title: Absorbable plate strength loss during molding.
abstract: Bioabsorbable plating systems play an integral role in cranial vault remodeling. After experiencing a case of plate failure requiring emergent reexploration, we investigated the potential causes. We hypothesize that extended submersion in the molding bath during plate preparation might advance the rate of hydrolysis and compromise plate structural integrity. Using an absorbable poly-D/L-lactic acid plating system, we assessed the effect of extended submersion on plate strength and stiffness when loaded in a cantilever fashion and with pure tension. We assessed these differences with the Student t test and linear regression modeling. We also generated a computer model of the plates for finite element analysis. When left in the molding bath for extended periods, the plates changed color and lost strength. After 5 minutes, 30% of maximum plate load capacity was lost in a cantilever beam test (P < 0.001) consistent with use of a 15% thinner plate. Tensile testing revealed the initial elastic modulus of 6.42 +/- 0.13 GPa decreased 16% to 5.41 +/- 0.50 GPa after 5 minutes of submersion (P = 0.027). The changes in plate strength and elastic modulus both worsened with increased submersion times. Finite element analysis of the plates also predicted clinically significant increases in plate deviation under normal loading conditions. Our study demonstrates that extended submersion of absorbable plates during molding results in a significant loss of plate strength and stiffness. Further, our computer model predicts that these changes could result in an unacceptable plate deviation under normal loading conditions. Together, these data caution against overmolding of plates to avoid compromising their structural integrity.
authors.affiliation: Vanderbilt University School of Medicine, Nashville, Tennessee 37232, USA.
authors.forename: Tiffany N S
authors.initials: TN
authors.lastname: Ballard
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Kelly
authors.forename: Victor
authors.initials: V
authors.lastname: Zaydfudim
authors.forename: Noah L
authors.initials: NL
authors.lastname: Walcutt
authors.forename: Soheil S
authors.initials: SS
authors.lastname: Lahijani
authors.forename: R Bruce
authors.initials: RB
authors.lastname: Shack
authors.forename: Wesley P
authors.initials: WP
authors.lastname: Thayer
mesh_terms: D020341:Absorbable Implants; D001696:Biomechanical Phenomena; D001860:Bone Plates; D019245:Compressive Strength; D003398:Craniosynostoses / Q000601:surgery*; D020342:Finite Element Analysis; D006358:Hot Temperature; D006801:Humans; D016014:Linear Models; D017755:Prosthesis Fitting / Q000379:methods*; D012886:Skull / Q000002:abnormalities* / Q000601:surgery*; D012984:Software; D013718:Tensile Strength; D016896:Treatment Outcome