Absorbable Screws Versus Metallic Screws for Distal Tibiofibular Syndesmosis Injuries: A Meta-Analysis

Xie, Yi; Cai, Lin; Deng, Zhouming; Ran, Bing; Hu, Chao

doi:10.1053/j.jfas.2015.03.010

Cited by 16 publications

(6 citation statements)

References 25 publications

(54 reference statements)

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“…Xie et al in a recent meta-analysis reported a greater incidence of tissue response when absorbable syndesmotic screws were applied instead of metallic ones (N = 1.208, p < 0.001). Although the reoperation rate was higher after introduction of metallic implants, the functional outcome was similar in both groups [22].…”

Section: Discussionmentioning

confidence: 77%

Does the Inion OTPS^TM absorbable plating system induce higher foreign-body reaction than titanium implants? An experimental randomized comparative study in rabbits

et al. 2020

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Hardware removal after complete fracture healing is a laborious and traumatic procedure that bears the risks of refracture, infection, and soft tissue damage. Absorbable materials for fracture fixation have the advantage of eliminating the need for removal; however, they may stimulate a considerable inflammatory response. For that reason, we compared in a prospective randomized experimental animal model study the incidence of foreign-body reactions between Inion OTPSTM absorbable plate implants, consisting of carbon trimethylene, L-polylactic acid, and D, L-polylactic acid, and conventional titanium plates. Seventy rabbits were equally divided into two groups. Titanium (Group A) or absorbable (Group B) plates and screws were implanted in the femoral shaft of the rabbits. Wound reaction and laboratory tests including white blood cell count (WBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) values were measured and compared at different time points. Radiographs and histological analysis of tissue samples from all animals were also used to identify potential foreign-body reactions. WBC showed normal values in both groups. In Group A, ESR levels were higher at all time points but CRP values were normalized at 3 weeks postoperatively. In Group B, ESR and CRP levels reached a peak at 3 weeks and were above normal values throughout the whole experiment (p < 0.001). Radiologic examination revealed periosteal thickening and surrounding sclerosis in 23 out of 35 animals of Group B (66%). All Group A animals had normal radiographic findings. Histopathology showed a typical non-specific foreign-body reaction in all animals in Group B (100%) but none in Group A. However, only four of them (11.8%) developed non-infected wound complications and showed significantly elevated CRP and ESR values (p = 0.054). Although Inion OTPSTM Biodegradable Plating System stimulates a foreign-body reaction, only a small but not negligible percentage of almost 12% may lead to wound problems. However, this difference compared to titanium plates was of borderline not statistically significant. Future studies should focus on the development of absorbable implants with improved biocompatibility aiming to further decrease the potential of foreign-body reaction and eliminate the need for additional reoperative procedures.

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Section: Discussionmentioning

confidence: 77%

Does the Inion OTPS^TM absorbable plating system induce higher foreign-body reaction than titanium implants? An experimental randomized comparative study in rabbits

et al. 2020

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“…4 However, these ossifications can be difficult to detect as they can form years after injury or surgery. 5 Often times if these ossifications become symptomatic they warrant surgical intervention to correct them. 4 These interventions often involve removal of surgical hardware and the associated ossification.…”

Section: Discussionmentioning

confidence: 99%

Fracture of a Heterotopic Ossification of the Syndesmosis in a Collegiate Football Player: A Case Report

Cage

Warner

Gallegos

2019

JSMAHS

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Objective: Present a clinical case detailing the assessment and management of a collegiate football player suffering from the fracturing of a heterotopic ossification of the syndesmosis. Background: Heterotopic ossifications are not uncommon following surgical fixation of the tibiofibular syndesmosis. Typically, properly healed fibular fractures do not result in further complications associated with heterotopic ossification. Treatment: A 21-year-old collegiate football player (1.8 m, 77.1 kg) reported to the athletic training staff complaining of acute lateral ankle pain following a plant and twist mechanism while running receiving routes. Initial evaluation led to a diagnosis of a syndesmotic ankle sprain, with a plan to pursue conservative management. When patient was unable to participate in the following practice due to intensity of pain, the patient was referred for x-rays a revealed poorly healed Weber Type C fracture that had been mislabeled as a Maisonneuve fracture at the patient’s previous university. This previous injury led to a heterotopic ossification of the syndesmosis that had fractured during the more recent injury. With this new diagnosis, the patient consented to conservative treatment that allowed the patient to return to football activities the following offseason. Uniqueness: While heterotopic ossification of the ankle syndesmosis has been reported in literature, there has yet to be extensive research on the condition. Generally, when these ossifications become symptomatic best practices involve surgical removal. In spite of presenting with symptoms, the patient was able to return to full participation following conservative treatment. Conclusion: When providing patient care, accurate diagnosis is crucial to optimal outcomes. Caring for patients in a collegiate setting presents a unique number of instances of patient care transfer, which may make previous misdiagnosis hard to recognize. Diligent health care practitioners should always ensure that a comprehensive medical history is obtained in order to make an accurate assessment.

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“…Absorbable screws are synthesized by polylactic acid, which degrades in vivo, resulting in no need for a second operation for screw removal. Nevertheless, it has not been widely used in clinical practice, because the biomechanical strength of polylactic acid is not as great as that of the metal implant (21). Recently, the use of Endobutton (Smith & Nephew, Jericho, NY) fixation has been rapidly increasing.…”

Section: Discussionmentioning

confidence: 99%

Novel Elastic Syndesmosis Hook Plate Fixation Versus Routine Screw Fixation for Syndesmosis Injury

Xian

Miao

Zhou

et al. 2018

The Journal of Foot and Ankle Surgery

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Unstable external-rotation type ankle fractures with concomitant syndesmosis injury commonly occur. Syndesmosis screw fixation has long been regarded as a reference standard treatment for syndesmosis injury. However, its complications and biomechanical disadvantages have become controversial; thus, we designed a novel elastic syndesmosis hook plate (ESHP) that combines the features of both rigidity and flexibility. The purpose of the present study was to introduce this new method and compare its clinical outcomes with those of routine screw fixation. We randomized 25 patients to the screw fixation group and ESHP group. The average follow-up period was 12 months. The clinical outcomes included malreduction or loss of reduction, overall complications, and function. During the follow-up period, 3 cases (25%) of malreduction were found in screw fixation group on postoperative computed tomography. In the ESHP group, only 1 patient (7.69%) had a narrowed anterior gap between the distal tibia and fibula. However, the difference in the malreduction rate between the 2 groups was not significant statistically (p = .32). The overall complication rate in the ESHP group was lower than that in the screw group, although no significant differences were found between the 2 groups. The mean visual analog scale scores in the ESHP and screw groups were 1.46 ± 1.33 and 2.42 ± 2.07, respectively. The average dorsiflexion range of motion in both groups was satisfactory (14.77° versus 12.83°; p = .16). However, a statistically significant difference was found in the plantarflexion range of motion between the 2 groups (p < .05). In addition, the ESHP group had an earlier time to return to work (p < .05). The ESHP fixation construct can stably fix syndesmosis, retain the physiologic micromotion function of the syndesmosis, and results in fewer complications compared with routine syndesmosis screw fixation for syndesmotic instability. In conclusion, our results have shown ESHP to be a viable method for treatment of syndesmosis instability.

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Absorbable Screws Versus Metallic Screws for Distal Tibiofibular Syndesmosis Injuries: A Meta-Analysis

Cited by 16 publications

References 25 publications

Does the Inion OTPS^TM absorbable plating system induce higher foreign-body reaction than titanium implants? An experimental randomized comparative study in rabbits

Does the Inion OTPS^TM absorbable plating system induce higher foreign-body reaction than titanium implants? An experimental randomized comparative study in rabbits

Fracture of a Heterotopic Ossification of the Syndesmosis in a Collegiate Football Player: A Case Report

Novel Elastic Syndesmosis Hook Plate Fixation Versus Routine Screw Fixation for Syndesmosis Injury

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Absorbable Screws Versus Metallic Screws for Distal Tibiofibular Syndesmosis Injuries: A Meta-Analysis

Cited by 16 publications

References 25 publications

Does the Inion OTPSTM absorbable plating system induce higher foreign-body reaction than titanium implants? An experimental randomized comparative study in rabbits

Does the Inion OTPSTM absorbable plating system induce higher foreign-body reaction than titanium implants? An experimental randomized comparative study in rabbits

Fracture of a Heterotopic Ossification of the Syndesmosis in a Collegiate Football Player: A Case Report

Novel Elastic Syndesmosis Hook Plate Fixation Versus Routine Screw Fixation for Syndesmosis Injury

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Does the Inion OTPS^TM absorbable plating system induce higher foreign-body reaction than titanium implants? An experimental randomized comparative study in rabbits

Does the Inion OTPS^TM absorbable plating system induce higher foreign-body reaction than titanium implants? An experimental randomized comparative study in rabbits