Refixation of osteochondral fractures by ultrasound-activated, resorbable pins

Neumann, H.; Schulz, Arndt P.; Gille, Justus; Klinger, M.; Jürgens, Christian; Reimers, Nils; Kienast, B.

doi:10.1302/2046-3758.22.2000099

Cited by 8 publications

(4 citation statements)

References 31 publications

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“…Alternative resorbable pins have been developed to overcome the necessity for pin removal and have been introduced onto the market [19,[21][22][23]. For example, biodegradable polymer pins based on polyglycolic acid (PGA), polylactic acid (PLA) and other homopolymers and copolymers have been studied to replace titanium devices [24,25]. Additionally, pins obtained from decellularized human or bovine cortical bone have been described [19].…”

Section: Introductionmentioning

confidence: 99%

Biocompatibility Analyses of HF-Passivated Magnesium Screws for Guided Bone Regeneration (GBR)

Jung

Hesse²,

Stojanović

et al. 2021

IJMS

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Background: Magnesium (Mg) is one of the most promising materials for human use in surgery due to material characteristics such as its elastic modulus as well as its resorbable and regenerative properties. In this study, HF-coated and uncoated novel bioresorbable magnesium fixation screws for maxillofacial and dental surgical applications were investigated in vitro and in vivo to evaluate the biocompatibility of the HF coating. Methods: Mg alloy screws that had either undergone a surface treatment with hydrofluoric-acid (HF) or left untreated were investigated. In vitro investigation included XTT, BrdU and LDH in accordance with the DIN ISO 10993-5/-12. In vivo, the screws were implanted into the tibia of rabbits. After 3 and 6 weeks, degradation, local tissue reactions and bony integration were analyzed histopathologically and histomorphometrically. Additionally, SEM/EDX analysis and synchrotron phase-contrast microtomography (µCT) measurements were conducted. The in vitro analyses revealed that the Mg screws are cytocompatible, with improved results when the surface had been passivated with HF. In vivo, the HF-treated Mg screws implanted showed a reduction in gas formation, slower biodegradation and a better bony integration in comparison to the untreated Mg screws. Histopathologically, the HF-passivated screws induced a layer of macrophages as part of its biodegradation process, whereas the untreated screws caused a slight fibrous tissue reaction. SEM/EDX analysis showed that both screws formed a similar layer of calcium phosphates on their surfaces and were surrounded by bone. Furthermore, the µCT revealed the presence of a metallic core of the screws, a faster absorbing corrosion front and a slow absorbing region of corroded magnesium. Conclusions: Overall, the HF-passivated Mg fixation screws showed significantly better biocompatibility in vitro and in vivo compared to the untreated screws.

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Section: Introductionmentioning

confidence: 99%

Biocompatibility Analyses of HF-Passivated Magnesium Screws for Guided Bone Regeneration (GBR)

Jung

Hesse²,

Stojanović

et al. 2021

IJMS

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“…The ultrasonic signal of high frequency and low amplitude is applied resulting in a local melting of the pin tip. Tissue damage because of the heat impact could not be found [ 23 , 30 ]. The liquefied polymer flows out of the perforation in the screw and fills the lacunae of the cancellous bone (Figure 2 ).…”

Section: Methodsmentioning

confidence: 99%

Osteosynthesis-screw augmentation by ultrasound-activated biopolymer - an ovine in vivo study assessing biocompatibility and bone-to-implant contact

Neumann

Breer

Reimers

et al. 2015

Journal of Orthopaedic Surgery and Research

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ObjectivesScrew fixation and fragment anchoring in osteoporotic bones is often difficult. Problems like the cut out phenomenon and implant migration in osteoporotic bones have been reported. One possibility of improving the anchoring force of screws is augmentation of the screw. Cement-augmented screws in spinal surgery could exhibit a better anchoring in osteoporotic bones.MethodsThe purpose of this study was to examine the effect of screw augmentation using a resorbable polymer. Ultrasound-activated biodegradable pins were used for the purpose of a resorbable augmentation technique. Cannulated screws were inserted into the femur of 12 sheep and augmented by an ultrasound-activated polylactic acid (PLDLA) pin. In a paired approach, four screws were implanted in each animal: 2× a 10-mm thread and 2× a 20-mm thread, both of which were augmented with polymer. Both screws, named A and B, were also applied without augmentation (control group) and implanted into the contralateral hind limb. After 4, 8, and 12 weeks, the sheep were euthanized and a macroscopical and histological examination followed.ResultsThe polymer spread well out of the screws into the cancellous lacunae. Around the polymer, the peripheral bone showed signs of healthy and active bone tissue. No evidence of inflammation or infection was observed. The boneto-implant contact was significantly higher in the augmented screws. Biocompatibility was proven in histopathological examination. After 12 weeks, no pathological changes were found.ConclusionUltrasound-activated polymer augmentation of cannulated screws may improve the anchoring in osteoporotic bone.Article focusCan screw augmentation using a resorbable polymer improve the bone-to-implant contact in case of screw osteosynthesis?Is there any effect on the surrounding tissue by the induced temperature and liquefied polymer?Can biocompatibility be proven by this new osteosynthesis?Key messagesScrew augmentation by ultrasound-activated biopolymer leads to a significant higher bone-to-implant contact than pure screw osteosynthesis.No tissue damage could be observed by the application of the SonicFusion™.Strength and limitations of this studyThe ovine in vivo study concept can simulate physiological conditions.First examination of screw augmentation by ultrasound-activated biopolymer.No biomechanical testing of the higher bone-to-implant contact by now.

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“…The aim of this study was the radiological assessment of refixated osteochondral fragments by CT and scanning electron microscopy. The good biocompatibility concerning a possible heat damage of cartilage surfaces of the SonicPin™ system could be stated by another study [ 19 ]. To evaluate whether an ultrasound-activated pin (SonicPin™, Stryker, Schönkirchen, Germany) could safely refixate an osteochondral fragment under physiological conditions, 16 merino sheep were operated.…”

Section: Introductionmentioning

confidence: 97%

Refixation of Osteochondral Fractures by an Ultrasound-Activated Pin System – An Ovine In Vivo Examination Using CT and Scanning Electron Microscope

Neumann¹,

A.P

Breer³

et al. 2015

TOORTHJ

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Background: Osteochondral injuries, if not treated appropriately, often lead to severe osteoarthritis of the affected joint. Without refixation of the osteochondral fragment, human cartilage only repairs these defects imperfectly. All existing refixation systems for chondral defects have disadvantages, for instance bad MRI quality in the postoperative follow-up or low anchoring forces. To address the problem of reduced stability in resorbable implants, ultrasound-activated pins were developed. By ultrasound-activated melting of the tip of these implants a higher anchoring is assumed. Aim of the study was to investigate, if ultrasound-activated pins can provide a secure refixation of osteochondral fractures comparing to conventional screw and conventional, resorbable pin osteosynthesis. CT scans and scanning electron microscopy should proovegood refixation results with no further tissue damage by the melting of the ultrasound-activated pins in comparison to conventional osteosynthesis.Methods: Femoral osteochondral fragments in sheep were refixated with ultrasound-activated pins (SonicPin™), Ethipins® and screws (Asnis™). The quality of the refixated fragments was examined after three month of full weight bearing by CT scans and scanning electron microscopy of the cartilage surface.Results: The CT examination found almost no statistically significant difference in the quality of refixation between the three different implants used. Concerning the CT morphology, ultrasound-activated pins demonstrated at least the same quality in refixation of osteochondral fragments as conventional resorbable pins or screws. The scanning electron microscopy showed no major surface damage by the three implants, especially any postulated cartilage damage induced by the heat of the ultrasound-activated pin. The screws protruded above the cartilage surface, which may affect the opposingtibial surface.Conclusion: Using CT scans and scanning electron microscopy, the SonicPin™, the Ethipin® and screws were at least equivalent in refixation quality of osteochondral fragments.

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Refixation of osteochondral fractures by ultrasound-activated, resorbable pins

Cited by 8 publications

References 31 publications

Biocompatibility Analyses of HF-Passivated Magnesium Screws for Guided Bone Regeneration (GBR)

Biocompatibility Analyses of HF-Passivated Magnesium Screws for Guided Bone Regeneration (GBR)

Osteosynthesis-screw augmentation by ultrasound-activated biopolymer - an ovine in vivo study assessing biocompatibility and bone-to-implant contact

Refixation of Osteochondral Fractures by an Ultrasound-Activated Pin System – An Ovine In Vivo Examination Using CT and Scanning Electron Microscope

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