Polymer-Based Resorbable vs Non-resorbable Implants for Pediatric Upper Extremity Fractures: A Systematic Review.

BACKGROUND

Pediatric upper extremity fractures are common and frequently require surgical intervention. Traditional fixation methods using metallic implants, such as Kirschner wires and elastic stable intramedullary nails, offer reliable mechanical stability but necessitate secondary procedures for hardware removal. Polymer-based resorbable implants offer an advantage by eliminating the need for secondary procedures for hardware removal while maintaining efficacy. This systematic review evaluates the safety, efficacy, and clinical outcomes of resorbable compared to non-resorbable implants in pediatric patients.

METHODS

A systematic search of PubMed, Embase, and Web of Science was conducted according to PRISMA guidelines. Inclusion criteria targeted studies comparing outcomes of resorbable versus non-resorbable implants in pediatric upper extremity fractures. Risk of bias was assessed using the JBI critical appraisal tools. Nine studies met inclusion criteria, comprising one randomized controlled trial and eight retrospective cohort studies.

RESULTS

Nine studies including 391 pediatric patients were analyzed. The most common fractures involved the forearm (four studies), followed by lateral condyle (three studies) and medial epicondyle injuries (two studies). Mean patient age ranged from 5.6 to 11.6 years. Surgical site infections, skin irritation, postoperative pain, and nonunion were less common with resorbable implants with only one case requiring implant removal. Re-displacement was more frequent with resorbable implants but rarely required revision. Functional outcomes were comparable across groups.

CONCLUSIONS

Resorbable implants are a safe and efficacious alternative to traditional metallic devices for pediatric upper extremity fractures. Their favorable complication profile and elimination of hardware removal procedures support wider clinical adoption. Further randomized trials are warranted.