Cutaneous metal sensitivity in patients with orthopaedic injuries.
BACKGROUND
Manufactures of orthopaedic fracture implants have turned to titanium in a pure form and an alloy during the past ten to fifteen years. Although primarily because of the biomechanical properties of this metal, concern for allergy to nickel and chromium ions in stainless steel was a factor in these decisions.


OBJECTIVE
To document the incidence of baseline sensitivity to metal ions and the incidence of conversion to sensitivity to one of three ions in stainless steel in a population of trauma patients at a Level I trauma center.


METHODS
Prospective, consecutive patient series.


METHODS
Level I trauma center.


METHODS
Patients eighteen years of age and older with no history of metallic implants were recruited for this study between October 1995 and July 1997. Four hundred ninety-three patients had a Finn chamber device with chromium, nickel, and cobalt ions, which were read using a photographic scale on day three. Two hundred forty-two of these patients had placement of a second patch, at a mean interval of 187 days (range 45 to 589 days).


METHODS
Internal fixation of fracture or osteotomy with metal implant. MAIN OUTCOME MANAGEMENT: Cutaneous reactivity to metal ions.


RESULTS
Prevalence of sensitivity to chromium was 0.2 percent, to nickel 1.3 percent, and to cobalt 1.8 percent. Rates for conversion from a negative to positive status were 2.7 percent for chromium, 3.8 percent for nickel, and 3.8 percent for cobalt. Rates for desensitization (i.e., converting from a positive to negative status) were 2.1 percent for nickel and 3.8 percent for cobalt.


CONCLUSIONS
The prevalence of sensitivity to nickel, cobalt, and chromium is apparently low. Similarly, internal fixation devices composed of stainless steel appear to result in an equal incidence of conversion to metal ionic sensitivity and desensitization to metal ions. It is conceivable that cutaneous sensitivity is not representative of deep immune response.
Department of Orthopaedic Surgery, University of Minnesota, Minneapolis 55455, USA.
M F
MF
Swiontkowski
J
J
Agel
J
J
Schwappach
P
P
McNair
M
M
Welch
D000328:Adult; D001858:Bone Nails; D001860:Bone Plates; D002857:Chromium / Q000494:pharmacology; D003035:Cobalt / Q000009:adverse effects; D003877:Dermatitis, Contact / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D050723:Fractures, Bone / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D008670:Metals / Q000009:adverse effects*; D008875:Middle Aged; D009532:Nickel / Q000009:adverse effects; D010328:Patch Tests; D015995:Prevalence; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity
D008670:Metals; D002857:Chromium; D003035:Cobalt; D009532:Nickel