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

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).

Graft osteolysis and recurrent instability after the Latarjet procedure performed with bioabsorbable screw fixation

“…3,6,8 Foreign body reaction was associated with third-generation implants too. 22 In our study, we used a second-generation screw (RFS screw) for fixation of the coracoid process during the Latarjet procedure. This screw is composed of a copolymer of L-lactic/co-glycolic acid (PLGA 85L/15G), which is reported by the manufacturer to be fully resorbed within 2 years.…”

Metacarpal Fractures: Treatment and Complications

“…All fractures united and there were no reported complications with a minimum of 6-month follow-up [39]. Prospective, randomized controlled trials of absorbable plates are lacking, however, and delayed foreign body reactions have been described up to 2 years after fracture fixation [17]. Bioabsorbable plates are also more expensive, and one cost-benefit analysis found that a hardware removal of at least 19 % would be required to break even as compared to use of metal plates [6].…”

Absorbable implants versus metal implants for the treatment of ankle fractures: A meta-analysis

“…The incidence of foreign body reactions in our study was 4.8% (9/186), which is slightly lower than that of 6.1% reported in the study by Böstman (26). Although foreign body reactions occurred and fluid accumulated topically, the fracture healing was uneventful (27). AIs had no specific inhibitory and stimulatory effects on bone compared with metal materials (28).…”