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A prospective randomized clinical trial was performed to evaluate the use of self-reinforced absorbable composites (Biofix) in the fixation of ankle fractures. The aim of this study was to demonstrate that fixation with Biofix rods and screws is as good as the standard A.O. fixation. The benefits of Biofix rods and screws are: a reduction in costs since no secondary operation is needed, prevention of stress-shielding and thereby diminishing the risk of bone porosity. Patients aged between 16 and 75 years old with closed, non-comminuted fractures of the lateral and/or medial malleolus and dislocation of the fracture fragments greater than 2 mm were included in the study. 22 patients were treated with Biofix rods and screws and the control group of 19 patients with a standard technique. After 3, 6 and 12 months, rontgenograms were taken. At the same time functional results were evaluated following the criteria of Olerud and Molander. Two patients were withdrawn from the trial for non-medical reasons. 22 patients (12 from the Biofix group, 10 from the AO group) operated two or more years ago were contacted to see if any complications had occurred since they were last seen. In 4 cases a Biofix screw broke down just beneath the head during insertion. This did not result in an insufficient fixation of the fracture. There were no early post-operative complications. The functional and rontgenological results in both groups were equal. In three cases a sterile sinus developed at the site of screw insertion. Biofix rods and screws, made of polylactic acid, are a good alternative for the fixation of fractures of the ankle. The use of resorbable fracture fixation material has the advantage that a second operation to remove osteosynthesis material is not necessary. The long term results are good. There is, however, a possibility of development of tissue reaction to the resorbable material.

Antibiotic prophylaxis in closed fractures is cost-effective if the risk of a deep infection is reduced by 0.25%. This control study was undertaken to assess the cost-effectiveness of prophylaxis of postoperative infections after surgical treatment of closed fractures. The costs for 16 patients with infections (8 with deep infections, 8 with superficial infections) were investigated and compared with the costs for 16 similar but non-infected patients with special reference to length of hospital stay, antibiotics and surgery. The data were collected from the trauma department of the University Hospital of the Free University in Amsterdam. Costs in the group of 8 patients with superficial wound infection were not substantially higher than those for their non-infected controls. The occurrence of a deep infection meant costs an average of DFL 35,224 higher than an uneventful postoperative course. On the basis of these results, antibiotic prophylaxis of postoperative wound infections is cost-effective if it reduces the risk of deep wound infections by about 0.25%.