Phedy Phedy, Djaja Yoshi P, Boedijono Dimas R, Wahyudi Muhammad, Silitonga Jamot, Solichin Iman
Department of Orthopaedic and Traumatology, Fatmawati General Hospital, Jakarta, Indonesia.
Rumah Sakit Orthopaedi Purwokerto, Purwokerto, Indonesia.
Int J Surg Case Rep. 2018;49:110-114. doi: 10.1016/j.ijscr.2018.06.011. Epub 2018 Jun 23.
Incidence of hypersensitivity to orthopaedic implant, once estimated in less than 1% of population, recently has increased to 10%. Controversies about the timing of implant removal remain, especially due to the fact that implant hypersensitivity may be a contributing factor to implant failure. We present a case report and literature reviews to establish the decision making for the timing of implant removal in the presence of implant hypersensitivity.
Female, 42 years old with nonunion of mid-shaft tibia and fibula which was treated with ORIF with conventional SAE16 stainless steel plate and bone graft. A week after, she developed a generalized rash, which is later diagnosed as erythroderma, that relapsed despite adequate systemic corticosteroid. Poor healing of surgical site wound were marked. After the implant removal, the cutaneous condition improved and no relapse were found.
Management of hypersensitivity to implants involved corticosteroid administration, removal or replacement of implants, or implants coating with polytetrafluoroethylene. Currently there are no specific guidelines regulating the management of implant allergy based on the timing of the onset, especially in fracture cases. The decision-making would be straightforward if union was already achieved. Otherwise, controversies would still occur. In this paper, we proposed an algorithm regarding the steps in managing metal allergy due to implant in fracture cases.
Despite the concerns regarding implant survival in hypersensitivity cases, the decision whether the implant should be removed or replaced should be based on the time and condition of the fracture healing process.
对骨科植入物过敏的发生率，曾估计在不到1%的人群中，最近已增至10%。关于植入物取出时机仍存在争议，尤其是因为植入物过敏可能是植入物失败的一个促成因素。我们呈现一例病例报告并进行文献综述，以确立在存在植入物过敏情况下植入物取出时机的决策依据。
一名42岁女性，胫骨干和腓骨干中段骨不连，采用常规SAE16不锈钢钢板切开复位内固定术及植骨治疗。一周后，她出现全身皮疹，后来被诊断为红皮病，尽管给予了足够的全身性皮质类固醇治疗，皮疹仍复发。手术部位伤口愈合不良明显。取出植入物后，皮肤状况改善，未再复发。
对植入物过敏的处理包括给予皮质类固醇、取出或更换植入物，或用聚四氟乙烯涂覆植入物。目前尚无基于发病时间来规范植入物过敏处理的具体指南，尤其是在骨折病例中。如果已经实现骨愈合，决策会很简单。否则，争议仍会出现。在本文中，我们提出了一种关于骨折病例中因植入物导致金属过敏的处理步骤的算法。
尽管在过敏病例中对植入物存活存在担忧，但关于是否应取出或更换植入物的决策应基于骨折愈合过程的时间和状况。
