Fixation of osteochondral fractures with absorbable pins

Abstract

Smaller osteschondral fragments containing little or no cortex present difficult treatment dilemma. Metallic screws or Kirschner wires often require subsequent removal either as part of the original operative plan or because of problems such as loosening and/or cartilage erosion. An attractive alternative would be a biodegradable implant that would transfix an osteochondral fragment with minimal violation of the articular surface. The objectives of this study are (1) to compare osteochondral fracture fixation of 2mm polyglycolic acid (PGA) absorbable pins (Acufex, Manfield, Mass) with that of Kirschner wires (K-wires) in cadavers, (2) to review patient data where osteochondral fractures were fixed with PGA-pins. The following conclusions were obtained: (1) Cadaver Studies: The biomechanical parameters of the osteochondral fractures fixed with absorbable PGA pins were not statistically different from those fixed with K-wires. Based on these laboratory studies it appears that fixation of osteochondral fractures with bioabsorbable PGA pins may offer a viable alternative to the use of K-wires. (2) Clinical Cases: A short follow up period with four clinical cases indicated that in carefully selected injuries, fixation with absorbable pins could become the treatment of choice of smaller joints. For severely comminuted fractures about major joints, PGA absorbable pins may be an adjunct to metal fixation.