Delayed foreign-body reaction to absorbable implants in metacarpal fracture treatment.
BACKGROUND
First-generation bioabsorbable implants have been associated with a high complication rate attributable to weak mechanical properties and rapid degradation. This has led to the development of stronger devices with improved durability. However, the modern implants have raised concerns about potential late-occurring adverse reactions.


OBJECTIVE
This retrospective study addressed the following questions: Can absorbable implants consisting of trimethylene carbonate, L-lactide, and D,L-lactide provide adequate fixation for healing of a metacarpal fracture? Will these implants obviate a second removal operation? What complications can occur in the reaction to implant breakdown?


METHODS
Twelve unstable, displaced, metacarpal fractures were studied in 10 consecutive patients (seven men, three women; mean age, 36.4 years; range, 18-75 years). The fractures were treated with absorbable plates and screws consisting of the aforementioned copolymers and designed to resorb in 2 to 4 years. Nine patients (10 fractures) were available for clinical and radiographic followups (mean, 45.7 months; range, 34-61 months).


RESULTS
Fracture healing was uneventful in all cases. Four patients experienced a foreign-body reaction during the second postoperative year and required surgical débridement to remove implant remnants. Histologic examination confirmed the diagnosis of a foreign-body reaction. Two other patients reported a transient local swelling that subsided without treatment.


CONCLUSIONS
Our results indicate these absorbable implants for metacarpal fractures achieved adequate bone healing but simply postponed the problem of foreign-body reactions. Patients treated with bioabsorbable implants should be advised of potential late complications and should be followed for at least 2 years, possibly longer.
Givissis
Panagiotis K
PK
1st Department of Orthopaedics, Aristotle University of Thessaloniki, G. Papanikolaou General Hospital, Thessaloniki, Greece. givissis@otenet.gr
Stavridis
Stavros I
SI
Papagelopoulos
Panayiotis J
PJ
Antonarakos
Petros D
PD
Christodoulou
Anastasios G
AG
D020341:Absorbable Implants / Q000009:adverse effects*; D000293:Adolescent; D000328:Adult; D000368:Aged; D001860:Bone Plates / Q000009:adverse effects*; D001863:Bone Screws / Q000009:adverse effects*; D003646:Debridement; D020878:Device Removal; D004146:Dioxanes / Q000009:adverse effects; D004867:Equipment Design; D005260:Female; D005549:Foreign-Body Reaction / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D005593:Fracture Fixation, Internal / Q000009:adverse effects* / Q000295:instrumentation; D017102:Fracture Healing; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D006115:Greece; D006801:Humans; D008297:Male; D050279:Metacarpal Bones / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D008875:Middle Aged; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D004146:Dioxanes; C443643:trimethylene carbonate; C091880:dilactide
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