Risk of complications of first metatarsal head osteotomies with biodegradable pin fixation: Biofix versus Orthosorb

Bioabsorbable materials for fracture repair have recently become available in the United States. These products have been especially attractive to surgeons that perform elective foot surgeries because an additional surgery is not required to remove internal fixation, and exposed pins and their complications can be avoided. The aim of this study was to compare complications in distal first metatarsal head osteotomies fixed with Biofix, polyglycolide pins and Orthosorb, polydioxanon pins. The authors identified nine patients with 11 distal first metatarsal osteotomies repaired with Biofix and 28 patients with 34 osteotomies repaired with Orthosorb from surgery logs for a 2-year period. The authors abstracted medical records and radiographs to identify sterile sinus formation, non-unions, malunions, and osteolytic lesions. The age and gender of patients in the Orthosorb and Biofix groups were similar. Six osteotomies in five patients in the Biofix group demonstrated bone resorption and osteolytic changes involving the osteotomy. Two of these patients also had a dorsally subluxed malunion of the first metatarsal head. There was one dorsally subluxed malunion in the Orthosorb group. No sterile sinus tracts were identified in either group. Complications were more common in distal first metatarsal osteotomies fixed with Biofix compared with Orthosorb (Biofix 55%, Orthosorb 3%, p < 0.001, odds ratio: 39.6, confidence interval (CI) = 3.9-401.6). Complications in the Biofix group were significantly more common in patients 50 years of age and older (p < 0.05).