J Korean Foot Ankle Soc.  2020 Sep;24(3):107-112. 10.14193/jkfas.2020.24.3.107.

Comparing the Results of Using Bioabsorbable Magnesium Screw with Those Using a Titanium Screw for the Treatment of Mild to Moderate Hallux Valgus: Short-term Follow-Up

• Hong Sy
• Kim GL
• Han W

• KMID: 2506527
• DOI: http://doi.org/10.14193/jkfas.2020.24.3.107

Abstract

Purpose
Hallux valgus (HV) is a common foot deformity that causes pain in the first metatarsophalangeal joint. Distal metatarsal osteotomies are commonly performed as a treatment. This retrospective study compared the clinical and radiological results of bioabsorbable magnesium (Mg) versus titanium (Ti) screw fixation for modified distal chevron osteotomy in HV.
Materials and Methods
Forty-nine patients, who underwent modified distal chevron osteotomy for HV in 2018 and 2019, were reviewed retrospectively. Bioabsorbable Mg screw fixation was applied in 20 patients (22 feet), and a traditional Ti compression screw was applied in 29 patients (40 feet). The patients were followed up for at least six months. The clinical results were evaluated using the American Orthopaedic Foot and Ankle Society hallux metatarsophalangeal-interphalangeal (AOFAS-MTP-IP) scale and a visual analogue scale (VAS). The hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA) were measured before, after surgery, and at the six months follow-up.
Results
The AOFAS-MTP-IP scale and VAS points were improved in both groups, with no significant difference between them. At the six-month follow-up, HVA, IMA, and DMAA were similar. Bone union was confirmed in both groups, and there were no significant major complications in both groups. Four people in the Ti screw group underwent implant removal surgery.
Conclusion
Bioabsorbable Mg screws showed comparable clinical, radiologic results to Ti standard screws six months after distal modified chevron osteotomy. These screws are an alternative fixation material that can be used safely and avoid the need for implant removal operations.

Keyword

Hallux valgus; Absorbable implants; Osteotomy; Magnesium

Figure

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  Figure. 1 (A) Bioabsorbable magnesium alloy screw (Resomet™ headless screw; U & I Corporation, Seoul, Korea). (B) Standard titanium compression screw (TwinFix cannulated compression Screw; Stryker, Freiburg, Germany).

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  Figure. 2 Simple radiographs of preoperative (A), postoperative (B), and 24 weeks follow-up (C) using bioabsorbable screws.

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  Figure. 3 Simple radiographs of preoperative (A), postoperative (B), and 24 weeks follow-up (C) using standard titanium compression screw.

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  Figure. 4 Simple radiographs for 6 weeks (A), 12 weeks (B), and 24 weeks (C) after surgery. Although it has decreased over time, the radiolucent sign remains.

Reference

1. Schneider W, Aigner N, Pinggera O, Knahr K. 2004; Chevron osteotomy in hallux valgus. Ten-year results of 112 cases. J Bone Joint Surg Br. 86:1016–20. doi: 10.1302/0301-620x.86b7.15108. DOI: 10.1302/0301-620X.86B7.15108. PMID: 15446530.

2. Cassinelli SJ, Herman R, Harris TG. 2016; Distal metatarsal osteotomy for moderate to severe hallux valgus. Foot Ankle Int. 37:1137–45. doi: 10.1177/1071100716667280. DOI: 10.1177/1071100716667280. PMID: 27694269.

3. Austin DW, Leventen EO. 1981; A new osteotomy for hallux valgus: a horizontally directed “V” displacement osteotomy of the metatarsal head for hallux valgus and primus varus. Clin Orthop Relat Res. (157):25–30. DOI: 10.1097/00003086-198106000-00007. PMID: 7249456.

4. Stienstra JJ, Lee JA, Nakadate DT. 2002; Large displacement distal chevron osteotomy for the correction of hallux valgus deformity. J Foot Ankle Surg. 41:213–20. doi: 10.1016/s1067-2516(02)80017-5. DOI: 10.1016/S1067-2516(02)80017-5.

5. Yearian PR, Brown T, Goldman F. 1996; Chevron bunionectomy with microplate and screw fixation: a retrospective follow-up of 26 feet. J Foot Ankle Surg. 35:532–6. dicussion 601doi: 10.1016/s1067-2516(96)80126-8. DOI: 10.1016/S1067-2516(96)80126-8. PMID: 8986891.

6. Clancy JT, Berlin SJ, Giordano ML, Sherman SA. 1989; Modified Austin bunionectomy with single screw fixation: a comparison study. J Foot Surg. 28:284–9. PMID: 2794359.

7. Klein MS, Ognibene FA, Erali RP, Hendrix CL. 1990; Self-tapping screw fixation of the Austin osteotomy. J Foot Surg. 29:52–4. PMID: 2319102.

8. DeFronzo DJ, Landsman AR, Landsman AS, Stern SF. 1991; Austin bunionectomy with 3M Staplizer fixation. An assessment of 20 cases. J Am Podiatr Med Assoc. 81:140–9. doi: 10.7547/87507315-81-3-140. DOI: 10.7547/87507315-81-3-140. PMID: 2046014.

9. Zelen CM, Young NJ. 2013; Alternative methods in fixation for capital osteotomies in hallux valgus surgery. Clin Podiatr Med Surg. 30:295–306. doi: 10.1016/j.cpm.2013.04.002. DOI: 10.1016/j.cpm.2013.04.002. PMID: 23827488.

10. Kelly B, Heyworth B, Yen YM, Hedequist D. 2013; Adverse sequelae due to plate retention following submuscular plating for pediatric femur fractures. J Orthop Trauma. 27:726–9. doi: 10.1097/BOT.0b013e31829089e1. DOI: 10.1097/BOT.0b013e31829089e1. PMID: 23591806.

11. Jorgenson DS, Mayer MH, Ellenbogen RG, Centeno JA, Johnson FB, Mullick FG, et al. 1997; Detection of titanium in human tissues after craniofacial surgery. Plast Reconstr Surg. 99:976–9. discussion 980–1. doi: 10.1097/00006534-199704000-00006. DOI: 10.1097/00006534-199704000-00006. PMID: 9091942.

12. Alpert B, Seligson D. 1996; Removal of asymptomatic bone plates used for orthognathic surgery and facial fractures. J Oral Maxillofac Surg. 54:618–21. doi: 10.1016/s0278-2391(96)90645-x. DOI: 10.1016/S0278-2391(96)90645-X. PMID: 8632247.

13. Pavlovich R Jr, Caminear D. 2003; Granuloma formation after chevron osteotomy fixation with absorbable copolymer pin: a case report. J Foot Ankle Surg. 42:226–9. doi: 10.1016/s1067-2516(03)70033-7. DOI: 10.1016/S1067-2516(03)70033-7. PMID: 12907934.

14. Böstman OM, Pihlajamäki HK. 2000; Adverse tissue reactions to bioabsorbable fixation devices. Clin Orthop Relat Res. (371):216–27. DOI: 10.1097/00003086-200002000-00026. PMID: 10693569.

15. Pelto-Vasenius K, Hirvensalo E, Vasenius J, Rokkanen P. 1997; Osteolytic changes after polyglycolide pin fixation in chevron osteotomy. Foot Ankle Int. 18:21–5. doi: 10.1177/107110079701800105. DOI: 10.1177/107110079701800105. PMID: 9013110.

16. Seitz JM, Eifler R, Bach FW, Maier HJ. 2014; Magnesium degradation products: effects on tissue and human metabolism. J Biomed Mater Res A. 102:3744–53. doi: 10.1002/jbm.a.35023. DOI: 10.1002/jbm.a.35023. PMID: 24222399.

17. Li RW, Kirkland NT, Truong J, Wang J, Smith PN, Birbilis N, et al. 2014; The influence of biodegradable magnesium alloys on the osteogenic differentiation of human mesenchymal stem cells. J Biomed Mater Res A. 102:4346–57. doi: 10.1002/jbm.a.35111. DOI: 10.1002/jbm.a.35111. PMID: 24677428.

18. Witte F, Kaese V, Haferkamp H, Switzer E, Meyer-Lindenberg A, Wirth CJ, et al. 2005; In vivo corrosion of four magnesium alloys and the associated bone response. Biomaterials. 26:3557–63. doi: 10.1016/j.biomaterials.2004.09.049. DOI: 10.1016/j.biomaterials.2004.09.049. PMID: 15621246.

19. Zeng J, Ren L, Yuan Y, Wang Y, Zhao J, Zeng R, et al. 2013; Short-term effect of magnesium implantation on the osteomyelitis modeled animals induced by Staphylococcus aureus. J Mater Sci Mater Med. 24:2405–16. doi: 10.1007/s10856-013-4982-6. DOI: 10.1007/s10856-013-4982-6. PMID: 23793564.

20. Lee JW, Han HS, Han KJ, Park J, Jeon H, Ok MR, et al. 2016; Long-term clinical study and multiscale analysis of in vivo biodegradation mechanism of Mg alloy. Proc Natl Acad Sci U S A. 113:716–21. doi: 10.1073/pnas.1518238113. DOI: 10.1073/pnas.1518238113. PMID: 26729859. PMCID: PMC4725539.

21. Acar B, Kose O, Turan A, Unal M, Kati YA, Guler F. 2018; Comparison of bioabsorbable magnesium versus titanium screw fixation for modified distal chevron osteotomy in hallux valgus. Biomed Res Int. 2018:5242806. doi: 10.1155/2018/5242806. DOI: 10.1155/2018/5242806. PMID: 30581858. PMCID: PMC6276507.