Dr. med.
Christian Kinast
Dr. med.
Wolfram Reisner
Prof. Dr. med.
Johannes Hamel
Priv.Doz. Dr. med.
Oliver Linhardt
Dr. med.
Michael Olos
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Orthopädisches Anti-Aging
Hallux Valgus
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Das Orthopädiezentrum Arabellapark München, Dr. med. Christian Kinast, Prof. Dr. med. Johannes Hamel und Kollegen wurde am 13.04.2010 nach ISO 9001:2008 für organisatorische Abläufe zertifiziert.
Christian Kinast, M.D., Bouliopoulos Panagiotis, M.D., Johannes Hamel, M.D.
(München, Germany)

Internal Fixation in Forefoot-Surgery with Resorbable Implants

Hypotheses/Purpose: The advantage of resorbable implants over metallic implants is that they need not to be removed. Patients like their x-rays better because resorbable screws are not visible. The goal of this prospective study was to observe patients who underwent internal fixation with lactosorb ( Biomet inc ) screws and pins in forefoot surgery for any side-effects or fixation failure.

Conclusions/Significance: 2.5 mm Lactosorb screw fixation was save in scarf osteotomies. 2.0 mm screws can be used for Weil osteotomy fixation but metallic implants are more stable. Resorption of the implant might have helped to induce infection in one case but other hyperactive resorption processes such as sterile inflammation or bone resorption were not observed. Increased swelling could be a result of resorptive action but so far whether clinical observation nor objective data certifies this possible side effect of resorbable implants. We continue to use this type of resorbable implants. Patients like to have resorbable implants instead of metallic implants.

Summary of Methods/Results: Material and method: Since two years lactosorb implants have been used for fixation of various types of osteotomies: scarf M 1( n = 82)( 2.5 mm screws ) chevron ( n = 16 ) ( 2.5 mm screws ), Akin ( 94 ), distal Weil (54) proximal Weil ( 4) M 5 scarf ( n = 4 ) ( 2.0 mm screws ) and PIP-joints in hammertoes ( n = 95 ) 1.5mm pins.This study will present the prospectively collected clinical and radiological data after 2, 6, 12 weeks 6, 12 month of 100 continuous cases.

Results: Failure of fixation occurred in 2 chevron osteotomies within 3 days after surgery. In the scarf group one heavy male patient showed proximal diaphyseal fracture without failure of resorbable implant fixation. All of the distal Weil osteotomies ( 2.0 lactosorb screws ) healed without dislocation but as compared with metallic implant fixation unusual callus healing in 45% of the cases. M5 scarf healed but one patient had early wound healing disturbances and clear infection after 8 weeks with need of revision and implant removal. The Kitaoka score at 6 month was 90. The total range of motion was 68°.The radiological results showed following results: hallux valgus angle 33°/ 9° (preop/ postop), intermatatarsal angle 13°/ 5 °( maximum 22°), the intermetatarsal distance was decreased from 12 to 7 mm. 96% of the patients were subjectively overall satisfied and would have this type of surgery again.

Quelle: AOFAS

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