Fracture Fixation, Internal
Conditions
Keywords
Silk fibroin bone screws, Fracture fixation, Knee and ankle joints, Safety and efficacy evaluation, Prognosis
Brief summary
Traditional fracture fixation devices can cause corrosion, allergies, and stress shielding effects. They often require removal after healing, risking secondary damage. Recently, biodegradable materials have gained attention for their effective clinical use in fracture fixation. Absorbable bone nails, for example, eliminate the need for a second surgery, reducing pain and costs while avoiding infection and tissue re-injury. They do not corrode and are invisible on X-rays, allowing for thorough patient examination and better fracture healing assessment.
Detailed description
Traditional fracture internal fixation devices implanted in the human body for a long time will cause corrosion, allergy and adverse effects due to stress shielding effect, etc. Due to the non-absorbability of its own materials, it needs to be removed again after fracture healing, which is easy to cause secondary damage to patients. However, in recent years, biodegradable materials have attracted the attention of scholars. The fracture fixation made of biodegradable biomaterials has achieved better internal fixation effect in clinic. For example, the implantation of absorbable bone nails can enable patients to avoid a second surgery, reduce the pain and economic burden of patients, while avoiding the problems of infection and tissue re-injury caused by the second surgery. In addition, absorbable bone nails have no metal corrosion effect and are not visible under the X-ray line, which is conducive to comprehensive examination of the patient and further understanding of the fracture healing. Common biodegradable materials are polymer materials (such as polylactic acid), ceramic materials (such as calcium phosphate) and metal materials. Among them, the strength of polymer materials is lower, and the toughness of ceramic materials is poorer, while the bone nails made of natural silk protein are biocompatible, non-toxic, no irritant, no side-effective, no antigenic and no carcinogenic to tissues. It can be completely degraded into amino acids and peptides in the body, participate in human metabolism, and eventually be excreted from the body. Silk was first used as a surgical suture, which can be gradually absorbed and degraded by the body after wound healing, which protected patients from the pain of removing stitches. Animal experiments have shown that the use of silk protein gel and commonly used ethyl lactate to repair rabbit thigh bone injuries, with the number, thickness and gap of bone trabeculae as evaluation indexes, the result showed that the use of silk protein gel was more conducive to the repair of rabbit thigh bone injury, and was also closer to the regeneration of human bone. In addition, the silk was able to maintain 50% tension two months after implantation in the animals. Therefore, the purpose of this clinical trial study was to evaluate the safety and effectiveness of biologic hollow bone screws for the fixation of fractures in the knee joint and ankle joint. Researchers can use the above results to provide better treatment for patients.
Interventions
Device: Absorbable screw for internal fixation of fracture. Patients were divided into the Inion Freedom Screws group and the Biological Hollow Bone Screws group according to the type of the screws they used.
Device: Absorbable screw for internal fixation of fracture. Patients were divided into the Inion Freedom Screws group and the Biological Hollow Bone Screws group according to the type of the screws they used.
Sponsors
Study design
Masking description
The researchers can visually distinguish the experiment products and the control products, so the researchers cannot be blinded and the participants were blinded.
Intervention model description
The experimental group was treated with biologic hollow bone screws (Jiangxi Sike Biotechnology, China); the control group was treated with Freedom Screws (Inion Oy, Finland).
Eligibility
Inclusion criteria
1. Aged 18-75 years old (inclusive), both sexes; 2. Patients with knee and ankle fractures requiring internal fixation confirmed by imaging examination; 3. Voluntary participation in the clinical trial and signing of the informed consent.
Exclusion criteria
1. The following conditions exist at the fracture site: infection, osteofascial compartment syndrome, osteitis, pathological fracture, open fracture, severe tissue or vascular and nerve injury, or insufficient bone mass of the affected limb affecting screw implantation, etc. 2. Abnormal liver and kidney function with clinical significance (ALT, AST 2 times the upper limit of normal value and Cr 2 times the upper limit of normal value); 3. Abnormal coagulation function with clinical significance (APTT \> 2 times the upper limit of normal value); 4. Patients with difficult-to-control diabetes (any blood glucose \> 11.1mmol/L or glycosylated hemoglobin \> 9%); 5. Past allergies to silk protein materials; 6. Mental illness; 7. Patients who cannot guarantee to quit smoking during the fracture healing period; 8. Pregnant or lactating women or women of childbearing age who plan to get pregnant within 6 months; 9. Those who have participated in other pre-clinical trials within 1 month before the trial; 10. Those who are considered inappropriate to participate in the clinical trial.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Cinical Fracture Healing Rate | 24 weeks after surgery+4 weeks | 1. No local tenderness or longitudinal percussion pain, no local abnormal activity; 2. X-rays show a continuous bone scab or trabeculae crossing the fracture line at the fracture site and the fracture line has been blurred. If both of these are met, the fracture is considered healed, and vice versa. 3. Healing rate = (Healing cases / Total cases) ×100% |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Cinical Fracture Healing Rate | 12 weeks after surgery±1 week | 1. No local tenderness or longitudinal percussion pain, no local abnormal activity; 2. X-rays show a continuous bone scab or trabeculae crossing the fracture line at the fracture site and the fracture line has been blurred. If both of these are met, the fracture is considered healed, and vice versa. 3. Healing rate = (Healing cases / Total cases) ×100% |
| Visual Analogue Scale (VAS) | During the screening period | In the Visual Analogue Scale (VAS), the minimum value is 0 and the maximum value is 10. The higher the score, the more severe the pain and the worse the outcome. A score of 0 means painless; A score of 1-3 means mild pain, tolerable; A score of 4-6 indicates moderate pain that affects sleep and is tolerable; A score of 7-10 indicates severe pain, unbearable pain, affecting appetite, and affecting sleep. |
| The American Knee Society (AKS) Clinical Rating System | 6 weeks after surgery±1 week | AKS score is divided into two parts: knee score and functional score. The knee score includes pain, range of motion and stability, and the functional score includes the ability to walk and go up and down stairs. The knee score is an assessment of knee pain, stability, and range of motion. And the functional score is an assessment of walking ability and the ability to walk up and down stairs. The total score of AKS is 200 points, of which knee score and functional score are 100 points each. The higher the score, the better the status. If the score is negative, it is calculated as 0. |
| Mazur Ankle Joint Functional Evaluation | 6 weeks after surgery±1 week | On the Mazur ankle joint functional evaluation, the highest score is 100, and a higher score indicates better ankle function. Excellent: \>92 points, ankle joint without swelling pain, normal gait, free movement. Good: 87-92 points, ankle joint slight swelling pain, normal gait, range of motion up to 3/4 of normal. General: 65-86 points, pain during activity, only 1/2 of normal motion, normal gait, need to take non-steroidal anti-inflammatory drugs. Poor: \<65 points, walking or resting pain, only 1/2 of normal range of motion, claudication, swollen ankle. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Examination of Infectious Diseases | Before surgery | Hepatitis B Surface Antigen (HBsAg) |
| Record Surgical Information | During Surgery | Operation time |
| Vital Signs-Body Temperature | Before surgery | Body Temperature |
| Vital Signs-Respiration | Before surgery | Respiration |
| Vital Signs-Heart Rate | Before surgery | Heart Rate |
| Vital Signs-Blood Pressure | Before surgery | Blood Pressure |
| Laboratory Examinations-X-Ray Examination | During the screening period | X-Ray Examination |
| Demographic Data | Before surgery | It mainly includes the age, gender, place of birth and education level of the patient |
| Laboratory Examinations-Routine Blood Test | During the screening period | Hemoglobin (Hb) |
| Laboratory Examinations-Routine Urine Test | During the screening period | Urine Protein (PRO) |
| Laboratory Examinations-Blood Biochemical Examination | During the screening period | Creatinine (Cr) |
| Defects of Device | During the screening period | In the process of clinical trials, there are unreasonable risks of medical devices that may endanger human health and life safety under normal use, such as labeling errors, quality problems and malfunctions. In the course of this clinical trial, if the device fails due to the defect of the device, the investigator will carry out routine treatment according to clinical needs. Investigators should document all device discoveries that occur during the course of the clinical trial Defects. |
| Safety Parameters-Adverse Events | Before Surgery | During screening or follow-up, subjects were not counted as serious adverse events for anticipated or scheduled procedures. |
| Drug Combination | During the screening period | The relevant drugs other than glucose, normal saline and narcotic drugs used during the trial were recorded. |
| Laboratory Examinations-Coagulation Function | During the screening period | Prothrombin Time (PT) |
| History of Disease and Treatment | Before surgery | Medical history within 3 months before signing the informed consent, medication history, surgery history, smoking history, drinking history and allergy history within 1 month before signing the informed consent were asked. |
| Bone Mineral Density (BMD) Examination | Before surgery | Bone Mineral Density (BMD) Examination |
| Blood Glucose Testing | Before surgery | Blood Glucose Testing |
| C-Reactive Protein | Before surgery | C-Reactive Protein |
Countries
China