Abstract
Bone fixation devices made of bioabsorbable polymers have advantages over traditional metallic implants as the latter require a secondary operation to remove the device. However, bone fixation devices are expected to have much higher mechanical strengths than polymers used in soft tissue applications. Poly(l-lactide) (PLLA) is a semicrystalline bioabsorbable polymer that can be drawn to increase its mechanical strength. The present chapter describes the chemistry of PLLA and its applications in bone fixation devices. Degradation of PLLA takes a few years which may be adequate for bone regeneration. An important issue of bioabsorbable fixation devices is the balance between the bioabsorption rate and the mechanical strength maintenance. It is known that PLLA exhibits a piezoelectric effect that can accelerate new bone formation. Currently, PLLA bone fixation devices, including screws, pins, rods, and plates, are clinically available. They are used preferentially in non-load-bearing applications such as in maxillofacial surgery.
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References
Cutright DE, Hunsuck EE, Beasley JD (1971) Fracture reduction using a biodegradable material, polylactic acid. J Oral Surg 29:393–397
Kulkarni RK, Pani KC, Neuman C, Leonard F (1966) Polylactic acid for surgical implants. Arch Surg 93:839–843
Yoshino N, Takai S, Watanabe Y, Kamata K, Hirasawa Y (1998) Delayed aseptic swelling after fixation of talar neck fracture with a biodegradable poly-l-lactide rod: case reports. Foot Ankle Int 19:634–637
Suganuma J, Alexander H (1993) Biological response of intramedullary bone to poly-l-lactic acid. J Appl Biomater 4:13–27
Eufinger H, Rasche C, Lehmbrock J, Wehmöller M, Weihe S, Schmitz I, Schiller C, Epple M (2007) Performance of functionally graded implants of polylactides and calcium phosphate/calcium carbonate in an ovine model for computer assisted craniectomy and cranioplasty. Biomaterials 28:475–485
Pietrzak WS (2000) Principles of development and use of bioabsorbable internal fixation. Tissue Eng 6:425–433
Matsusue Y, Yamamuro T, Yoshii S, Oka M, Ikada Y, Hyon S, Shikinami Y (1991) Biodegradable screw fixation of rabbit tibia proximal osteotomies. J Appl Biomater 2:1–12
Hanafusa S, Matsusue Y, Yasunaga T, Yamamuro T, Oka M, Shikinami Y, Ikada Y (1995) Biodegradable plate fixation of rabbit femoral shaft osteotomies. A comparative study. Clin Orthop Relat Res 315:262–271
Yasuda I, Noguchi K, Iida H (1955) Application to electrically-induced callus. J Jpn Orthop Assoc 29:351–353 (in Japanese)
Ikada Y, Shikinami Y, Hara Y, Tagawa M, Fukada E (1996) Enhancement of bone formation by drawn poly(l-lactide). J Biomed Mater Res 3:553–558
Tajitsu Y (2008) Piezoelectricity of chiral polymeric fiber and its application in biomedical engineering. IEEE Trans Ultrason Ferroelectr Freq Control 55:1000–1008
Matsusue Y, Yamamuro T, Oka M, Shikinami Y, Hyon SH, Ikada Y (1992) In vitro and in vivo studies on bioabsorbable ultra-high-strength poly(l-lactide) rods. J Biomed Mater Res 26:1553–1567
Laine P, Kontio R, Lindqvist C, Suuronen R (2004) Are there any complications with bioabsorbable fixation devices? A 10 year review in orthognathic surgery. Int J Oral Maxillofac Surg 33:240–244
Maurer P, Holweg S, Knoll WD, Schubert J (2002) Study by finite element method of the mechanical stress of selected biodegradable osteosynthesis screws in sagittal ramus osteotomy. Br J Oral Maxillofac Surg 40:76–83
Oba Y, Yasue A, Kaneko K, Uchida R, Shioyasono A, Moriyama K (2008) Comparison of stability of mandibular segments following the sagittal split ramus osteotomy with poly-l-lactic acid (PLLA) screws and titanium screws fixation. Orthodontic Waves 67:1–8
Pietrzak WS, Kumar M (2009) An enhanced strength retention poly(glycolic acid)-ÂpolyÂ(l-lactic acid) copolymer for internal fixation: in vitro characterization of hydrolysis. J Craniofac Surg 20:1533–1537
Konan S, Haddad FS (2009) A clinical review of bioabsorbable interference screws and their adverse effects in anterior cruciate ligament reconstruction surgery. Knee 16:6–13
Sugimoto K, Takakura Y, Tanaka Y, Kawate K (2003) Technique tip: fixation of Mitchell’s osteotomy using a PLLA screw. Foot Ankle Int 24:372–373
Suzuki T, Kawamura H, Kasahara T, Nagasaka H (2004) Resorbable poly-l-lactide plates and screws for the treatment of mandibular condylar process fractures: a clinical and radiologic follow-up study. J Oral Maxillofac Surg 62:919–924
Ricalde P, Caccamese J, Norby C, Posnick JC, Hartman MJ, von Fraunhofer JA (2008) Strength analysis of 6 resorbable implant systems: does heating affect the stress–strain curve? J Oral Maxillofac Surg 66:2493–2497
Vaccaro AR, Singh K, Haid R, Kitchel S, Wuisman P, Taylor W, Branch C, Garfin S (2003) The use of bioabsorbable implants in the spine. Spine J 3:227–237
van Dijk M, Smit TH, Sugihara S, Burger EH, Wuisman PI (2002) The effect of cage stiffness on the rate of lumbar interbody fusion: an in vivo model using poly(l-lactic Acid) and titanium cages. Spine 27:682–688
van Dijk M, Tunc DC, Smit TH, Higham P, Burger EH, Wuisman PI (2002) In vitro and in vivo degradation of bioabsorbable PLLA spinal fusion cages. J Biomed Mater Res 63:752–759
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Suzuki, S., Ikada, Y. (2012). Devices for Bone Fixation. In: Biomaterials for Surgical Operation. Humana Press. https://doi.org/10.1007/978-1-61779-570-1_6
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DOI: https://doi.org/10.1007/978-1-61779-570-1_6
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