title: Debris of carbon-fibers originated from a CFRP (pEEK) wrist-plate triggered a destruent synovitis in human.
abstract: Application of carbon-fiber-reinforced-polymer (CFRP) artifacts in humans has been promoted in Orthopedic and Trauma Surgery. Literature documents the biocompatibility of materials used, namely carbon fibers (CF) and poly-ether thermoplastics, like poly-ether-ether-ketone (PEEK). A properly designed and accurately implanted composite artifact should not expose its fibers during or after surgery: however this may happen. A white Caucasian woman came to our attention 11 months after surgery for a wrist fracture. She had a severe impairment, being unable to flex the thumb; index finger and distal phalanx of third finger. We retrieved a correctly positioned plate and documented an aggressive erosive flexor tendons synovitis with eroded stumps of flexor tendons. The plate and soft tissues were analyzed by Visible Light and Scanning Electron Microscopy. Histopathology showed granulomatous fibrogenic process with CF engulfed inside multinucleated giant cells. Fibers were unmasked and disrupted inside the holes where screws were tightened and corrugation of the polymer coating led to further unmasking. The mechanism of foreign-body reaction to CF has not been studied in depth yet, particularly at the ultrastructural level and in Humans. This case documents a damage occurred in a clinical application and which was theoretically possible. Our opinion is that a proper way to promote the use of CRFP in the Clinic in the short term is to direct Research towards finding a better way to prevent CF debris to be exposed and released. In the longer term, the biological response to CF deserves a deeper understanding.
authors.affiliation: Orthopedic and Trauma Surgery, Policlinico Gemelli, Clinica Ortopedica, Fondazione Policlinico Universitario Gemelli, Universita' Cattolica del Sacro Cuore, Largo Gemelli 8, 00168, Rome, Italy. antonio.merolli@gmail.com.
authors.forename: Antonio
authors.initials: A
authors.lastname: Merolli
authors.affiliation: Orthopedic and Hand Surgery, Fondazione Policlinico Universitario Gemelli, Universita' Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Rocchi
authors.affiliation: Central Laboratory for Microscopy, Fondazione Policlinico Universitario Gemelli, Universita' Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: De Spirito
authors.affiliation: Service for Histopathology, Fondazione Policlinico Universitario Gemelli, Universita' Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Federico
authors.affiliation: Orthopedic and Hand Surgery, Fondazione Policlinico Universitario Gemelli, Universita' Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Morini
authors.affiliation: Orthopedic and Hand Surgery, Fondazione Policlinico Universitario Gemelli, Universita' Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Mingarelli
authors.affiliation: Orthopedic and Hand Surgery, Fondazione Policlinico Universitario Gemelli, Universita' Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Fanfani
mesh_terms: D000328:Adult; D000368:Aged; D001672:Biocompatible Materials; D001860:Bone Plates / Q000009:adverse effects*; D002244:Carbon / Q000009:adverse effects*; D000077482:Carbon Fiber; D005260:Female; D006801:Humans; D008855:Microscopy, Electron, Scanning; D010969:Plastics / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology / Q000473:pathology; D013499:Surface Properties; D013585:Synovitis / Q000209:etiology* / Q000473:pathology
chemical_list: D001672:Biocompatible Materials; D000077482:Carbon Fiber; D010969:Plastics; C037808:plastic, carbon fiber reinforced; D002244:Carbon