Biodegradable Magnesium Screws for Unstable Ankle Fracture Surgery
Magnesium-Based Screws for Syndesmotic Fixation in Unstable Ankle Fractures
Ankle fractures are among the most common injuries that need surgery. When the broken bones make the ankle unstable, surgeons usually fix them with metal screws and plates. Metal hardware holds the bones in place well, but it can cause irritation, can loosen or break, and often has to be removed in a second surgery later.
This study looks at a different kind of screw called the RemeOs magnesium-based screw. It is made from a magnesium alloy and is designed to slowly dissolve and be absorbed by the body over about two to three years after it has done its job of holding the bone together. Because it dissolves on its own, patients may not need a second surgery to remove the hardware. These screws are authorized by the U.S. Food and Drug Administration (FDA) for use in medial malleolus ankle fractures. In this study, they are being used as an off-label indication.
The purpose of this study is to learn how well these magnesium screws work and how safe they are when used to repair unstable ankle fractures. The study will enroll at least 25 adults (ages 18 to 80) who have an unstable ankle fracture that needs surgery. All participants will have their fracture repaired with RemeOs screws as part of their normal surgical care.
After surgery, participants will be followed for 12 months. They will return for check-ups at about 6 weeks, 3 months, 6 months, and 12 months. At these visits, the study team will examine the ankle, take X-rays to see how the bone is healing and how the screws are dissolving, ask about any complications, and have participants fill out questionnaires about their ankle function and pain.
The main thing the study measures is ankle function at 12 months, scored using a standard ankle questionnaire (the Olerud-Molander Ankle Score). The study also tracks pain, healing on X-rays, how the screws break down over time, and any complications such as infection, loss of fixation, non-healing, or the need for additional surgery.
The surgery, X-rays, and follow-up visits in this study are the same care patients would receive whether or not they take part. The only research-specific parts are giving consent and filling out the study questionnaires. Taking part is voluntary and does not change the care a patient receives.
調査の概要
詳細な説明
Background: A substantial proportion of operatively treated lower-extremity injuries are ankle fractures, including unimalleolar, bimalleolar, bimalleolar-equivalent, and trimalleolar patterns, often with associated distal tibiofibular syndesmotic instability. Conventional metallic fixation provides reliable initial stability but carries well-recognized drawbacks, including hardware irritation, implant breakage or loosening, and the frequent need for secondary removal procedures-particularly for syndesmotic screws. Magnesium-based biodegradable implants are designed to provide sufficient mechanical stability during fracture healing while gradually degrading, thereby eliminating routine hardware removal. RemeOs magnesium-based screws (Bioretec), composed of a magnesium-calcium-zinc alloy, medial malleolus ankle fractures and are absorbed over approximately 2 to 3 years.
Design: This is a prospective, single-arm, interventional, post-market clinical follow-up study. A minimum of 25 patients (planned enrollment of 28 to allow for attrition) will be enrolled at participating Mass General Brigham sites. Fellowship-trained orthopaedic foot and ankle surgeons will perform all procedures.
Intervention: All participants will undergo open reduction and internal fixation (ORIF) of their ankle fracture using RemeOs magnesium-based biodegradable screws for fracture fixation and/or syndesmotic stabilization, in accordance with the device Instructions for Use. RemeOs screw types (Screw LAG, Screw COM, Screw FT, and Screw LAG Solid) may be used at the surgeon's discretion. Fixation of additional fracture components may be supplemented with plates, K-wires, or non-resorbable screws as clinically indicated.
Assessments: Participants are evaluated preoperatively (baseline characteristics, radiographs, and patient-reported outcomes) and postoperatively at 6 weeks, 3 months, 6 months, and 12 months, with an optional 9-month visit if delayed healing or complications are suspected. Each follow-up includes clinical examination, radiographic assessment of healing and screw biodegradation, complication assessment, and patient-reported outcomes.
Primary outcome: Functional recovery measured by the Olerud-Molander Ankle Score (OMAS) at 12 months.
Secondary outcomes: OMAS at 3 and 6 months; radiographic fracture healing and alignment; radiographic evaluation of RemeOs screw biodegradation; complication rates (loss of fixation, infection, non-union, revision surgery); pain intensity (Visual Analog Scale); and PROMIS Physical Function and Pain Interference.
Statistical analysis: Longitudinal OMAS changes will be analyzed using a linear mixed-effects model with time as a fixed effect and subject as a random effect. Secondary outcomes will be summarized descriptively; continuous variables compared with paired t-tests or Mann-Whitney U tests as appropriate; time to revision evaluated by Kaplan-Meier analysis where applicable. A p-value < 0.05 is considered significant.
All clinical procedures (surgery, imaging, follow-up) are standard care delivered regardless of study participation; the only research-specific procedures are informed consent and completion of patient-reported outcome measures.
研究の種類
入学 (推定)
段階
- 適用できない
連絡先と場所
研究連絡先
- 名前：Mani Eftekhari, BS
- 電話番号：15108506056
- メール：meftekhari@mgh.harvard.edu
研究場所
-
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Massachusetts
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Boston、Massachusetts、アメリカ、02114
- Massachusetts General Hospital
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-
参加基準
適格基準
就学可能な年齢
- 大人
- 高齢者
健康ボランティアの受け入れ
説明
Inclusion Criteria:
- Age 18-80 years
- Unstable closed ankle fracture requiring surgical fixation, including unimalleolar, bimalleolar, bimalleolar-equivalent, or trimalleolar fractures
- Fractures may be with or without syndesmotic instability
- Willingness to follow postoperative visits and rehabilitation protocols
- Ability to complete patient-reported outcome measures (PROMs)
Exclusion Criteria:
- Body mass index (BMI) > 40
- Open fractures
- Pathologic fractures
- Active infection at the surgical site
- Known allergy or hypersensitivity to magnesium or implant components
- Severe peripheral vascular disease
- Uncontrolled diabetes mellitus
- Prior ankle surgery on the affected limb
- Concomitant osteochondral lesions requiring treatment
- Neuromuscular disorders affecting the lower extremity
- Worker's compensation cases
- Pregnancy
- Non-adherence concerns or inability to comply with follow-up requirements
研究計画
研究はどのように設計されていますか？
デザインの詳細
- 主な目的：処理
- 割り当て：なし
- 介入モデル：単一グループの割り当て
- マスキング：なし（オープンラベル）
武器と介入
参加者グループ / アーム |
介入・治療 |
|---|---|
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実験的：RemeOs Magnesium Screw Fixation
All participants undergo open reduction and internal fixation (ORIF) of their unstable ankle fracture using RemeOs magnesium-based biodegradable screws for fracture fixation and/or syndesmotic stabilization, in accordance with the device Instructions for Use.
Screw type is selected at the surgeon's discretion.
Additional fracture components may be supplemented with plates, K-wires, or non-resorbable screws as clinically indicated.
Participants are followed for 12 months postoperatively.
|
ORIF performed using RemeOs magnesium-alloy biodegradable screws (Screw LAG, Screw COM, Screw FT, and/or Screw LAG Solid) for fixation of any malleolus and/or for syndesmotic fixation where indicated, per the device Instructions for Use.
The screws provide mechanical stability during healing and gradually biodegrade over approximately 2-3 years, eliminating the need for routine hardware removal.
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この研究は何を測定していますか？
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
|
Olerud-Molander Ankle Score (OMAS)
時間枠：12 months
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Functional recovery assessed by the Olerud-Molander Ankle Score, a patient-reported instrument scored 0 to 100, where 0 indicates totally impaired and 100 indicates no impairment.
Higher scores indicate better ankle function.
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12 months
|
二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
|
Radiographic Fracture Healing and Alignment
時間枠：6 weeks, 3 months, 6 months, and 12 months postoperatively
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Radiographic assessment of fracture union and maintenance of anatomic alignment of the ankle mortise on serial postoperative radiographs.
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6 weeks, 3 months, 6 months, and 12 months postoperatively
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Radiographic RemeOs Screw Biodegradation
時間枠：3 months, 6 months, and 12 months postoperatively
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Radiographic evaluation of the biodegradation behavior of the RemeOs magnesium-based screws over time, including gas formation and implant resorption.
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3 months, 6 months, and 12 months postoperatively
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Complication Rate
時間枠：12 months
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Proportion of participants experiencing complications, including loss of fixation, infection, non-union, and revision surgery.
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12 months
|
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Pain Intensity
時間枠：Baseline, 6 weeks, 3 months, 6 months, and 12 months postoperatively
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Pain intensity measured on a Visual Analog Scale ranging from 0 (no pain) to 10 (worst imaginable pain); lower scores indicate less pain.
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Baseline, 6 weeks, 3 months, 6 months, and 12 months postoperatively
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PROMIS
時間枠：Baseline, 6 weeks, 3 months, 6 months, and 12 months postoperatively
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ROMIS Physical Function and PROMIS Pain Interference.
Both are reported as Patient-Reported Outcomes Measurement Information System (PROMIS) T-scores standardized to the US general population (mean 50, SD 10, minimum 0, maximum 100).
For Physical Function, higher scores indicate a better outcome.
For Pain Interference, higher scores indicate a worse outcome.
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Baseline, 6 weeks, 3 months, 6 months, and 12 months postoperatively
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協力者と研究者
協力者
研究記録日
主要日程の研究
研究開始 (推定)
一次修了 (推定)
研究の完了 (推定)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (実際)
学習記録の更新
投稿された最後の更新 (実際)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
本研究に関する用語
その他の研究ID番号
- 2026P000142
個々の参加者データ (IPD) の計画
個々の参加者データ (IPD) を共有する予定はありますか?
IPD プランの説明
医薬品およびデバイス情報、研究文書
米国FDA規制医薬品の研究
米国FDA規制機器製品の研究
米国で製造され、米国から輸出された製品。
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