Juha Laiho

BIODEGRADABLE IMPLANTS IN FRACTURE FIXATION: EARLY RESULTS OF TREATMENT OF FRACTURES OF THE ANKLE

Biodegradable polylactide-glycolide copolymer implants for fracture fixation were developed and tested in rabbits. In a prospective clinical study 44 patients with a displaced fracture of the ankle were randomly allocated to two groups; one was treated with conventional metallic implants and the other with the biodegradable implants. There were no differences between the two groups in the early results, but the biodegradable fixation method is advantageous because the removal procedure associated with metallic implants is avoided.

Strength and strength retention vitro, of absorbable, self-reinforced polyglycolide (PGA) rods for fracture fixation

The initial shear strength and changes in flexural strength of self-reinforced, absorbable polyglycolide (PGA) composite rods, submerged in distilled water (at 37 degrees C) for a period of 6 wk, were investigated. The recently developed self-reinforced absorbable material consists of an absorbable polymeric matrix reinforced with fibres of the same polymer. The initial shear strength of self-reinforced cylindrical PGA rods with a diameter of 3.2 mm was 250 MPa and the initial flexural strength of the rods was 370 MPa. During the first week of immersion the level of flexural strength decreased very little i.e. to 320 MPa. The loss of flexural strength increased after 1 wk immersion. However, after 3 wk it was 90 MPa. After 5 wk the flexural strength decreased to the level of strength of cancellous bone i.e. 10-20 MPa. The gamma-irradiation of the PGA rods (total dosage 2.5 Mrad) decreased the initial bending strength to 300 MPa but the hydrolytic behaviour of the rods was not changed. The in vitro strength and the strength retention of self-reinforced PGA rods are clearly better than the corresponding values for self-reinforced glycolide/lactide copolymer rods which we developed recently. Self-reinforced PGA rods are now used routinely in Helsinki University Central Hospital in the treatment of certain types of cancellous bone fracture.

The Role of Polyglycolic Acid Rods in the Regeneration of Cartilage from Perichondrium in Rabbits

The role of polyglycolic acid (PGA) rods in the regeneration of cartilage from perichondrium was investigated in 12 growing rabbits. The fifth rib cartilage was resected subperichondrially from both sides. A 10 X 1.5 mm self-reinforced polyglycolic acid (SR-PGA) rod was inserted on one side to replace the resected cartilage and the retained perichondrium was sutured around the implant. On the control side the perichondrium was shaped into a tube without an implant. Samples were taken 4, 12, and 20 weeks after operation. Pronounced neocartilage formation was seen on both sides, and had grown to form a tube around the implant. Also new bone formation was seen in 12 and 20 weeks. Foreign body reaction was seen inside the implants in every animal.

Healing of physeal fracture after fixation with biodegradable self-reinforced polyglycolic acid pins. An experimental study on growing rabbits

Physeal fractures occur at a frequency of 15% of all long bone fractures in children. Undisturbed continued bone growth is the main goal of the treatment of these fractures. After the operative reduction and fixation, whenever needed, a second operation for the removal of the pins is inevitable. The purpose of this study was to develop a biodegradable fixation device for transphyseal fracture fixation, abolishing the need of removal operation. Epiphyseal separation of the distal femoral physis was made on the right side in 18 five-week-old rabbits. The fixation of the physeal fracture was made with two self-reinforced polyglycolic acid (SR-PGA) pins 1mm in nominal diameter and 25mm in length. The follow-up times were 3, 6, 12, 24, and 28 weeks. The distal femoral growth-plate of both femurs was analyzed by radiographic, microradiographic, oxytetracycline-fluorescence, histological and histomorphometric studies. Histomorphometric studies showed normal features of growth. Two growth-plate-penetrating transcondylar SR-PGA implants, of 1mm in diameter, provided sufficient stability for the fixation of a distal femoral physeal fracture in a growing rabbit, and did not cause any growth disturbance.

Remodelling of rabbit rib cartilages with perichondrial flaps and biodegradable implants

Remodelling of rib cartilages using the regenerative potential of perichondrium and self-reinforced polyglycolic acid (SR-PGA) implants was studied in eight growing rabbits. The 5th rib cartilage was resected subperichondrially on both sides and a 10 × 1.1-mm SR-PGA rod was placed inside the perichondrium on one side while the other served as a control. In one-half of the cases the perichondrium was used as a vascularized flap while in the other half it was used as a non-vascularized flap. Samples were taken 6 weeks postoperatively. Neocartilage formation was observed from vascularized as well as non-vascularized flaps.