Search Results (17)

Background: Pediatric olecranon fractures, though rare, can be serious. Treatment varies by type and severity; displaced, intraarticular fractures usually need surgery, where biodegradable implants are emerging as an encouraging option to metal hardware. Methods: Our prospective, single-center, single-arm case series evaluates three pediatric olecranon fracture patients treated by resorbable poly-L-lactic-co-glycolic acid (PLGA) pins and polydioxanone (PDS) loops between Jan 2022 and January 2023 at the Department of Pediatrics, University of Pécs, Clinical Complex. Results: All patients achieved complete radiological healing with excellent functional recovery and no implant-related complications at one-year follow-up. Conclusions: Resorbable PLGA pins and PDS loops provide a promising alternative to conventional metallic fixation in pediatric olecranon fractures, abolishing the need for a second implant-removal surgery while maintaining stability and biocompatibility. Our findings support the child-friendly nature and growing role of biodegradable materials in pediatric fracture management. Full article

The emerging paradigm of personalised bone repair embodies a transformative triad comprising bio-inspired design, digital fabrication, and the exploration of innovative materials. The increasing average age of the population, alongside the rising incidence of fractures associated with age-related conditions such as osteoporosis, necessitates the development of customised, efficient, and minimally invasive treatment modalities as alternatives to conventional methods (e.g., autografts, allografts, Ilizarov distraction, and bone fixators) typically employed to promote bone regeneration. A promising innovative technique involves the use of cellularised scaffolds incorporating mesenchymal stem cells (MSCs). The selection of materials—ranging from metals and ceramics to synthetic or natural bio-derived polymers—combined with a design inspired by natural sources (including bone, corals, algae, shells, silk, and plants) facilitates the replication of geometries, architectures, porosities, biodegradation capabilities, and mechanical properties conducive to physiological bone regeneration. To mimic internal structures and geometries for construct customisation, scaffolds can be designed using Computer-aided Design (CAD) and fabricated via 3D-printing techniques. This approach not only enables precise control over external shapes and internal architectures but also accommodates the use of diverse materials that improve biological performance and provide economic advantages. Finally, advanced numerical models are employed to simulate, analyse, and optimise the complex processes involved in personalised bone regeneration, with computational predictions validated against experimental data and in vivo studies to ascertain the model’s ability to predict the recovery of bone shape and function. Full article

Magnesium (Mg) has attracted considerable attention as a biodegradable material for medical implants owing to its excellent biocompatibility, mitigating long-term toxicity and stress shielding. Nevertheless, challenges arise from its rapid degradation and low corrosion resistance under physiological conditions. To overcome these challenges, titanium (biocompatibility and corrosion resistance) has been integrated into Mg. The incorporation of titanium significantly improves mechanical and corrosion resistance properties, thereby enhancing performance in biological settings. Mg–Ti alloys are produced through mechanical alloying and spark plasma sintering (SPS). The SPS technique transforms powder mixtures into bulk materials while preserving structural integrity, resulting in enhanced corrosion resistance, particularly Mg80-Ti20 alloy in simulated body fluids. Moreover, Mg–Ti alloy revealed no more toxicity when assessed on pre-osteoblastic cells. Furthermore, the ability of Mg–Ti-based alloy to create composites with polymers such as PLGA (polylactic-co-glycolic acid) widen their biomedical applications by regulating degradation and ensuring pH stability. These alloys promote temporary orthopaedic implants, offering initial load-bearing capacity during the healing process of fractures without requiring a second surgery for removal. To address scalability constraints, further research is necessary to investigate additional consolidation methods beyond SPS. It is essential to evaluate the relationship between corrosion and mechanical loading to confirm their adequacy in physiological environments. This review article highlights the importance of mechanical characterization and corrosion evaluation of Mg–Ti alloys, reinforcing their applicability in fracture fixation and various biomedical implants. Full article

Magnesium alloys are attractive candidates for use as temporary fixation devices in osteosynthesis because they have a density and Young’s modulus similar to those of cortical bone. One of the main requirements for biodegradable implants is its substitution by tissues during the healing process. In this article, the Mg–Zn–Ga–(Y) alloys were investigated that potentially can increase the bone growth rate by release of Ga ions during the degradation process. Previously, the effectiveness of Ga ions on bone tissue regeneration has been proved by clinical tests. This work is the first systematic study on the microstructure and mechanical properties of Mg–Zn–Y alloys containing Ga as an additional major alloying element prepared by the hot-extrusion process. The microstructure and phase composition of the Mg–Zn–Ga–(Y) alloys in as-cast, heat-treated, and extruded conditions were analyzed. In addition, it was shown that the use of hot extrusion produces Mg–Zn–Ga–(Y) alloys with favorable mechanical properties. The tensile yield strength, ultimate tensile strength, and elongation at fracture of the MgZn4Ga4 alloy extruded at 150 °C were 256 MPa, 343 MPa, and 14.2%, respectively. Overall, MgZn4Ga4 alloy is a perspective for applications in implants for osteosynthesis with improved bone regeneration ability. Full article

Traditional inert materials used in internal fixation have caused many complications and generally require removal with secondary surgeries. Biodegradable materials, such as magnesium (Mg)-, iron (Fe)- and zinc (Zn)-based alloys, open up a new pathway to address those issues. During the last decades, Mg-based alloys have attracted much attention by researchers. However, the issues with an over-fast degradation rate and release of hydrogen still need to be overcome. Zn alloys have comparable mechanical properties with traditional metal materials, e.g., titanium (Ti), and have a moderate degradation rate, potentially serving as a good candidate for internal fixation materials, especially at load-bearing sites of the skeleton. Emerging Zn-based alloys and composites have been developed in recent years and in vitro and in vivo studies have been performed to explore their biodegradability, mechanical property, and biocompatibility in order to move towards the ultimate goal of clinical application in fracture fixation. This article seeks to offer a review of related research progress on Zn-based biodegradable materials, which may provide a useful reference for future studies on Zn-based biodegradable materials targeting applications in orthopedic internal fixation. Full article

Reconstruction of defects in the maxillofacial region following traumatic injuries, craniofacial deformities, defects from tumor removal, or infections in the maxillofacial area represents a major challenge for surgeons. Various materials have been studied for the reconstruction of defects in the maxillofacial area. Biodegradable metals have been widely researched due to their excellent biological properties. Magnesium (Mg) and Mg-based materials have been extensively studied for tissue regeneration procedures due to biodegradability, mechanical characteristics, osteogenic capacity, biocompatibility, and antibacterial properties. The aim of this review was to analyze and discuss the applications of Mg and Mg-based materials in reconstructive oral and maxillofacial surgery in the fields of guided bone regeneration, dental implantology, fixation of facial bone fractures and soft tissue regeneration. Full article

Bone fractures often require fixation devices that frequently need to be surgically removed. These temporary implants and procedures leave the patient more prone to developing medical device-associated infections, and osteomyelitis associated with trauma is a challenging complication for orthopedists. In recent years, biodegradable materials have gained great importance as temporary medical implant devices, avoiding removal surgery. The purpose of this systematic review was to revise the literature regarding the use of biodegradable bone implants in fracture healing and its impact on the reduction of implant-associated infections. The systematic review followed the PRISMA guidelines and was conducted by searching published studies regarding the in vivo use of biodegradable bone fixation implants and its antibacterial activity. From a total of 667 references, 23 studies were included based on inclusion and exclusion criteria. Biodegradable orthopedic implants of Mg-Cu, Mg-Zn, and Zn-Ag have shown antibacterial activity, especially in reducing infection burden by MRSA strains in vivo osteomyelitis models. Their ability to prevent and tackle implant-associated infections and to gradually degrade inside the body reduces the need for a second surgery for implant removal, with expectable gains regarding patients’ comfort. Further in vivo studies are mandatory to evaluate the efficiency of these antibacterial biodegradable materials. Full article

Intramedullary nails (INs) have significant advantages in rigid fracture fixation. Due to the stress shielding effect and lack of biological activity, traditional metal INs often lead to delay union or nonunion fracture healing. Undegradable metals also need to be removed by a second surgery, which will impose a potential risk to the patient. Current degradable biomaterials with low strength cannot be used in INs. Manufacturing high-strength biodegradable INs (BINs) is still a challenge. Here, we reported a novel high strength bioactive magnesium-containing silicate (CSi-Mg) BIN. This BIN is manufactured by using casting, freeze drying, and sintering techniques and has extremely high bending strength and stable internal and external structures. The manufacturing parameters were systematically studied, such as the paste component, freeze-drying process, and sintering process. This manufacturing method can be applied to various sizes of BINs. The CSi-Mg BIN also has good bioactivity and biodegradation properties. This novel bioactive BIN is expected to replace the traditional metal INs and become a more effective way of treating fractures. Full article

The present study investigates Mg–2Zn–1Ca/XMn alloys as biodegradable implants for orthopedic fracture fixation applications. The effect of the presence and progressive addition of manganese (X = 0.3, 0.5, and 0.7 wt.%) on the degradation, and post-corrosion compressive response were investigated. Results suggest that the addition of manganese at 0.5 wt.% improved the corrosion resistance of Mg–2Zn–1Ca alloys. The pH values stabilized for the 0.5Mn-containing alloy and displayed a lower corrosion rate when compared to other Mg–2Zn–1Ca/Mn alloys. Mg–2Zn–1Ca showed a progressive reduction in the compressive strength properties at the end of day 21 whereas Mg–2Zn–1Ca/0.3Mn and Mg–2Zn–1Ca/0.5Mn samples showed a decrease until day 14 and stabilized around the same strength range after day 21. The ability of Mg–2Zn–1Ca/0.5Mn alloy to develop a network of protective hydroxide and phosphate layers has resulted in the corrosion control of the alloy. Mg–2Zn–1Ca/0.7Mn displays segregation of Mn particles at the grain boundaries resulting in decreased corrosion protection. The mechanism behind the corrosion protection of Mg–2Zn–1Ca alloys was discussed. Full article

Study Design: Pediatric mandible fractures mandate special consideration because of unerupted teeth, mixed dentition, facial growth and the inability to tolerate maxillomandibular fixation. No consensus exists as to whether resorbable or titanium plating systems are superior with regards to clinical outcomes. Objective: This study aims to systematically review and compare the outcomes of both material types in the treatment of pediatric mandible fractures. Methods: After PROSPERO registration, studies from 1990–2020 publishing on outcomes of ORIF of pediatric mandible fractures were systematically reviewed according to PRISMA guidelines. An additional retrospective review was conducted at a pediatric level 1 trauma center. Results: 1144 patients met inclusion criteria (30.5% resorbable vs. 69.5% titanium). Total complication rate was 13%, and 10% required a second, unplanned operation. Complication rates in the titanium and resorbable groups were not significantly different (14% vs. 10%; p = 0.07), and titanium hardware was more frequently removed on an elective basis (p < 0.001). Condylar/sub-condylar fractures were more often treated with resorbable hardware (p = 0.01); whereas angle fractures were more often treated with titanium hardware (p < 0.001). Within both cohorts, fracture type did not increase the risk of complications, and comparison between groups by anatomic level did not demonstrate any significant difference in complications. Conclusions: Pediatric mandible fractures requiring ORIF are rare, and hardware-specific outcomes data is scarce. This study suggests that titanium and resorbable plating systems are equally safe, but titanium hardware often requires surgical removal. Surgical approach should be tailored by fracture anatomy, age-related concerns and surgeon preference. Full article

The preferred surgical fixation of forearm shaft fractures in children is Elastic Stable Intramedullary Nailing (ESIN). Due to known disadvantageous effects of metal implants, a new surgical method using biodegradable polylactide-co-glycolide (PLGA) intramedullary nails has been developed but its long-term outcomes are unclear. The aim of this study was to compare the long-term outcomes of Biodegradable Intramedullary Nailing (BIN) to ESIN and assess the biodegradation of the study implants via magnetic resonance imaging (MRI). The study population of the prospective, randomized trial consisted of paediatric patients whose forearm shaft fractures were treated with BIN (n = 19) or ESIN (n = 16). Forearm rotation at minimally four years’ follow-up was the main outcome. There was no clinically significant difference in the recovery of the patients treated with the BIN as compared to those treated with the ESIN. More than half of the implants (57.7%, n = 15/26) were completely degraded, and the rest were degraded almost completely. The PLGA intramedullary nails used in the treatment of forearm shaft fractures in this study resulted in good function and anatomy. No unexpected disadvantages were found in the degradation of the implants. However, two implant failures had occurred in three months postoperatively. Full article

Since the removal of a metallic interlocking nail system leaves a blank cavity inside a healed bone, bioactive and biodegradation materials have been used instead to induce bone formation and eliminate complications of the material removal procedure. The previous study presented the possibility of an interlocking nail fabrication from polylactic acid (PLA), polycaprolactone (PCL), and hydroxyapatite (HA) using 3D printing, namely fused filament fabrication (FFF), for canine diaphyseal fractures. Therefore, a finite element analysis (FEA) was used to predict the maximum principal stress of this 3D-printed composite interlocking nail to stabilize a canine femoral fracture, and the biomechanical performance was evaluated for the treatment of canine femoral shaft fractures using both traditional and new fixation techniques. Three-dimensional FEA models were created, and the composite interlocking nail was tested for implant strength and stability. Three types of canine femoral shaft fracture (proximal shaft fracture, middle shaft fracture, and distal shaft fracture) fixed by traditional and new fixation techniques, consisting of two, four, and six locking screws, were analyzed with a multilevel factorial design technique. The maximum principal stresses of the composite interlocking nail were compared with each fixation technique. According to the multilevel factorial design, gap type, fracture gap, and fixation techniques are factors that affect the maximum principal stress of the composite interlocking nail for two and four locking screws. For six locking screws, all factors, including gap type, fracture gap, nail length, and fixation techniques, significantly affect the maximum principal stress. The use of a 3D-printed composite interlocking nail system with new fixation techniques demonstrated lower maximum principal stresses than the interlocking nail system that used a traditional fixation technique. The results of this study could help orthopedic veterinary surgeons to understand the biomechanical performances of traditional and new fixation techniques. Furthermore, surgeons may use the numerical results of this analysis to choose a fixation technique based on a patient’s condition. Full article

The high demand for biodegradable implants in bone fracture fixations has dramatically increased the use of polymers for biomedical applications as well. However, the replacement of stainless steel and titanium screws by biodegradable materials represents one of the most critical aspects of biomechanics. In this study, the mechanical behavior of polycaprolactone (PCL) in tension and compression is examined. Driven by the advanced technology of computational mechanics, the fixation of the posterior malleolus fracture has been designed and analyzed. The core idea depicts the static analysis of screws made of PCL fixed in the ankle joint. The focus of the study is on this bio-absorbable, polymer-based material performance under constant compression. Parametric analysis is employed for the optimization of the PCL scaffold. Future studies will focus on the experimental verification of the numerical analysis results. Full article

Osteosynthesis surgery for rib fractures is controversial and challenging. This study developed a noval poly(ε-caprolactone) (PCL)-based biodegradable “cable-tie” fixator for osteosynthesis surgery for rib fractures. A biodegradable fixator specifically for fractured ribs was designed and fabricated by a micro-injection molding machine in our laboratory. The fixator has three belts that could be passed through matching holes individually. The locking mechanism allows the belt movement to move in only one direction. To examine the in vitro biomechanical performance, ribs 3–7 from four fresh New Zealand rabbits were employed. The load to failure and stress-strain curve was compared in the three-point bending test among native ribs, titanium plate-fixed ribs, and PCL fixator-fixed ribs. In the in vivo animal study, the sixth ribs of New Zealand rabbits were osteotomized and osteosynthesis surgery was performed using the PCL fixator. Outcomes were assessed by monthly X-ray examinations, a final micro-computed tomography (CT) scan, and histological analysis. The experimental results suggested that the ribs fixed with the PCL fixator were significantly less stiff than those fixed with titanium plates (p < 0.05). All ribs fixed with the PCL fixators exhibited union. The bridging callus was confirmed by gross, radiographic micro-three-dimensional (3D) CT, and histological examinations. In addition, there was no significant inflammatory response of the osteotomized ribs or the PCL-rib interface during application. The novel PCL fixator developed in this work achieves satisfactory results in osteosynthesis surgery for rib fractures, and may provide potential applications in other orthopedic surgeries. Full article

This clinical study aims to evaluate the stability and efficiency of biodegradable self-reinforced poly-L/DL-lactide (SR-PLDLA) plates and screws for fixation of pediatric mandibular fractures. The study included 12 patients (3–12 years old) with 14 mandibular fractures. They were treated by open reduction and internal fixation by SR-PLDLA plates and screws. Maxillomandibular fixation was maintained for 1 week postoperatively. Clinical follow-up was performed at 1 week, 6 weeks, 3 months, and 12 months postoperatively. Radiographs were done at 1 week, 3 months, and 12 months postoperatively to observe any displacement and fracture healing. All fractures healed both clinically and radiologically. No serious complications were reported in the patients. Normal occlusion was achieved in all cases. Biodegradable osteofixation of mandibular fractures offers a valuable clinical solution for pediatric patients getting the benefit of avoiding secondary surgery to remove plates, decreasing the hospital stay, further painful procedures, and psychological impact. Full article