. Objectives To compare the effects of bioresorbable fixation systems with titanium systems used during orthognathic surgery. Search methods Cochrane Oral Health’s Information Specialist searched the following databases: Cochrane Oral Health’s Trials Register (to 20 January 2017); the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 11) in the Cochrane Library (searched 20 January 2017); MEDLINE Ovid (1946 to 20 January 2017); and Embase Ovid (1980 to 20 January 2017). We searched the US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov (clinicaltrials.gov; searched 20 January 2017), and the World Health Organization International Clinical Trials Registry Platform (searched 20 January 2017) for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. Selection criteria Randomised controlled trials comparing bioresorbable versus titanium fixation systems used for orthognathic surgery in adults. Data collection and analysis Two review authors independently screened the results of the electronic searches, extracted data and assessed the risk of bias of the included studies.We resolved disagreement by discussion. Clinical heterogeneity between the included trials precluded pooling of data, and only a descriptive summary is presented. Main results This review included two trials, involving 103 participants, one comparing titanium with resorbable plates and screws and the other titanium with resorbable screws. Both studies were at high risk of bias and provided very limited data for the primary outcomes of this review. All participants in one trial suffered mild to moderate postoperative discomfort with no statistically significant difference between the two plating groups at different follow-up times. Mean scores of patient satisfaction were 7.43 to 8.63 (range 0 to 10) with no statistically significant difference between the two groups throughout follow-up. Adverse effects reported in one study were two plate exposures in each group occurring between the third and ninth months. Plate exposures occurred mainly in the posterior maxillary region, except for one titanium plate exposure in the mandibular premolar region. Known causes of infection were associated with loosened screws and wound dehiscence with no statistically significant difference in the infection rate between titanium (3/196), and resorbable (3/165) plates. Authors’ conclusions We do not have sufficient evidence to determine if titaniumplates or resorbable plates are superior for fixation of bones after orthognathic surgery. This review provides insufficient evidence to show any difference in postoperative pain and discomfort, level of patient satisfaction, plate exposure or infection for plate and screw fixation using either titanium or resorbable materials.
Resorbable implants in maxillofacial surgery: a reality check
Journal of maxillofacial and oral surgery, 2012
Stability is the main feature of fixation techniques in fracture management modalities, in vogue today. One of the most significant landmarks in the armamentarium of maxillofacial fracture management has been the introduction of rigid internal fixation (RIF). The biomaterials used in RIF have seen a gradual change from Stainless steel to titanium due to the evidence based advantages of the latter. However, the inherent problems with metallic implants led to the introduction of resorbable polymers in RIF. This article evaluates the efficacy of these polymers in fixation of bone segments as compared to titanium fixation implants in 40 patients of zygomatic complex fractures. The study compared the clinical efficacy, technique, cost and time factors in the use of these two biomaterials. The results showed very little difference after the use of these two biomaterials in spite of the increased time, technique sensitivity and cost of the resorbable system. The argument for use of the res...