title: A histologic analysis of the effects of stainless steel and titanium implants adjacent to tendons: an experimental rabbit study.
abstract: OBJECTIVE
  The current trend is to treat distal radius fractures with open reduction and internal fixation with either titanium or stainless steel plates. Both provide stable fixation; however, there is minimal evidence concerning the soft-tissue response to these materials. Our objective was to evaluate the response of adjacent extensor tendons to titanium and stainless steel in a rabbit in vivo model and to evaluate the influence of time.
  
  
  METHODS
  Forty rabbits were divided into 5 groups of 8 rabbits each. Groups I and II had unilateral osteotomy of the distal radius followed by dorsal fixation with titanium and stainless steel plates, respectively. Groups III and IV had fixation with titanium and stainless steel, respectively, but without osteotomy. Group V had surgical dissection without osteotomy or plates. Two animals per group were killed at 1, 4, 12, and 24 weeks. The specimens (distal radius, plate, overlying soft tissue, and extensor tendon) were harvested en bloc for histologic analysis. For interface preservation between implant and tissues the specimens were embedded in methylmethacrylate, sectioned, and stained with hematoxylin-eosin.
  
  
  RESULTS
  Histologic analysis showed a fibrous tissue layer formed over both implants between the plate and the overlying extensor tendons in the groups treated with plating independently of the material and the presence or absence of osteotomy. This fibrous layer contained the majority of debris. Metallic particles were not observed in the tendon or muscle substance of any animals; however, they were visualized in the tenosynovium. Hematoxylin-eosin-stained sections of groups I through IV showed proliferative fibroblasts and metallic particles; however, this layer was not observed in group V. Statistical analysis did not show differences between the groups regarding the number of cells or metallic particles.
  
  
  CONCLUSIONS
  Our results indicate that both implants generated adjacent reactive inflammatory tissue and particulate debris. There was no difference in cell or particle number produced by both materials. There is a statistically significant increase in inflammatory cells with increasing time of implantation.
authors.affiliation: Hand and Upper Extremity Service, Department of Plastic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. Anazzal@partners.org
authors.forename: Adam
authors.initials: A
authors.lastname: Nazzal
authors.forename: Santiago
authors.initials: S
authors.lastname: Lozano-Calderón
authors.forename: Jesse B
authors.initials: JB
authors.lastname: Jupiter
authors.forename: Jaime S
authors.initials: JS
authors.lastname: Rosenzweig
authors.forename: Mark A
authors.initials: MA
authors.lastname: Randolph
authors.forename: Sang Gil P
authors.initials: SG
authors.lastname: Lee
mesh_terms: D000818:Animals; D001860:Bone Plates; D049109:Cell Proliferation; D003238:Connective Tissue / Q000378:metabolism / Q000473:pathology; D005347:Fibroblasts / Q000378:metabolism; D005593:Fracture Fixation, Internal / Q000295:instrumentation; D015726:Giant Cells / Q000378:metabolism; D008264:Macrophages / Q000378:metabolism; D008853:Microscopy; D023421:Models, Animal; D010027:Osteotomy; D011817:Rabbits; D011885:Radius Fractures / Q000601:surgery*; D011897:Random Allocation; D013193:Stainless Steel; D013583:Synovial Membrane / Q000473:pathology; D013710:Tendons / Q000473:pathology*; D013997:Time Factors; D014025:Titanium
chemical_list: D013193:Stainless Steel; D014025:Titanium