Principles of Development and Use of Absorbable Internal Fixation

Abstract

Absorbable internal fixation implants, by virtue of their temporary in situ residence and variable load sharing with the healing tissues, have the potential to yield a clinical outcome that approaches the native state. Despite the growing availability and acceptance of absorbable fixation, however, many surgeons continue to rely upon metal fixation for their patients, due, in part, to unfamiliarity with the technology. Although many of the principles of metallic internal fixation also apply to absorbable internal fixation, significant differences exist as well. This paper presents basic background in absorbable technology and proposes a set of principles that may help govern the development and use of absorbable fixation devices in clinical practice.

Tissue response to partially in vitro predegraded poly-L-lactide implants

“…Polylactide (PLA) and polyglycolide (PGA) acid are the most commonly used biodegradable (co)polymers in surgery especially in osteosynthesis [1][2][3][4], and in general are considered safe for clinical use [5], although unexpected phenomena such as long degradation periods are not uncommon [6,7]. The aim for the use of these degradable polymers is the prevention of repeated surgery for the patient.…”

Comparison of the biomechanics and histology of two soft‐tissue fixators composed of bioabsorbable copolymers

“…Ideally, a bioabsorbable fixation system should lose strength in concert with the increase in strength of the healing union. 38 If the implant loses strength too quickly relative to healing, then fixation might be compromised. If it degrades too slowly, then long-term implant biocompatibility might be an issue, as well as there might be protracted mechanical protection of the repair site, perhaps reducing the mechanical stimulus for remodeling.…”

Perspectives on Resorbable Osteosynthesis Materials in Craniomaxillofacial Surgery

“…The absorption of these polymers begins with depolymerization through the hydrolysis of their ester bonds and subsequent metabolism, probably by macrophages, in the citric acid cycle into water and carbon dioxide [11] .…”

“…Most of these complications are long-term sequelae [33] . The negative reactions to poly(α-hydroxy acid) polymers seem to be caused by the degradation process of the polymers [11] and subsequent changes in the tissue surrounding the materials. After EtO sterilization, toxic or possibly carcinogenic gas residues are emitted by these polymers, which could leak out as residual monomers or other additives.…”