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Passive and active intracranial translocation of osteosynthesis plates in adolescent minipigs
J F Hönig1, H A Merten, H G Luhr
1Department of Maxillofacial Surgery, University Hospital and Medical School, Göttingen, Germany.
Insights
Osteosynthesis plates implanted in infant skulls can move inward, a process called intracranial translocation. This occurs regardless of plate type, necessitating early removal within 3 months to prevent complications.
Area of Science:
- Craniofacial surgery
- Pediatric neurosurgery
- Biomaterials science
Background:
- Intracranial translocation of osteosynthesis plates is a known complication in infants.
- The periosteum's role and the influence of plate design on translocation are not fully understood.
Purpose of the Study:
- To investigate the effects of different osteosynthesis plate designs on intracranial translocation in adolescent minipigs.
- To compare plate-bone interface healing and the periosteum's response to smooth versus multiple-point contact plates.
Main Methods:
- Animal study involving four adolescent Göttingen minipigs with frontal bone osteosynthesis.
- Comparison of two plate types: multiple-point contact and conventional smooth plates.
- Histological examination focusing on the plate-bone interface and periosteal response.
Main Results:
- Osseous regeneration surrounded plates within weeks of implantation.
- Intracranial translocation occurred in all animals between 12-16 weeks, irrespective of plate design.
- Epiperiosteal fixation delayed translocation, suggesting two mechanisms: passive (growth-related) and active (plate-dependent).
Conclusions:
- Intracranial translocation is a multifactorial process in pediatric cranial implants.
- Plate design influences translocation dynamics, but cranial growth is a primary driver.
- Early removal of osteosynthesis materials (within 3 months) is recommended for infant cranium implants.
Abstract:
On the basis of the clinical and experimental proof that intracranial translocation of osteosynthesis plates occurs in infants after fixation on frontal bone, we conducted an animal study on four adolescent Göttingen minipigs. Our aim was to study the effects on intracranial translocation of two different types of osteosynthesis plates by comparing the plate-bone interface on the intact frontal bone treated with a multiple-point contact plate versus a conventional smooth one, paying special emphasis to the periosteum. Within a few weeks of implantation, osseous regeneration products surrounded the plate. Total invagination of plates with initial intracranial translocation occurred 12 to 16 weeks postimplantation, regardless of plate design. In epiperiosteal fixation, intracranial translocation was delayed. The results revealed two mechanisms at play here: cranial growth-related passive intracranial translocation, which occurs regardless of plate design, and plate-dependent active intracranial translocation. In conclusion, we recommend that all metal osteosynthesis materials implanted in the infant cranium be removed as early as possible (within 3 months).