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At least 487 records · Page 27Linked to original sources
PubMed1997

Bioresorbable fracture fixation in orthopedics: a comprehensive review. Part II. Clinical studies.

Bioresorbable materials overcome two major disadvantages of the metal alloys most commonly used in fracture-fixation devices: their extreme stiffness, which causes stress shielding of the underlying bone, and the necessity, in a significant number of cases, of removing metallic implants after fracture healing is complete. The orthopedic surgeon now has the use of polylactic acid, polyglycolic acid, and polydioxanone implants for the fixation of small cancellous bone fractures. The currently available bioresorbable materials lack strength and stiffness and are associated with inflammatory reactions and osteolysis in a significant number of cases. Surgeons should use the available pins and screws with extreme care and attention to the characteristics of each individual injury, particularly its healing characteristics, as well as to the material's initial mechanical properties, degradation rates, and associated complications.

Biocompatible Materials↗
PubMed1996

Effects of diode laser welding with dye-enhanced glue on tensile strength of sutures commonly used in urology.

BACKGROUND AND OBJECTIVE: Tissue welding using laser-activated protein solders may soon become an alternative to sutured tissue approximation. In most cases, approximating sutures are used both to align tissue edges and provide added tensile strength. Collateral thermal injury, however, may cause disruption of tissue alignment and weaken the tensile strength of sutures. The objective of this study was to evaluate the effect of laser welding on the tensile strength of suture materials used in urologic surgery. STUDY DESIGN/MATERIAL AND METHODS: Eleven types of sutures were exposed to diode laser energy (power density = 15.9 W/cm2) for 10, 30, and 60 seconds. Each suture was compared with and without the addition of dye-enhanced albumin-based solder. After exposure, each suture material was strained (2"/min) until ultimate breakage on a tensometer and compared to untreated sutures using ANOVA. RESULTS: The strength of undyed sutures were not significantly affected; however, violet and green-dyed sutures were in general weakened by laser exposure in the presence of dye-enhanced glue. Laser activation of the smallest caliber, dyed sutures (7-0) in the presence of glue caused the most significant loss of tensile strength of all sutures tested. CONCLUSION: These results indicate that the thermal effects of laser welding using our technique decrease the tensile strength of dyed sutures. A thermally resistant suture material (undyed or clear) may prevent disruption of wounds closed by laser welding techniques.

Adhesives↗
PubMedDate not supplied

Surgical sutures: MR artifacts and sequence dependence.

Artifact reduction is fundamental to the daily clinical application of magnetic resonance (MR) imaging. Imaging of the postoperative patient may be difficult because of surgically introduced materials that result in artifacts. The authors tested some commonly used types of surgical suture for MR susceptibility artifact with various imaging sequences. Ten different suture types were studied. Suture was immersed in vegetable oil in separate plastic test tubes. The sutures were also studied embedded in meat. All samples were studied with T1-weighted and T2-weighted spin-echo, STIR (short-inversion-time inversion-recovery), and two-dimensional and three-dimensional gradient-echo sequences. Silk suture produced the most artifact.

Animals↗
PubMed1987

[Maxon and PDS--evaluation and physical and biologic properties of monofilament absorbable suture materials].

The physical parameters of monofilament absorbable sutures (Maxon and PDS) were studied. Compared to PDS Maxon proved somewhat more unwieldy, however, it required less complicated knot combinations for a secure placement than PDS did. In vivo experiments on rats showed a slight tissue reaction and a dissolution time of 120-180 days for Maxon and 180-240 days for PDS. With Maxon, tensile strength was measurable for 42-49 days, while the period for PDS amounted to 65-80 days. New indications for these materials are discussed, two parameters, easy knot formation and atraumatic passage through the tissue, especially favor the use of Maxon for one-row all-layer sutures in the gastrointestinal tract.

Animals↗
PubMed1986

[Closure of median sternotomy with resorbable synthetic sutures].

To date, the refixation of the bone halves after median sternotomy is accomplished with wire, steel bands or thick, not absorbable plastic threads. As the first, we used absorbable synthetic strings in 25 patients. During the absorbtion the development of a very strong bone scar was possible, because the absorbtion lasted very long. The refixation of the sternum in cases of aseptic instability was even possible. So we think to have found another range of application for absorbable synthetic material which recently has been used more and more in several parts of operative medicine, even in hard burdened connective tissue.

Adolescent↗
PubMed1995

[Can the results of cruciate ligament operations be arthrometrically evaluated? A comparison of subjective assessment, Lysholm score, clinical stability classification and measuring stability with the KT 1000 after complex knee injuries].

In a long-term follow-up of 88 patients with complex ligament knee injuries we examined 70 of these who were operated upon between 1.4. 1988 and 31.3. 1990. We specifically looked at local complications, clinical results and knee stability, using subjective and arthrometrical (KT-1000) results 1 or 2 years after operation. The only parameters with a good correlation with stability were the clinical examination (Lachman-test) and the results with the arthrometer in the anterior-posterior translation. Stability after ACL-reconstruction with augmentation with a polydiaxonaon (PDS) augmentation band was physiological (2 mm under 89 N anterior-posterior traction) in 77% of all knees but only in 57% under maximal anterior-posterior manual stress. Neither the subjective outcome of Lysholm-Score correlated with arthrometry and clinical examination.

Adolescent↗
PubMed2006

[Operative standardization in randomized controlled surgical trials. Meeting of the INSECT trial].

BACKGROUND: INSECT is an internationally registered, three-armed, multicentre, intraoperatively randomised model trial of the Study Centre of the German Surgical Society. The interventions being compared are running suture technique with slowly absorbable monofilament suture material (PDS vs MonoPlus) and interrupted technique with a braided, rapidly absorbable suture material (Vicryl). The primary endpoint is the rate of incisional hernias 1 year postoperatively. MATERIAL AND METHODS: A total of 25 surgeons from 24 different institutions at all levels of care evaluated the theoretical and practical sessions of the surgical investigator meeting using 25 criteria, including course organisation, content, and speaker evaluation, and a categorical grading system from 1 (very good) to 6 (insufficient). RESULTS: Distribution of the 625 grades was: very good (1) n=367, good (2) n=207, satisfactory (3) n=39, adequate (4) n=2, and "No statement" n=10. The average score for the investigator meeting was 1.5. CONCLUSION: The participants felt they were successfully prepared theoretically and practically for trial interventions and conduct by attending the meeting. Clear explanation of the measures for treatment equivalence before and during trials is mandatory in randomised controlled surgical trials.

Abdominal Wall↗
PubMed2000

[Reconstruction of traumatic skull base defects with alloplastic, resorbable fleece].

BACKGROUND AND OBJECTIVE: Defects of the frontal skull base can be reconstructed with different types of material. Homologous material possibly involves the risk of infection and thus complicated wound healing. Therefore, alloplastic material seems to be an interesting alternative. PATIENTS/METHODS: In the present paper, we report on a series of 45 patients who underwent reconstruction of the anterior skull base. The defects were localized in different regions and had a maximum diameter of 10 cm2. Of the defects, 39 were closed via a sandwich technique and 12 via an onlay. The rhinosurgical approaches were aimed at closing the defects with Ethisorb, a resorbable collagen texture, and supporting the surgical field with a balloon catheter from below. Postoperative controls were performed after 6 weeks (endoscopy, determination of beta 2-transferrin) and 6 months (CT scans). RESULTS: All defect reconstructions were stable and tight, i.e., neither a CSF leakage nor a meningoencephalocele was found. The healing was completely normal and the endoscopic controls showed a regular mucosal lining over the defects. CONCLUSIONS: We conclude that Ethisorb is a useful alternative material in the treatment of frontal skull base defects.

Adolescent↗
PubMed2001

[Effect of various suture strength factors on behavior of meniscus sutures in cyclic loading conditions].

The aim of this study was to analyze meniscal sutures under cyclic loading conditions for different suture types (vertical and horizontal mattress sutures) and suture materials (absorbable monofilament sutures: PDS 2-0; PDS-0, and PDS-1 USP). Testing was performed on medial porcine menisci, using a well-established biomechanical testing model with a complete longitudinal tear 3 mm from the periphery of the meniscus. Sixty specimens were used. One suture was tested at a time. During cyclic testing 100 load cycles were applied with a crosshead speed of 50 mm/min. Three different maximum loads (10 N, 20 N, and 40 N) were used. The preload was set at 5 N. After cyclic loading, the specimens were loaded until failure. During cyclic loading, a gap appeared between the two parts of the meniscus, and partial tissue failures were observed at the surface of the meniscus. Gapping was more marked with higher loads and with the weaker suture material (p < 0.001). Using PDS 0 and PDS 1 sutures, less partial tissue failures were observed compared to PDS 2-0 (p < 0.001). The ultimate failure loads after cyclic loading were higher with PDS-0 and PDS-1 sutures. With these suture materials vertical sutures were stronger than horizontal sutures (p < 0.05). Using PDS 2-0 this difference could not be found. These results show that the primary strength of meniscal sutures depends on the suture material. The frequency and the amount of gapping and partial tissue failures, which can be observed under cyclic loading, are less distinct with PDS-0 and PDS-1 compared to PDS 2-0. From a biomechanical point of view, PDS 0 and PDS 1 sutures are recommended for meniscal sutures to guarantee a high primary stability, a small amount of gapping, and few partial tissue failures.

Animals↗
PubMed2003

[Tossy III injuries of the acromioclavicular joint. In what circumstances is surgery still justified? Personal results and literature review].

In Germany AC-joint-dislocations type Tossy III are treated in most of the cases operatively. Over two times of period we treated AC-joint-dislocations type Tossy III with biodegradable PDS-cords. 54 patients were operated between 1989 and 1997 and followed up after 39 months. 87.5% of patients are satisfied with results and have 10.2 points at Taftscore. In this period we couldn't differentiated the results by Rockwood classification. 12 patients with Rockwood V were operated between 1998 and 2002 and followed up after 14 months. Excellent and good results were seen in 92% of cases. At Taftscore we seen 10.7 points. 3 patients with Rockwood III were treated conservative with 10.3 points and 3 patients were operated with 10.7 points at Taftscore. AC-joint dislocations should be classified to Rockwood. No differences were seen between operation and conservative treatment in Rockwood III in literature. We recommend operation with PDS cords with good results in Rockwood V.

Acromioclavicular Joint↗
PubMed2005

[A simplified technique for repair of quadriceps tendon rupture by transpatellar PDS-cord].

Quadriceps tendon ruptures are relatively unusual injuries caused by direct or more frequently indirect trauma. Since complete ruptures lead to loss of active extension of the knee joint, operative treatment is usually indicated. Several techniques are described in the literature. However, relatively little is known about the functional outcome after operative treatment of acute quadriceps tendon ruptures. We present a new operative technique using a 1.3-mm PDS cord passed through a transverse drill hole in the proximal pole of the patella. We operated ten consecutive cases of complete quadriceps tendon ruptures with the technique described between January 2000 and June 2003. Eight of ten patients were evaluated after a mean follow-up time of 38 months by physical examination, IKDC Subjective score, Lysholm and Tegner score as well as an isokinetic test of the quadriceps strength. No complications were noted in this period. The average postoperative scores were 87 (IKDC), 98 (Lysholm), and 4.5 (Tegner). Isokinetic testing showed an average of 25% quadriceps strength deficit. The operative treatment of complete quadriceps tendon ruptures using a PDS cord through a drill hole in the patella is a safe and effective technique permitting functional postoperative treatment.

Adolescent↗
PubMed2005

Arthroscopic single-stranded semitendinosus tendon- versus PDS-augmentation of reinserted acute femoral anterior cruciate ligament tears: 7 year follow-up study.

This study reviews the long-term results of acute complete femoral tears or combined femoral (2/3 of the ligament diameter) /interstitial tears of the anterior cruciate ligament (ACL) that were reinserted. Out of 27 patients, 11 were treated with reinsertion plus augmentation with single-stranded semitendinosus tendon, 16 patients had a reinsertion and augmentation with a double-stranded PDS-band. Operation was carried out 10 (2-42) days after trauma. A brace was applied for 12 weeks, full weight bearing was allowed after 6 weeks according to our standard rehabilitation protocol. Twenty two patients (81%) could be reevaluated after a mean follow-up time of 7 years 1 month (range 3 years 8 months -11 years 5 months). No statistically significant difference was found between both techniques concerning patient's satisfaction and subjective evaluation of knee function, OAK-scores (semitendinosus-augmentation: 96 point, SD 2.0 PDS-augmentation: 94 points, SD 5.1) and IKDC-scores. Only in the PDS-augmentation group a statistically significant decrease was found in the level of activity in sports (P=0.046). At follow-up, radiological evaluation of the anterior drawer test was performed. In the group of patients who had undergone semitendinosus augmentation (n=9), anterior displacement of the tibia (determined radiologically using the TELOS-device) of 0-2 mm was found in five patients, displacement of 3-5 mm was seen in three cases and displacement of 6-10 mm in one patient (average 2.7 mm). Patients treated with PDS-augmentation (n=13) showed anterior tibial displacement of 0-2 mm in five cases, 3-5 mm in five cases, and 6-10 mm in two knees (average 3.6 mm). One patient of this group underwent ACL-reconstruction 6 years after reinsertion because of recurrent instability. At follow up, flexion was limited to less than 135 degrees in three patients (12.5%). One patient who had undergone semitendinosus augmentation and three patients from the PDS-augmentation group developed a cyclops syndrome and intraarticular adhesions that were treated arthroscopically 6 to 18 month after reinsertion surgery. A tendency towards a higher rate of limitation in range of motion was found for the PDS augmentation group. The reinsertion of a femoral torn ACL plus augmentation with a single strand of semitendinosus tendon or a PDS-band leads to acceptable results, an aggressive rehabilitation protocol may help to decrease the rate of limitation of flexion.

Anterior Cruciate Ligament↗
PubMed2004

[Stability of osteosyntheses for condylar head fractures in the clinic and biomechanical simulation].

BACKGROUND: Fractures of the condylar head are traditionally managed by closed techniques, despite a considerable rate of dysfunctional problems. PDS pin osteosynthesis (presented by Rasse 1992) via a preauricular approach failed to become established as a standard procedure due to a lack of stability. Alternatively, mini- or microplating, as performed in our patients (101 condylar head fractures between 1993 and 2000), showed high-grade limitations of translatory movements in about 30% due to scarification after loosening of osteosynthesis materials. The aim of this study was to establish an efficient procedure for achieving a functionally stable and atraumatic osteosynthesis. METHODS: For the definition of a suitable procedure, models of the mandible (standardized fractures, types A, B, and C) were osteosynthesized (six samples for each type of fracture and type of screw), each with three PDS pins, 2.0 mm resorbable, 2.0 cortical, 1.7 and 1.2 mm small fragment screws, and exposed to increasing loads in centric (0-20-35 mm opening) and eccentric (35 mm opening) condylar positions. A computerized biomechanical test stand allowed a dynamic simulation of chewing forces (16 hydraulic drives). The resulting fracture gaps were measured without contact by a motion capture system. RESULTS: Within physiological limits, only 1.7 small fragment and 2.0 mm cortical screws were able to bear occlusal loadings up to 200 N (1.2 mm small fragment screws up to 150 N, resorbable 2.0 mm screws up to 100 N, and PDS-pins up to 50 N). In a pullout experiment (condylar spongious bone of young pigs, aged 4-6 months), 1.7 mm small fragment screws showed superior retention. A consecutively developed small fragment screw-system has been applied clinically in 74 condylar head fractures (58 patients). After removal of osteosynthesis material, 41 of 49 TM joints have so far shown complete restitution. CONCLUSIONS: The newly developed osteosynthesis system using a retroauricular approach based on 1.7 mm small fragment screws makes maxillomandibular immobilization unnecessary. The extra-articular position of the screw heads prevents scar-induced articular limitations. Preexisting degenerative alterations of the TMJ soft tissues, however, will affect functional results adversely.

Absorbable Implants↗
PubMed2006

Effects of different kinds of meshes on postoperative adhesion formation in the New Zealand White rabbit.

The aim of this study was to compare the effect of different kinds of surgical meshes on postoperative adhesion formation. Forty-two New Zealand White rabbits were studied. The rabbits were grouped into six groups, according to the type of surgical meshes (Prolene, Mersilene, Vypro, polytetraflouroethylene (PTFE), Proceed and control group) implanted into the peritoneum cavity. Thirty days after the operation, the relaparotomies were carried out, and any adhesions observed between the implanted mesh and tissues were evaluated and graded. The mean adhesion degree was 9.2 in the Mersilene mesh group, 9.5 in the Prolene mesh group, 9.7 and in the Vypro mesh group (P > 0.05). The mean adhesion degree was 1 in the control group, 2.75 in the Proceed mesh group and 2.25 in the PTFE mesh group. There was a significant difference in adhesion degree between the control, Proceed and PTFE groups and the Prolene, Mersilene and Vypro mesh groups. The adhesion degree was significantly lower in the Proceed and PTFE mesh groups when comparing them with the Prolene, Mersilene and Vypro meshes.

Abdominal Wall↗
PubMed2002

[Orbital floor reconstruction. Comparison of a new perforated 0.15 mm thick PDS layer with established titanium dynamic mesh].

INTRODUCTION: For surgical reconstruction of the orbital floor after blow-out fractures, a new perforated PDS (poly-p-dioxanon) foil (0.15 mm thickness) has recently become available. The main target of this prospective and randomized interdisciplinary clinical study was to compare this new PDS foil with the proven titanium dynamic mesh (0.3 mm thickness). PATIENTS/METHODS: Aside from the common diagnostic procedures, an extensive ophthalmologic examination was performed and documented preoperatively (U1), 4 days (U3), 1 month (U4), and 6 months (U5) postoperatively. RESULTS: In both groups the surgical procedure was tolerated well. The new perforated PDS foil turned out to be easier to handle intraoperatively because of smooth and clean cutting edges. The surgical treatment was well tolerated in all randomized groups. In contrast to the control group, the PDS and TD groups showed postoperatively a slight increase of the preoperative exophthalmos (mean 0.5 mm). CONCLUSION: The new perforated PDS foil is comparable concerning cosmetic and functional aspects. Especially with regard to stability after blow-out fractures, the new perforated PDS foil is equal to titanium dynamic mesh up to 20 mm in diameter. PDS foil is felt to be superior regarding bioresorption and due to the more convenient handling.

Adolescent↗