title: Pre-packed vacuum bone cement mixing systems. A further step in reducing methylmethacrylate exposure in surgery.
abstract: OBJECTIVE
  Polymethylmethacrylate bone cements are widely used in orthopaedic and trauma surgery as well as in dentistry. The toxic side effects of inhaled methylmethacrylate (MMA) fumes generated during mixing have been well studied. Vacuum cement mixing systems have been shown to reduce the risk of airborne MMA significantly compared to handmixing. In an effort to further reduce MMA exposure, the latest generation of mixing devices are pre-packed with the ingredients and thus allow preparation in nearly closed circuits. Until now, there has been no study proofing the efficacy of those systems in protecting theatre staff from MMA vapours.
  
  
  METHODS
  A pre-packed vacuum mixing system (Optipac®) was compared with two standard systems (Palamix® and Easymix®) regarding MMA emission. The latter systems require loading with the bone cement compounds prior to mixing. Following a standardized procedure, 10 mixes were performed with each system and the emission of MMA vapours in the breathing zone was recorded using photoionization detection over a period of 3 min.
  
  
  RESULTS
  The mean MMA exposure was reduced when using the pre-packed system compared to the devices that require filling with the components. The highest emission peaks were recorded during the mixing and preparation steps in all systems.
  
  
  CONCLUSIONS
  Modern pre-packed vacuum mixing systems further help to reduce the occupational hazards created by bone cement preparation. However, MMA fumes can still be detected using this technique. Although this is an important step in reducing MMA exposure in the operating theatre, further technical effort has to be taken to eliminate the continuous leakage of monomer from the devices while mixing and to minimize necessary manipulation for final delivery.
authors.affiliation: Department of Orthopaedic and Trauma Surgery, University of Cologne, Joseph-Stelzmann-Strasse 9, 50924 Cologne, Germany. ulf.schlegel@gmx.net
authors.forename: Ulf J
authors.initials: UJ
authors.lastname: Schlegel
authors.forename: Michael
authors.initials: M
authors.lastname: Sturm
authors.forename: Peer
authors.initials: P
authors.lastname: Eysel
authors.forename: Steffen J
authors.initials: SJ
authors.lastname: Breusch
mesh_terms: D016902:Air Pollution, Indoor / Q000032:analysis / Q000517:prevention & control*; D001843:Bone Cements / Q000009:adverse effects* / Q000627:therapeutic use; D004867:Equipment Design; D004864:Equipment and Supplies; D006801:Humans; D019570:Inhalation Exposure / Q000032:analysis / Q000517:prevention & control* / Q000706:statistics & numerical data; D008768:Methylmethacrylates / Q000009:adverse effects / Q000032:analysis* / Q000627:therapeutic use; D016273:Occupational Exposure / Q000032:analysis / Q000517:prevention & control* / Q000706:statistics & numerical data; D009873:Operating Rooms; D019637:Orthopedic Procedures; D019064:Product Packaging; D014618:Vacuum
chemical_list: D001843:Bone Cements; D008768:Methylmethacrylates