Dissolving Doubts: Resorbable Fixation in Posterior Vault Distraction Osteogenesis

Posterior cranial vault distraction osteogenesis (PVDO) traditionally requires titanium screw fixation of metallic distractor footplates. Cho and colleagues recently described an off-label application of the Synthes RapidSorb Injectable Polymer System for footplate fixation in PVDO, reporting reduced distractor removal operative time in an initial single-institution series. This study expands that cohort and further evaluates operative outcomes across a multisurgeon institutional experience. Retrospective review identified consecutive PVDO patients treated between 2013 and 2025. The most recent patients in each fixation cohort were included; patients undergoing concurrent procedures at distractor removal were excluded. The primary outcome was the distractor removal operative time. Multivariable regression and within-surgeon analyses were performed to assess surgeon and era confounding. Among 84 patients (42 titanium; 42 resorbable [27 full IPS, 15 hybrid]), resorbable fixation was associated with a 25.4% reduction in removal operative time (37.4±12.6 versus 50.2±16.1 min; mean difference 12.8 min, 95% CI: 6.5-19.0; P<0.001). The effect was robust to year adjustment (P<0.001) and demonstrated within a single surgeon's practice (P<0.001). No instances of fixation system failure occurred. Wound complications did not differ significantly between groups (P=0.41). In the largest comparative experience reported to date, off-label application of the Rapidsorb IPS for cranial distractor fixation in PVDO was associated with reduced removal operative time without fixation failure, extending the favorable on-label safety profile of the 85:15 PLG copolymer into the higher-mechanical-demand setting of cranial vault distraction.