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Contents lists available at ScienceDirect

Injury
journal homepage: www.elsevier.com/locate/injury

Safety and performance of biodegradable magnesium-based implants

in children and adolescents
Julian Stürznickel a, Maximilian M. Delsmann a, Oliver D. Jungesblut b,c, Ralf Stücker b,c,
Christian Knorr d, Tim Rolvien c, Michael Kertai d,∗, Martin Rupprecht b,c,∗∗
a
Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
b
Department of Pediatric Orthopaedics, Children’s Hospital Hamburg-Altona, Hamburg, Germany
c
Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
d
Department of Pediatric Surgery, Klinik St. Hedwig, University Medical Center Regensburg, Regensburg, Germany

a r t i c l e i n f o a b s t r a c t

Article history: Aims: Biodegradable magnesium-based alloy implants represent a promising option in orthopedic
Accepted 15 March 2021 surgery, as the clinical outcomes have been reported to be comparable to those of titanium implants
Available online xxx
and no surgical interventions are required for removal. To date, little is known about the results of the
Keywords: use of these implants in children and adolescents. Therefore, the aim of the present study was to analyze
Magnesium screws the safety and performance of these implants in children and adolescents.
Pediatrics Patients and Methods: Eighty-nine patients treated with magnesium-based implants for fracture stabi-
Osteosynthesis
lization, osteotomy and osteochondral refixation were analyzed; 38 were treated by osteosynthesis; 18,
Osteotomy
Osteochondral refixation
osteotomy; and 33, osteochondral refixation. The mean follow-up duration was 8.2 months (range, 1.5–
30 months). Clinical and radiographical follow-up examinations were performed at 4–8 weeks and 3–6
months, respectively, to evaluate implant performance and osseous consolidation.
Results: Clinical outcomes were rated as good to very good in all patients. Radiolucent zones were appar-
ent after surgery in all patients but were noted to decrease in size during the follow-up period. Revision
surgery was necessary in 1 of 89 patients who had a highly unstable osteochondritis dissecans lesion of
the knee. None of the magnesium-based implants required surgical removal.
Conclusion: Magnesium-based implants in children and adolescents results in good clinical outcomes
when used for fracture stabilization, osteotomy and osteochondral defect refixation. Future studies are
needed to further analyze the significance of the transient appearance and temporal development of ra-
diolucent zones in the growing skeleton as well as the long-term performance of these implants.
© 2021 Elsevier Ltd. All rights reserved.

Introduction duction, optimal stability, and successful fracture healing and avoid
long-term complications, such as nonunion or posttraumatic os-
While 10–25% of injuries per year in children and adolescents teoarthritis. In contrast to adults, in school-aged children, the use
can be attributed to fractures, an annual fracture incidence of of elastic nails and Kirschner wires is common for treating frac-
160/10,0 0 0 has been reported [1-3]. Compared to adults, children tures [5], indicating that comparably less implant stiffness and fix-
and adolescents have a more adaptable skeleton, with a greater ation are required for successful fracture healing in general. Espe-
regenerative capacity, resulting in excellent overall osseous heal- cially in children and adolescents, there is a trend toward less in-
ing and low rates of delayed union or pseudarthrosis [4]. However, vasive surgical techniques [5-7]. However, implant removal is gen-
osteosynthesis may be necessary to achieve adequate fracture re- erally recommended for all implants in children and adolescents
by the current national guideline [8]. Therefore, biodegradable im-
plants may be particularly applicable and useful for selective indi-
∗
Corresponding author.
cations in this patient group.
∗∗
Co-corresponding author at: Department of Pediatric Orthopaedic Surgery, Chil- In recent years, biodegradable magnesium-based implants have
dren’s Hospital Hamburg-Altona, Bleickenallee 38, 22763 Hamburg, Germany. been increasingly used in orthopedic surgery in adults [9-11]. The
E-mail addresses: Michael.Kertai@barmherzige-regensburg.de (M. Kertai), degradation of magnesium-based implants is a galvanic corrosion
Martin.Rupprecht@kinderkrankenhaus.net (M. Rupprecht).

https://doi.org/10.1016/j.injury.2021.03.037
0020-1383/© 2021 Elsevier Ltd. All rights reserved.

Please cite this article as: J. Stürznickel, M.M. Delsmann, O.D. Jungesblut et al., Safety and performance of biodegradable magnesium-
based implants in children and adolescents, Injury, https://doi.org/10.1016/j.injury.2021.03.037
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process that releases hydrogen gas [12]. The major advantage of classified as MgYREZr (i.e., magnesium, yttrium, zirconium and
these implants is that additional surgery for implant removal is other rare earth metals) alloys according to DIN EN 1753. The
no longer required. By using magnesium-based implants, the mor- double-threaded MAGNEZIX® CS compression screw is available
bidity and possible complications of a second surgery [13] are with diameters of 2.0, 2.7, 3.2 and 4.8 mm, each with varying
avoided. Previous studies have assessed the surgical outcomes of length options. One special characteristic of the 4.8-mm screw
magnesium-based screws for different indications, demonstrating (MAGNEZIX® CSC 4.8) is that the ceramic surface delays corrosion
promising results [11,14]. Other studies have tested the biome- in the first month compared to the smaller sizes. The MAGNEZ-
chanical characteristics, revealing properties more analogous to IX® pin is available with diameters of 1.5, 2.0, 2.7 and 3.2 mm and
those of bone than those of comparable titanium implants [15]. lengths of 8–50 mm (increments of 2 mm).
The successful implantation of magnesium-based implants in ado- The MAGNEZIX® CBS screw has a typical cortical screw design.
lescents with osteochondral defects was recently shown by our The surgical technique and instrumentation of the MAGNEZIX®
group [16]. CBS screws are comparable to those of conventional implants made
The aim of the present study was to investigate the safety and of steel or titanium. The threads of the head and the shaft have dif-
performance of biodegradable magnesium-based implants (MAG- ferent thread pitches, generating compressive forces supporting in-
NEZIX® CS or CBS screws and MAGNEZIX® pins, Syntellix AG, terfragmentary compression. The MAGNEZIX® screws are not self-
Hannover, Germany) for selected indications (fracture fixation, os- drilling but are self-cutting. Therefore, the screw hole needed to be
teotomy and osteochondral defect refixation) in children and ado- predrilled during the operation to avoid weakening of the implant.
lescents. In contrast, the MAGNEZIX® CSC 4.8 screw is cannulated, allow-
ing the usage of a guide wire, which was inserted via the drill
Materials and methods guide system and is a few millimeters longer than the selected
screw. This prevents the guide wire from being completely drilled
Study design off during the subsequent drilling process. The length of the screw
was determined, and predrilling was performed. To simplify inser-
All patients under 18 years of age who were treated between tion of the screw head, the head side was reamed using a counter-
04/2018 and 04/2020 with magnesium-based screws (MAGNEZIX® sink with the guide wire still in place. Finally, MAGNEZIX® CSC 4.8
CS or CBS screws) or magnesium-based pins (MAGNEZIX® pins) screw was positioned using the inserted guide wire.
(i) for fracture fixation, (ii) osteotomy, or (iii) osteochondral de- MAGNEZIX® pins were used during standard arthroscopy in
fect refixation and met the inclusion criteria were included in this cases of patellar luxation and/or OD. After reduction of the dis-
analysis after informed consent was obtained from the patients or placed fragments (in some cases, reduction wires were used for
the respective legal representatives. The end point of this study temporary stabilization), predrilling of the implant bed was per-
was successful healing of the fractures, osteotomies and osteochon- formed with the drill bit. Subsequently, the depth of the drilled
dral lesions as assessed by radiological examination. In addition, hole was determined with a depth gage to determine the required
the performance on follow-up, rate of complications, and number length, and a pin was then carefully impacted into the pilot hole
of surgical revisions were assessed. Preoperative imaging (X-ray, with the aid of a hammer while under protection by the impactor.
magnetic resonance imaging (MRI) or computed tomography (CT)) All pins were countersunk under the chondral surface to avoid
findings were used to assess the underlying pathologies and con- prominent protrusion.
firm the surgical indications. All patients returned for clinical and As magnesium-based implants undergo a degradation process,
radiographical follow-up examinations after 4–8 weeks and 3–6 with decreasing mechanical stability over time, axial deviation was
months. Furthermore, some patients returned for additional exam- not generally judged as implant failure. Accordingly, implant fail-
inations according to routine clinical practice, exceeding the mini- ure was defined as axial deviation observed without signs of im-
mum follow-up period of 3–6 months. At follow-up examinations, plant degradation, leading to nonhealing and the need for revision
X-rays and/or MRI scans were used to verify correct positioning of surgery.
the screws as well as determine radiographic healing of the lesions.
All patients were treated by an attending surgeon (three different Statistical analysis
senior surgeons). The postoperative regimen was not different from
that after surgeries performed with regular implants. Walking with Statistical analysis was performed using GraphPad Prism ver-
full weight-bearing and active exercises started after six weeks, if sion 8.4.0 software (GraphPad Software, Inc., USA). The results
applicable, and after confirmation of sufficient bone healing as de- are presented as absolute values or the mean ± standard devia-
termined by radiography. tion (SD). The normal distribution of the data was tested by the
Intra- and postoperative complications, such as fractures, im- Shapiro-Wilk test. The Kruskal-Wallis test with Dunn’s multiple
plant breakage, delayed union and nonunion, were documented. comparison test was applied for nonparametric data. The level of
Postoperative radiological outcomes (fracture consolidation and os- significance was defined as p<0.05.
seous integration) were documented at the follow-up visits. Fur-
thermore, clinical success was defined as complete restoration of Results
the clinical and functional status (full range of motion, no se-
vere pain, and full function within activities of daily life and Patient characteristics
sports/performing arts). This retrospective study was conducted
with approval from the local ethics committee (Ethikkommission In this study, 89 patients (45 females, 44 males; age, 12.9 ± 3.2
Ärztekammer, Hamburg, WF-075/20). years; BMI, 21.9 ± 4.9 kg/m2 ; Table 1) who received biodegrad-
able magnesium-based implants were included. Of the 89 patients,
Implants and surgical procedure 38 underwent fracture fixation (i.e., osteosynthesis, OS), 18 under-
went osteotomy or the Elmslie-Trillat procedure (OET), and 33 pa-
Implants with specific dimensions were used according to the tients underwent osteochondral lesion refixation (RFix) (Fig. 1A,
individual requirements. MAGNEZIX® CS or CBS screws and MAG- Table 1). Patients in the OS (11.5 ± 3.9 years) and RFix groups
NEZIX® pins (Syntellix AG, Hannover, Germany) are CE-certified (13.4 ± 2.1 years) were significantly younger than patients in the
aluminum-free magnesium alloy screws and pins, respectively, OET group (15.1 ± 1.3 years; OS vs. OET, p<0.0 0 01; RFix vs. OET,

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Table 1
Patient characteristics. Demographic characteristics of all patients and the respective sub-
groups (osteosynthesis, OS; osteotomy or Elmslie-Trillat procedure, OET; osteochondral re-
fixation, RFix), including sex distribution, age and BMI.

Individuals (n) Sex (f/m) Age (years) BMI (kg/m2 )

Total 89 45/44 12.9 ± 3.2 21.9 ± 4.9

OS 38 18/20 11.5 ± 3.9a 19.6 ± 4.9
OET 18 13/5 15.1 ± 1.3b 24.6 ± 5.1b

RFix 33 14/19 13.4 ± 2.1 20.7 ± 4.1

p (Kruskal-Wallis test) <0.0001 0.020

f – female; m – male.
a
p<0.05 for osteosynthesis vs OET.
b
p<0.05 for OET vs RFix.

Fig. 1. Overview of the presented surgeries and the included patient cohort. (A)
Osteosynthesis (OS) represented most of the performed implantations, followed by
osteochondral refixations (RFix) and osteotomies/Elmslie-Trillat (OET). (B) Age dis-
tribution in the three subgroups revealing that the patients receiving OET were
significantly older. (C) Number of surgeries performed at the different anatom-
ical localizations. OS – osteosynthesis; RFix – osteochondral refixations; OET –
osteotomies/Elmslie-Trillat; yrs – years.

Fig. 2. Representative images of the implants at the different anatomical local-

izations (red arrow indicating implants). UAJ – upper ankle joint; PT – proximal
tibia; DF – distal femur. (For interpretation of the references to colour in this figure
legend, the reader is referred to the web version of this article.)

p = 0.009; Fig. 1B, Table 1). Moreover, while patients in the OS

group (19.6 ± 4.9 kg/m2 ) did not differ significantly from those in Osteosynthesis
the other two groups in terms of BMI, patients in the OET group
had a significantly higher BMI (24.6 ± 5.1 kg/m2 ) than those in Fracture fixation (Fig. 3) was performed in 38 patients, mostly
the RFix group (20.7 ± 4.1 kg/m2 , p = 0.039; Table 1). Overall, 191 in the upper ankle joint (Fig. 3A) and the distal humerus (i.e., ra-
implants were used, and more screws were implanted than pins dial condyle or ulnar epicondyle; Fig. 3B), using screws varying in
(Table 2). The majority of all surgeries involved the lower limbs, size and number depending on the fracture location and dimen-
especially the proximal tibia and upper ankle joint (Fig. 1C, Fig. 2, sions. In five cases, four involving the radial condyle and one in-
Table 3). No variations in implant stability or degradation were ob- volving the acromioclavicular joint, both magnesium-based screws
served among locations. The combined use of multiple MgYREZr and Kirschner wires were implanted in close proximity. Healing in
alloy screws within one circumscribed area was safe and did not these cases occurred without complications or accelerated corro-
lead to altered implant degradation characteristics, radiographic sion processes as assessed on radiography. The follow-up period
findings, or fracture healing. One revision surgery (1.1%) was re- was the longest in this group (11.4 ± 10.6 months), and no cases of
quired in a patient with a highly unstable osteochondritis disse- implant failure were observed (Table 2). All fractures healed with-
cans (OD) lesion. out complications, and no revision surgeries were required.

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Table 2
Implant performance. The number of individuals, the follow-up period, the total number of implants and the number of cases of implant fail-
ure (defined as nondegradation-associated axial deviation of the implant and loss of function) with the number of required revision surgeries
are provided.

Individuals (n) Follow-up (months) Implants (n) Intraop. compl. Implant failure (n) Revision surgery (n)

Total 89 8.2 ± 8.2 191 0 1 1

Osteosynthesis 38 11.4 ± 10.6 54 0 0 0
OET 18 4.1 ± 2.9 39 0 0 0
Refixation 33 6.6 ± 4.9 98 0 1 1
Screws 64 8.2 ± 8.9 100 0 0 0
Osteosynthesis 37 11.4 ± 10.6 45 0 0 0
OET 18 4.1 ± 2.9 38 0 0 0
Refixation 9 4.4 ± 2.9 17 0 0 0
Pins 30 8.4 ± 7.0 91 0 1 1
Osteosynthesis 3 20.7 ± 10.1 9 0 0 0
OET 1 6.5 ± 0 1 0 0 0
Refixation 26 7.0 ± 5.3 81 0 1 1

Intraop. compl. – intraoperative complications; OET – osteotomy or Elmslie-Trillat procedure.

Table 3
Implant performance grouped by the most common sites. The number of individuals who underwent surgery were further divided by the use of
screws and pins, as well as the most common indications, if applicable. The follow-up period, the total number of implants, the number of cases of
implant failure (defined as nondegradation-associated axial deviation of the implant and loss of function) and the number of required revision surgeries
are provided.

Individuals (n) Follow-up (months) Implants (n) Intraop. compl. Implant failure (n) Revision surgery (n)

Proximal tibia 22 8.1 ± 8.9 41 0 0 0

Screws 22§ 8.1 ± 8.9 37 0 0 0
Pins 2§ 14.3 ± 11.0 4 0 0 0
ET (screws) 15 3.8 ± 2.2 30 0 0 0
Emin. interc. # (screws) 6 16.2 ± 12.2 6 0 0 0
Elbow 17 14.2 ± 11.2 19 0 0 0
Screws 16§ 14.0 ± 11.5 17 0 0 0
Pins 2§ 23.0 ± 9.9 2 0 0 0
Condylus rad. # (screws) 6 10.9 ± 9.1 6 0 0 0
Epicond. uln. # (screws) 7 11.6 ± 10.8 8 0 0 0
UAJ 16 5.1 ± 3.9 33 0 0 0
Screws 11§ 4.0 ± 4.0 17 0 0 0
Pins 6§ 6.3 ± 4.2 16 0 0 0
Transitional # (screws) 8 4.1 ± 3.1 12 0 0 0
OD talus 5 6.3 ± 4.7 17 0 0 0
Screws 1§ 10.0 ± 0.0 2 0 0 0
Pins 5§ 6.3 ± 4.7 15 0 0 0
Patellar flakes 13 7.6 ± 5.2 43 0 0 0
Screws 4§ 4.0 ± 2.8 7 0 0 0
Pins 11§ 7.9 ± 5.6 36 0 0 0
Distal femur 9 6.3 ± 5.0 29 0 1 1
Screws 2§ 5.3 ± 5.3 4 0 0 0
Pins 10§ 6.6 ± 5.3 25 0 0 1
OD femur (pin) 6 7.5 ± 5.3 22 0 1 1

Intraop. compl. – intraoperative complications.

§
– combined use of screws and pins; ET – Elmslie-Trillat; Emin. interc. # – eminentia intercondylaris fracture; Condylus rad. # – condylus radialis frac-
ture; Epicond. uln. # – epicondylus ulnaris fracture; UAJ – upper ankle joint; Transitional # – transitional fracture; OD talus – osteochondritis dissecans
tali; OD femur – osteochondritis dissecans femoris.

Osteotomy (n = 5) (Fig. 5). In the majority (27/33) of the included patients,

multiple magnesium pins were used for this procedure; in pa-
Of the 18 patients in the OET group, 16 patients with tients with lesions requiring a very high degree of stability (e.g.,
patellofemoral malalignment underwent the ET procedure (Fig. 4). refixation of an anterior cruciate ligament avulsion fracture or fix-
In each of these patients, two magnesium screws (MAGNEZIX® CSC ation of the medial patellofemoral ligament), magnesium screws
screw, 4.8) were used for fixation. Moreover, osteochondral defects were used. Overall, implant failure was detected in 1/98 cases
were simultaneously fixed in two of these patients using magne- (1.0%; Table 2); this patient (3.0% of included patients) had a highly
sium pins (MAGNEZIX® pin, 1.5 or 2.7) or small magnesium screws unstable OD lesion requiring arthroscopic revision surgery with
(MAGNEZIX® CS screw, 2.0). In the 2/18 patients who did not un- repeated drilling and bioresorbable implant placement (Chondral
dergo the ET procedure, osteotomies were performed for Taylor’s Darts, Arthrex), eventually leading to successful healing.
bunion and in the fibula. Within the observed period (4.1 ± 2.9
months; Table 2), patients in this group showed regular healing, Good implant stability prevents secondary surgery
with no signs of implant failure.
No intraoperative complications occurred in any group; more
Fixation of osteochondral defects specifically, there were no cases of fracture or implant failure dur-
ing surgery. Follow-up radiography revealed 6 screws with ax-
The fixation of osteochondral defects was mainly indicated af- ial deviation associated with degradation (6/100), which were ob-
ter patellar dislocation (n = 19) with resulting fragments or OD served after accidental weight-bearing or increased mechanical

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or pseudarthrosis were observed. The clinical and functional out-

comes were good to very good in all cases. Indeed, the patients
reported reduced pain levels without further need for analgesics,
successful reestablishment of the range of motion compared to
that on the contralateral site, and no persistent instability or re-
current dislocation at 6 months after surgery.

Discussion

Biodegradable magnesium-based implants have often received

attention during the last century due to their material character-
istics [15,17]. After the first application of magnesium-based im-
plants in 1906 by Lambotte in a child, rapid degradation of the
implant was observed due to combined implantation with iron
cerclage wires and steel screws [18]. Additional recent develop-
ments and alterations in material properties with improvements
in corrosion characteristics have reintroduced magnesium-based
implants as an important option for different indications in or-
thopedic surgery [17,19,20]. Magnesium-based implants applied in
adults for metatarsal osteotomies [9,11,14] yielded results similar
to those of titanium implants.
In this study, magnesium-based implants were used for three
different indications in patients. Fractures included in this study
occurred predominantly in the distal humerus and upper ankle
joint/distal tibia. Moreover, patients included in the OET group
primarily underwent ET with the implantation of two MAGNEZ-
IX® CSC 4.8 screws in the proximal tibia. The third group of pa-
Fig. 3. Representative images of osteosyntheses with magnesium-based screws. tients underwent osteochondral fixation, predominantly with mul-
(A) At initial presentation, a triplane fracture was detected by X-ray and computed tiple pins for patellar and femoral locations.
tomography (CT). Radiographic control 4 weeks post-surgery revealed intact os-
Our results indicate the safe and successful use of biodegrad-
teosynthesis with two MAGNEZIX® CSC 4.8 screws and regular implant configura-
tion with radiolucent zones surrounding the screws. (B) A fracture of the condylus able implants in children and adolescents, with no intraopera-
radialis was fixed by the use of three Kirschner wires and an additional MAGNEZ- tive complications, a low revision surgery rate and no cases of
IX® CS 2.7 screw. After consolidation, Kirschner wires were removed. The arrow prolonged wound healing; additionally, good functional outcomes
indicates the implant.
were reported by the patients at the follow-up examinations. Im-
w – weeks.
portantly, there were no differences in success among the vari-
ous skeletal sites observed within this study, which is in line with
our previous results [16] and those of studies assessing the perfor-
loading, as well as 1 broken pin (1/91). Radiolucent zones around mance of biodegradable implants at different anatomical locations
the implants were visible in all patients on follow-up radiogra- [10,21,22].
phy but decreased in size over time. Overall, in one patient (1/89) The results of biodegradable screws were promising, with stable
with a highly unstable osteochondral defect of the medial femoral fixation achieved in all cases. Regular fracture consolidation was
condyle, a broken pin was observed on follow-up, which led to observed in all patients who underwent fixation with those im-
implant migration and the need for revision surgery. Aside from plants. While this was partially expected, as the rate of nonunion
this patient, no patients required revision surgery or removal of described in the literature is very low [4], it was necessary to
the magnesium-based alloy implant, and no cases of delayed union confirm the success rate, as delayed union may require additional

Fig. 4. Representative images of osteotomy or Elmslie-Trillat procedure (OET) with magnesium-based alloy screws. The patient presented with patellar luxation and
post-traumatic contusion of the distal femur indicated by bone marrow edema in MRI (left panel). The axial view represents patellofemoral malalignment. Consequently,
Elmslie-Trillat procedure was performed with two MAGNEZIX® CSC 4.8 screws. Note the intermittent presence of radiolucent zones (2nd from right panel), as well as the
visible degradation of the screw head at the 1-year follow-up (right panel, arrow indicating the screw head degradation process).
d – day; w – weeks; yr – year.

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Fig. 5. Representative images of osteochondral defect refixation with magnesium-based alloy pins. A prominent osteochondritis dissecans of the talus was detected in
MRI (left panel), which was fixed with MAGNEZIX® 2.0 pins (middle panel, arrows indicating implants). Follow-up evaluation after 6 months revealed osseous integration
of the defect (2nd from right panel). Successful consolidation of the former defect and degradation of the magnesium-based implants was observed after 15 months (right
panel).
m – months.

surgery and impair the quality of life of the treated patients. An- Conclusion
other important finding of this study was that the implantation
of both titanium Kirschner wires and magnesium-based screws in To the best of our knowledge, this is the first study assessing
close proximity did not result in a significant acceleration of corro- the clinical safety and successful use of biodegradable magnesium-
sion kinetics. However, as only a limited number of patients were based implants in children and adolescents for fracture fixation,
treated with additional titanium wires, applications with very close osteotomy and osteochondral defect refixation. Patients who were
or direct contact must be avoided whenever possible, as rapid treated with those implants demonstrated adequate bone healing,
degradation with increased hydrogen gas formation should be an- did not experience prolonged wound healing and showed a low
ticipated [18], which may result in inferior osseous integration or rate of revision surgery, supporting the application of such im-
even the need for revision surgery. Implants showed stable fixa- plants. Furthermore, no general differences in outcomes were de-
tion, except in the single case of a highly unstable OD lesion [16]. tected among the skeletal sites.
However, long-term outcomes of the treatment of osteochondral
defects by magnesium-based implants are not yet available. Ethical approval
Whether to perform metal implant removal in children and
adolescents remains an ongoing debate in the literature, with no This study was approved by the institutional review board
consensus [23-25]. In line with our national guidelines [8], metal (Ethikkommission Ärztekammer Hamburg WF-075/20).
implant removal is performed to avoid potential complications,
such as pain, infection, growth disturbances, or mechanical dys- Authors’ contributions
function. Surgery itself poses risks for complications, and hospi-
talization affects quality of life [13,26]) and increases medical ex- JS conceived and designed the study, collected data and wrote
penses [23]. Therefore, the number of surgeries should be reduced, the manuscript. MMD collected data and reviewed the manuscript.
if possible, especially in children and adolescents. By implanting ODJ, RS, CK, TR reviewed the manuscript. MK and MR orga-
biodegradable magnesium-based screws, the need for a second nized and performed the study, enrolled patients and reviewed the
surgery is reduced by a relevant degree. manuscripts.
Radiolucent zones were apparent in all follow-up radiographs
but were of self-limiting character and did not affect the outcomes. Declaration of Competing Interests
As previously described in the literature [10,14,27], these zones are
a regular phenomenon and must not be misinterpreted during ra- MR advises the Syntellix AG (Hannover, Germany) on clinical
diographical evaluation. Reports in adults did not reveal the persis- matters. All other authors have no conflicts of interest to disclose.
tence of radiolucent zones at the three-year follow-up examination
[11].
Funding
There are limitations to this study, such as the retrospective
study design, the heterogeneous indication spectrum, the lack of
This study received no specific funding.
a control group and the use of X-rays instead of high-resolution
imaging. Regardless of these limitations, the size of our cohort and References
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