Radiolucent zones of biodegradable magnesium-based screws in children and adolescents-a radiographic analysis

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

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.

High Complication Rate and High Percentage of Regressing Radiolucency in Magnesium Screw Fixation in 18 Consecutive Patients

(1) Background: Magnesium-based implants use has become a research focus in recent years. Radiolucent areas around inserted screws are still worrisome. The objective of this study was to investigate the first 18 patients treated using MAGNEZIX^® CS screws. (2) Methods: This retrospective case series included all 18 consecutive patients treated using MAGNEZIX^® CS screws at our Level-1 trauma center. Radiographs were taken at 3-, 6- and 9-month follow-ups. Osteolysis, radiolucency and material failure were assessed, as were infection and revision surgery. (3) Results: Most patients (61.1%) had surgery in the shoulder region. Radiolucency regressed from 55.6% at 3-month follow-ups to 11.1% at 9-month follow-ups. Material failure occurred in four patients (22.22%) and infection occurred in two patients, yielding a 33.33% complication rate. (4) Conclusion: MAGNEZIX^® CS screws demonstrated a high percentage of radiolucency that regressed and seems to be clinically irrelevant. The material failure rate and infection rate require further research.

Corrosion Behavior and Biocompatibility of Hot-Extruded Mg-Zn-Ga-(Y) Biodegradable Alloys

Fixation screws and other temporary magnesium alloy fixation devices are used in orthopedic practice because of their biodegradability, biocompatibility and acceptable biodegradation rates. The substitution of dissolving implant by tissues during the healing process is one of the main requirements for biodegradable implants. Previously, clinical tests showed the effectiveness of Ga ions on bone tissue regeneration. This work is the first systematic study on the corrosion rate and biocompatibility of Mg-Zn-Ga-(Y) alloys prepared by hot extrusion, where Ga is an additional major alloying element, efficient as a bone-resorption inhibitor. Most investigated alloys have a low corrosion rate in Hanks' solution close to ~0.2 mm/year. No cytotoxic effects of Mg-2Zn-2Ga (wt.%) alloy on MG63 cells were observed. Thus, considering the high corrosion resistance and good biocompatibility, the Mg-2Zn-2Ga alloy is possible for applications in osteosynthesis implants with improved bone tissue regeneration ability.

Microstructure and Mechanical Properties of Hot-Extruded Mg-Zn-Ga-(Y) Biodegradable Alloys

Magnesium alloys are attractive candidates for use as temporary fixation devices in osteosynthesis because they have a density and Young's modulus similar to those of cortical bone. One of the main requirements for biodegradable implants is its substitution by tissues during the healing process. In this article, the Mg-Zn-Ga-(Y) alloys were investigated that potentially can increase the bone growth rate by release of Ga ions during the degradation process. Previously, the effectiveness of Ga ions on bone tissue regeneration has been proved by clinical tests. This work is the first systematic study on the microstructure and mechanical properties of Mg-Zn-Y alloys containing Ga as an additional major alloying element prepared by the hot-extrusion process. The microstructure and phase composition of the Mg-Zn-Ga-(Y) alloys in as-cast, heat-treated, and extruded conditions were analyzed. In addition, it was shown that the use of hot extrusion produces Mg-Zn-Ga-(Y) alloys with favorable mechanical properties. The tensile yield strength, ultimate tensile strength, and elongation at fracture of the MgZn4Ga4 alloy extruded at 150 °C were 256 MPa, 343 MPa, and 14.2%, respectively. Overall, MgZn4Ga4 alloy is a perspective for applications in implants for osteosynthesis with improved bone regeneration ability.

Systems, Properties, Surface Modification and Applications of Biodegradable Magnesium-Based Alloys: A Review

In recent years, biodegradable magnesium (Mg) alloys have attracted the attention of many researchers due to their mechanical properties, excellent biocompatibility and unique biodegradability. Many Mg alloy implants have been successfully applied in clinical medicine, and they are considered to be promising biological materials. In this article, we review the latest research progress in biodegradable Mg alloys, including research on high-performance Mg alloys, bioactive coatings and actual or potential clinical applications of Mg alloys. Finally, we review the research and development direction of biodegradable Mg alloys. This article has a guiding significance for future development and application of high-performance biodegradable Mg alloys, promoting the future advancement of the magnesium alloy research field, especially in biomedicine.