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Clinical Orthopaedics and Related Research®

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01-12-2010 | Clinical Research

Delayed Foreign-body Reaction to Absorbable Implants in Metacarpal Fracture Treatment

Authors: Panagiotis K. Givissis, MD, PhD, Stavros I. Stavridis, MD, PhD, Panayiotis J. Papagelopoulos, MD, PhD, Petros D. Antonarakos, MD, PhD, Anastasios G. Christodoulou, MD, PhD

Published in: Clinical Orthopaedics and Related Research® | Issue 12/2010

Abstract

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.

Questions/purposes

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?

Patients and 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.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Title: Delayed Foreign-body Reaction to Absorbable Implants in Metacarpal Fracture Treatment
Authors: Panagiotis K. Givissis, MD, PhD
Stavros I. Stavridis, MD, PhD
Panayiotis J. Papagelopoulos, MD, PhD
Petros D. Antonarakos, MD, PhD
Anastasios G. Christodoulou, MD, PhD
Publication date: 01-12-2010
Publisher: Springer-Verlag
Published in: Clinical Orthopaedics and Related Research® / Issue 12/2010
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-010-1388-3

At a glance: The STEP trials

Springer Medicine

Delayed Foreign-body Reaction to Absorbable Implants in Metacarpal Fracture Treatment

Abstract

Background

Questions/purposes

Patients and Methods

Results

Conclusions

Level of Evidence

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Questions/purposes

Patients and Methods

Results

Conclusions

Level of Evidence

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