Skip to main content
SpringerLink
Log in

Bioabsorbable screw fixation for the treatment of ankle fractures

  • Original article
  • Published:
Journal of Orthopaedic Science

Abstract

Background

Self-reinforced poly(l/dl)lactide 70:30 (SR-PLA70) retains its strength in bone for 24 weeks, whereas self-reinforced poly-l-lactide (SR-PLLA) retains its strength for over 36 weeks. In this prospective randomized study, bioabsorbable 4.5-mm SR-PLA70 screws were compared with SR-PLLA screws in the treatment of displaced ankle fractures in adults.

Methods

Sixty-two patients with ankle fractures needing operative treatment were randomized into two groups. Comminuted fractures needing plating were excluded. In total 54 of 62 patients were followed up for 1 year by clinical evaluation, radiographs, and Olerud-Molander score.

Results

The study groups differed significantly only in the mean duration of sick leave (SR-PLA70, 60 days; SR-PLLA, 65 days; P = 0.02). At the 1-year follow-up, syndesmotic ossification was more common in the SR-PLA70 group (5 versus 1 patient, not significant). Radiologically, the screw channel had not disappeared in any of the patients by the 1-year follow-up.

Conclusions

Both implant types proved to have good biocompatibility. SR-PLA70 and SR-PLLA screws are suitable in selected cases for the fixation of ankle fractures, but the mechanical stability of the fixation has to be carefully monitored perioperatively.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. P Rokkanen O Böstman S Vainionpää K Vihtonen P Törmälä J Laiho et al. (1985) ArticleTitleBiodegradable implants in fracture fixation: early results of treatment of fractures of the ankle Lancet 22 1422–4 10.1016/S0140-6736(85)91847-1 Occurrence Handle10.1016/S0140-6736(85)91847-1

    Article  Google Scholar 

  2. PU Rokkanen O Böstman E Hirvensalo EA Mäkelä EK Partio H Pätiälä et al. (2000) ArticleTitleBioabsorbable fixation in orthopaedic surgery and traumatology Biomaterials 21 2607–13 10.1016/S0142-9612(00)00128-9 Occurrence Handle10.1016/S0142-9612(00)00128-9 Occurrence Handle1:CAS:528:DC%2BD3cXmvFylsLo%3D Occurrence Handle11071610

    Article  CAS  PubMed  Google Scholar 

  3. WD Hovis BW Kaiser JT Watson RW Bucholz (2002) ArticleTitleTreatment of syndesmotic disruptions of the ankle with bioabsorbable screw fixation J Bone Joint Surg Am 84 26–31 Occurrence Handle11792776

    PubMed  Google Scholar 

  4. ST Sauer J Marymont MS Mizel (2004) ArticleTitleWhat's new in foot and ankle surgery? J Bone Joint Surg Am 86 878–86 Occurrence Handle15069165

    PubMed  Google Scholar 

  5. JD Michelson (2003) ArticleTitleAnkle fractures resulting from rotational injuries J Am Acad Orthop Surg 11 403–12 Occurrence Handle14686825

    PubMed  Google Scholar 

  6. EK Partio (1992) Absorbable screws in the fixation of cancellous bone fractures and arthrodeses. A clinical study of 318 patients A doctoral thesis Helsinki University Helsinki

    Google Scholar 

  7. IP Sinisaari PM Lüthje RM Mikkonen (2002) ArticleTitleRuptured tibio-fibular syndesmosis: comparison study of metallic to bioabsorbable fixation Foot Ankle Int 23 744–8 Occurrence Handle12199389

    PubMed  Google Scholar 

  8. DB Thordarson M Samuelson LE Shepherd PF Merkle J Lee (2001) ArticleTitleBioabsorbable versus stainless steel screw fixation of the syndesmosis in pronation-lateral rotation ankle fractures: a prospective randomized trial Foot Ankle Int 22 335–8 Occurrence Handle1:STN:280:DC%2BD3M3lsFyntA%3D%3D Occurrence Handle11354448

    CAS  PubMed  Google Scholar 

  9. WD Hovis RW Bucholz (1997) ArticleTitlePolyglycolide bioabsorbable screws in the treatment of ankle fractures Foot Ankle Int 18 128–31 Occurrence Handle1:STN:280:DyaK2s3jtFSqtA%3D%3D Occurrence Handle9116891

    CAS  PubMed  Google Scholar 

  10. O Böstman H Pihlajamäki (2000) ArticleTitleClinical biocompatibility of biodegradable orthopaedic implants for internal fixation: a review Biomaterials 21 2615–21 10.1016/S0142-9612(00)00129-0 Occurrence Handle10.1016/S0142-9612(00)00129-0 Occurrence Handle11071611

    Article  PubMed  Google Scholar 

  11. A Joukainen H Pihlajamäki EA Mäkelä N Ashammakhi J Viljanen H Pätiälä et al. (2000) ArticleTitleStrength retention of self-reinforced drawn poly-l/dl-lactide 70/30 (SR-PLA70) rods and fixation properties of distal femoral osteotomies with these rods. An experimental study on rats J Biomater Sci Polym Ed 11 1411–28 10.1163/156856200744318 Occurrence Handle10.1163/156856200744318 Occurrence Handle1:STN:280:DC%2BD3M7mtVKitA%3D%3D Occurrence Handle11261881

    Article  CAS  PubMed  Google Scholar 

  12. SM Perren (2002) ArticleTitleEvolution of the internal fixation of long bone fractures: the scientific basis of biological internal fixation: choosing a new balance between stability and biology J Bone Joint Surg Br 84 1093–110 10.1302/0301-620X.84B8.13752 Occurrence Handle10.1302/0301-620X.84B8.13752 Occurrence Handle12463652

    Article  PubMed  Google Scholar 

  13. HK Uhthoff P Poitras DS Backman (2006) ArticleTitleInternal plate fixation of fractures: short history and recent developments J Orthop Sci 11 118–26 10.1007/s00776-005-0984-7 Occurrence Handle10.1007/s00776-005-0984-7 Occurrence Handle16568382

    Article  PubMed  Google Scholar 

  14. T Pohjonen P Helevirta P Törmälä K Koskikare H Pätiälä P Rokkanen (1997) ArticleTitleStrength retention of self-reinforced poly-l-lactide screws. A comparison of compression moulded and machine cut screws J Mater Sci Mater Med 8 311–20 10.1023/A:1018516529591 Occurrence Handle10.1023/A:1018516529591 Occurrence Handle1:CAS:528:DyaK2sXjtF2is7s%3D Occurrence Handle15348754

    Article  CAS  PubMed  Google Scholar 

  15. LE Claes AA Ignatius KE Rehm C Scholz (1996) ArticleTitleNew bioresorbable pin for the reduction of small bony fragments: design, mechanical properties and in vitro degradation Biomaterials 17 1621–6 10.1016/0142-9612(95)00327-4 Occurrence Handle10.1016/0142-9612(95)00327-4 Occurrence Handle1:CAS:528:DyaK28XkvFWis70%3D Occurrence Handle8842367

    Article  CAS  PubMed  Google Scholar 

  16. AA Ignatius LE Claes (1996) ArticleTitleIn vitro biocompatibility of bioresorbable polymers: poly(l, dl-lactide) and poly(l-lactide-co-glycolide) Biomaterials 17 831–9 10.1016/0142-9612(96)81421-9 Occurrence Handle10.1016/0142-9612(96)81421-9 Occurrence Handle1:CAS:528:DyaK28XisFCku74%3D Occurrence Handle8730968

    Article  CAS  PubMed  Google Scholar 

  17. A Prokop A Jubel HJ Helling T Eibach C Peters SE Baldus et al. (2004) ArticleTitleSoft tissue reactions of different biodegradable polylactide implants Biomaterials 25 259–67 10.1016/S0142-9612(03)00496-4 Occurrence Handle10.1016/S0142-9612(03)00496-4 Occurrence Handle1:CAS:528:DC%2BD3sXotlynsLo%3D Occurrence Handle14585713

    Article  CAS  PubMed  Google Scholar 

  18. I Kallela RM Tulamo J Hietanen T Pohjonen R Suuronen C Lindqvist (1999) ArticleTitleFixation of mandibular body osteotomies using biodegradable amorphous self-reinforced (70l:30dl) polylactide or metal screws: an experimental study in sheep J Craniomaxillofac Surg 27 124–33 Occurrence Handle1:STN:280:DyaK1M3ntlKqtQ%3D%3D Occurrence Handle10342151

    CAS  PubMed  Google Scholar 

  19. NH Voutilainen K Jukkala-Partio PU Rokkanen (2002) ArticleTitleArthrodesis of the first metatarsophalangeal joint in patients with rheumatoid arthritis with bioabsorbable self-reinforced poly(l/dl)lactide 70:30 screw fixation — a preliminary report Foot 12 233–41 10.1016/S0958259202000731 Occurrence Handle10.1016/S0958259202000731

    Article  Google Scholar 

  20. BG Weber C Colton (1991) Malleolar fractures ME Muller M Allgöwer R Schneider H Willenegger (Eds) Manual of internal fixation Springer Berlin 595–612

    Google Scholar 

  21. C Olerud H Molander (1986) ArticleTitleBi- and trimalleolar ankle fractures operated with nonrigid internal fixation Clin Orthop 206 253–60 Occurrence Handle3086009

    PubMed  Google Scholar 

  22. J Kankare EK Partio E Hirvensalo O Böstman P Rokkanen (1996) ArticleTitleBiodegradable self-reinforced polyglycolide screws and rods in the fixation of displaced malleolar fractures in the elderly. A comparison with metallic implants Ann Chir Gynaecol 85 263–70 Occurrence Handle1:STN:280:DyaK2s7gslOisg%3D%3D Occurrence Handle8950450

    CAS  PubMed  Google Scholar 

  23. NH Voutilainen MW Hess TS Toivonen LA Krogerus EK Partio HV Pätiälä (2002) ArticleTitleA long-term clinical study on dislocated ankle fractures fixed with self-reinforced polylevolactide (SR-PLLA) implants J Long Term Eff Med Implants 12 35–52 Occurrence Handle12096641

    PubMed  Google Scholar 

  24. K Jukkala-Partio EK Partio P Helevirta T Pohjonen P Törmälä P Rokkanen (2000) ArticleTitleTreatment of subcapital femoral neck fractures with bioabsorbable or metallic screw fixation. A preliminary report Ann Chir Gynaecol 89 45–52 Occurrence Handle1:STN:280:DC%2BD3c3ltVartg%3D%3D Occurrence Handle10791645

    CAS  PubMed  Google Scholar 

  25. SK Kim JK Oh (1999) ArticleTitleOne or two lag screws for fixation of Danis-Weber type B fractures of the ankle J Trauma 46 1039–44 10.1097/00005373-199906000-00010 Occurrence Handle10.1097/00005373-199906000-00010 Occurrence Handle1:STN:280:DyaK1M3pvFygtA%3D%3D Occurrence Handle10372621

    Article  CAS  PubMed  Google Scholar 

  26. OM Böstman (1993) ArticleTitleDistal tibiofibular synostosis after malleolar fractures treated using absorbable implants Foot Ankle 14 38–43 Occurrence Handle8381109

    PubMed  Google Scholar 

  27. GHR Albers AFCC de Kort PRJM Middendorf CN Van Dijk (1996) ArticleTitleDistal tibiofibular synostosis after ankle fracture: a 14-year follow-up study J Bone Joint Surg Br 78 250–2 Occurrence Handle1:STN:280:DyaK283gvFCmuw%3D%3D Occurrence Handle8666636

    CAS  PubMed  Google Scholar 

  28. K Jukkala-Partio O Laitinen J Vasenius EK Partio T Toivonen P Tervahartiala et al. (2002) ArticleTitleHealing of subcapital femoral osteotomies fixed with self-reinforced poly-l-lactide screws: an experimental long-term study in sheep Arch Orthop Trauma Surg 122 360–4 Occurrence Handle12136303

    PubMed  Google Scholar 

  29. J Viljanen (2003) Comparison of absorbable self-reinforced polylevo-lactide and metallic devices in the fixation of femoral osteotomies: an experimental study on rabbits and rats. Academic dissertation Helsinki University Helsinki

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, Kuopio University Hospital, P.O. Box 1777, FIN-70211, Kuopio, Finland

    Antti Joukainen, Jaakko Joukainen, Heikki Kröger & Pertti Törmälä

  2. Department of Surgery, Iisalmi District Hospital, Iisalmi, Finland

    Antti Joukainen

  3. Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland

    Esa K. Partio & Pentti Rokkanen

  4. Department of Surgery, St Michel Central Hospital, Mikkeli, Finland

    Pekka Waris

  5. Department of Surgery, Lappeenranta Central Hospital, Lappeenranta, Finland

    Jaakko Joukainen

  6. Department of Surgery, Bone and Cartilage Research Unit, University of Kuopio, Kuopio, Finland

    Heikki Kröger

  7. Institute of Biomaterials, Tampere University of Technology, Tampere, Finland

    Pertti Törmälä

Authors
  1. Antti Joukainen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Esa K. Partio
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Pekka Waris
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jaakko Joukainen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Heikki Kröger
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Pertti Törmälä
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Pentti Rokkanen
    View author publications

    You can also search for this author in PubMed Google Scholar

About this article

Cite this article

Joukainen, A., Partio, E., Waris, P. et al. Bioabsorbable screw fixation for the treatment of ankle fractures. J Orthop Sci 12, 28–34 (2007). https://doi.org/10.1007/s00776-006-1077-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00776-006-1077-y

Keywords

Search

Navigation