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

  • Orthopaedic Surgery
  • Published:
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Abstract

Introduction

Albeit the implantation of magnesium-based biodegradable implants can avoid a second surgery for implant removal, the postoperative occurrence of radiolucent zones around these implants based on corrosion processes has not been previously investigated in children and adolescents. We sought to characterize the distinct temporal and spatial dynamics for magnesium-based implants based on standard clinical routine radiographs.

Materials and methods

We retrospectively analyzed 29 patients, treated with magnesium-based compression screws (MAGNEZIX® CS 2.7 mm, CS 3.2 mm, CSC 4.8 mm; Syntellix AG) for fracture fixation, osteotomy, or osteochondral refixation. During a follow-up examination, the clinical and functional status was evaluated. Based on digital radiographs, the ratio of the area of the radiolucent zone and that of the screw was evaluated to assess implant degradation at two follow-up visits (i.e., after 6–8 weeks and 12–24 weeks).

Results

In 29 patients (16/29 females, 14.03 ± 2.13 years), a total of 57 implants were evaluated that were used for osteotomy (n = 13, screws n = 26), fracture fixation (n = 9, screws n = 18), or osteochondral refixation (n = 7, screws n = 13). All patients healed without complications and regained full function. Radiolucent zones were observed in 27/29 patients at the first follow-up, with significantly decreased ratios at the second follow-up (2.10 ± 0.55 vs 1.64 ± 0.60, p = 0.0006). Regression analyses were performed to assess the temporal dynamics of radiolucent zones and revealed significant logarithmic developments for the 2.7 mm and 3.2 mm screws, marked by a strong ratio decrease during the first weeks and an almost complete disappearance after approximately 100 days and 200 days, respectively. In contrast, the ceramic-coated 4.8 mm screws presented a significant linear and slower decrease of radiolucent zones.

Conclusion

Radiolucent zones are a common phenomenon in the course of implant degradation. However, they represent a self-limiting phenomenon. Remarkably, neither implant failure nor affected implant function is noted in this context. Yet, the microstructural changes accompanying the presence of radiolucent zones remain to be analyzed by three-dimensional high-resolution imaging.

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Abbreviations

RZ:

Radiolucent zone

AP:

Anterior–posterior

SA:

Screw area

SD:

Standard deviation

CI:

Confidence intervall

OS:

Osteosynthesis

ET:

Elmslie-Trillat osteotomy

RFix:

Osteochondral refixation

UAJ:

Upper ankle joint

DT:

Distal tibia

PT:

Proximal tibia

yrs:

Years

d:

Days

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Authors and Affiliations

  1. Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Maximilian M. Delsmann, Julian Stürznickel, Ralf Stücker, Tim Rolvien & Martin Rupprecht

  2. Department of Osteology and Biomechanics, University Medical Center Hamburg Eppendorf, Hamburg, Germany

    Maximilian M. Delsmann, Julian Stürznickel & Tim Rolvien

  3. Department of Pediatric Surgery, Klinik St. Hedwig, University Medical Center Regensburg, Regensburg, Germany

    Michael Kertai

  4. Department of Pediatric Orthopaedics, Children’s Hospital Hamburg-Altona, Altonaer Kinderkrankenhaus gGmbH, Bleickenallee 38, 22763, Hamburg, Germany

    Ralf Stücker & Martin Rupprecht

Authors
  1. Maximilian M. Delsmann
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  2. Julian Stürznickel
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  3. Michael Kertai
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  4. Ralf Stücker
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  6. Martin Rupprecht
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Correspondence to Martin Rupprecht.

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All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

Ethical approval

This study was performed in accordance with the local ethics committee and was approved by the institutional review board (Ethikkommission Ärztekammer Hamburg WF-075/20).

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Informed consent was obtained from all patients or the legal guardians of the child.

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Delsmann, M.M., Stürznickel, J., Kertai, M. et al. Radiolucent zones of biodegradable magnesium-based screws in children and adolescents—a radiographic analysis. Arch Orthop Trauma Surg 143, 2297–2305 (2023). https://doi.org/10.1007/s00402-022-04418-0

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