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Prospective evaluation of ultrasound features of magnesium-based bioabsorbable screw resorption in pediatric fractures

  • Ultrasound
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Abstract

Objective

Bioabsorbable magnesium-based alloy screws release gas upon resorption. The resulting findings in the adjacent soft tissues and joints may mimic infection. The aim of the study was to evaluate the ultrasound (US) findings in soft tissues and joints during screw resorption.

Methods

Prospectively acquired US studies from pediatric patients treated with magnesium screws were evaluated for screw head visibility, posterior acoustic shadowing, twinkling artifact, foreign body granuloma, gas (soft tissue, intra-articular), alterations of the skin and subcutaneous fat, perifascial fluid, localized fluid collections, hypervascularization, and joint effusion.

Results

Sixty-six US studies of 28 pediatric patients (nfemale = 9, nmale = 19) were included. The mean age of the patients at the time of surgery was 10.84 years; the mean time between surgery and ultrasound was 128.3 days (range = 6–468 days). The screw head and posterior acoustic shadowing were visible in 100% of the studies, twinkling artifact in 6.1%, foreign body granuloma in 92.4%, gas locules in soft tissue in 100% and intra-articular in 18.2%, hyperechogenicity of the subcutaneous fat in 90.9%, cobblestoning of the subcutaneous fat in 24.2%, loss of normal differentiation between the epidermis/dermis and the subcutaneous fat in 57.6%, localized fluid collection in 9.9%, perifascial fluid in 12.1%, hypervascularization in 27.3%, and joint effusion in 18.2%.

Conclusion

US findings in pediatric patients treated with magnesium screws strongly resemble infection, but are normal findings in the setting of screw resorption.

Clinical relevance statement

Bioabsorbable magnesium-based alloy screws release gas during resorption. The resulting US findings in the adjacent soft tissues and joints in pediatric patients may mimic infection, but are normal findings.

Key Points

• Bioabsorbable magnesium-based alloy screws release gas upon resorption.

• The resulting ultrasound findings in children’s soft tissues and joints closely resemble those of soft tissue infection or osteosynthesis-associated infection.

• Be familiar with these ultrasound findings in order to avoid inadvertently misdiagnosing a soft tissue infection or osteosynthesis-associated infection.

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Abbreviations

GLM:

Generalized linear model

MHz:

Megahertz

MRI:

Magnetic resonance imaging

US:

Ultrasound

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Acknowledgements

We thank Evelyn Wirth and Kathleen Rüger for their excellent support.

Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Radiology and Nuclear Medicine, Children’s Hospital of Eastern Switzerland, Claudiusstrasse 6, 9006, St. Gallen, Switzerland

    Stephan L. Waelti, Jozef Fandak & Stefan Markart

  2. Department of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland

    Stephan L. Waelti, Jozef Fandak, Stefan Markart, Simon Wildermuth, Tim Fischer & Tobias J. Dietrich

  3. Clinical Trials Unit, Biostatistics, Cantonal Hospital St. Gallen, St. Gallen, Switzerland

    Erik P. Willems

  4. Department of Pediatric Surgery, Children’s Hospital of Eastern Switzerland, St. Gallen, Switzerland

    Christoph Matissek & Thomas Krebs

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  1. Stephan L. Waelti
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Correspondence to Stephan L. Waelti.

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Guarantor

The scientific guarantor of this publication is Stephan L. Waelti.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Erik P. Willems, one of the authors, has significant statistical expertise (Cantonal Hospital St. Gallen, Clinical Trials Unit, Biostatistics, St. Gallen, Switzerland).

Informed consent

Written informed consent was obtained from the patients themselves (if 14 years of age or older) or their parents.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in Waelti, S.L., et al, Radiographic features of magnesium-based bioabsorbable screw resorption in paediatric fractures. Pediatr Radiol, 2022.

The patients prospectively examined by ultrasound in the present study were examined by radiographs during normal fracture follow-up. In this previous study, the radiographs were evaluated retrospectively. The study included 35 patients, including the 28 patients included in the present ultrasound study.

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• prospective

• observational

• performed at one institution

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Waelti, S.L., Fandak, J., Markart, S. et al. Prospective evaluation of ultrasound features of magnesium-based bioabsorbable screw resorption in pediatric fractures. Eur Radiol 34, 1556–1566 (2024). https://doi.org/10.1007/s00330-023-10091-7

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