Peri-articular elbow fracture fixations with magnesium implants and a review of current literature: A case series

Table 1 Results

	Fracture sustained	Follow up	Clinical outcomes scores (At latest follow up)		ROM (Latest follow up)	Clinical outcomes
			Mayo score	DASH score
67/F	Bryan & Morrey Type 3 capitellum fracture	7 months	100 points	0.8 points	25-130 degrees; Full prono/supination	Pain free; Went back to work as a cleaner without issues
34/M	Coronoid #: Regan and Morrey type 2	11 months	100 points	0.8 points	10–130 degrees; Full prono/supination	Pain free; Went back to recreational exercise (football)
58/M	Comminuted olecranon #; Radial head #: Mason type 2	13 months	100 points	0.9 points	0-150 degrees; 80 degrees prono/supination	Went back to work as a machine operator
38/M	Radial head #: Mason type 2	13 months	100 points	0.8 points	0–150 degrees; Full prono/supination	Pain free; Back to Gym work including weights
76/M	Terrible triad injury; Coronoid #: Regan and Morrey type 3; Radial head #: Mason type 4	11 months	100 points	10.3 points	10–130 degrees; Full prono/supination	Posterior elbow pain (Olecranon bursitis) – Resolved; Pain free from six months onwards

DASH: Disabilities of the arm, shoulder and hand.

Table 2 Literature review

Fracture	Ref. and Journal	Methodology	Results
Elbow fractures – Capitellum fracture	Biber et al[10], 2016; Case Reports in Orthopedics	Case report of 73 yr old female with a humerus capitellum fracture	Successful results with complete fracture union and full elbow range of motion
Elbow fractures – Distal humerus fractures (Lateral column)	Aktan et al[11], 2018; Cureus	Case report of 50 yr old male with bi-column distal humerus fracture	Successful results with complete fracture union at four months, and elbow range of motion from 5-130 degrees
Hand fractures – Scaphoid fractures	Könneker et al[15], 2019	Multi-centre RCT: 190 patients	Pending
Hand fractures – Scaphoid fractures	Meier et al[13], 2016	Case series of five patients with acute scaphoid fractures treated with a single Magnesium screw	Unsatisfactory results with 3 out of 5 patients experiencing extensive osteolysis and bone cyst; All had good wrist scores and fracture union eventually
Hand fractures – Scaphoid fractures	Grieve et al[14], 2017; Hand Surg Rehab	Case series; 3 Scaphoid fractures (Two acute and one revision); 3 Intercarpal fusions	One acute scaphoid fracture lost to follow up; All other cases united except 1 case (partial union at twelve weeks)
Hand fractures – Radial styloid fractures	Turan et al[12]; Thieme Medical Publishers	Case series; 2 patients with isolated radial styloid fractures	Good fracture union in both patients with no complications
Young displaced neck of femur fractures	Yu et al[16], 2015; BMC, Musculoskeletal disorders	Case series of 19 patients; Mg screws used to fix vascularized iliac bone graft	Successful results with 94.7% union
Tibial spine avulsion fractures	Gigante et al[17], 2018; Injury	Case series of three paediatric patients treated surgically with Magnesium screws	Successful results with all three patients obtaining excellent functional recovery
Ankle fractures – Isolated lateral malleolus	Acar et al[18], 2018; Cureus	Case report of a 19 yr old female with an isolated Weber A fracture	Successful results with complete fracture union at 8 wk, AOFAS score 100 points at 2 yr
Ankle fractures – Medial malleolar fractures	Kose et al[19], 2018; Archives of Orthopaedic and Trauma Surgery	Case series of 11 medial malleolar fractures (Isolated, Bi-malleolar or Tri-malleolar)	Successful results with 100% fracture union, Mean AOFS score of 94.9 at time of final follow up

RCT: Randomised controlled trial.

Table 3 Magnesium implants pros & cons

Pros	Cons
Bioabsorbable and osteoconductive[1,20]; Higher stability than existing polymers[21,22]; Similar stiffness to bone – less stress shielding[4]; Good biocompatibility[1-4]; Minimal artefacts on MRI and CT[23]	Production of hydrogen gas creates peri-implant radiolucencies[3]; Risk of osteolysis[3,24]; Unproven long term track record

CT: Computed tomography; MRI: Magnetic resonance imaging.