Since the 1980s, bioabsorbable implants have been increasingly utilized for fracture fixation and also for other orthopaedic procedures, including ligament reconstruction, meniscal repair, rotator cuff repair, and shoulder labral lesion repair1-4. The majority of bioabsorbable materials for implants are monopolymers or copolymers of polylactic acid (PLA) (including a levorotatory [PLLA] and a dextrorotatory [PDLLA] configuration), polyglycolic acid (PGA), and polydioxanone (PDS)3,4. The foreign-body reactions related to polyglycolic acid usually have emerged one to four months after implantation and have been well documented in the literature1,3,5. However, the in vivo degradation time of the stereoisomeric form of polylactic acid copolymers is much longer6. In contrast to polyglycolic acid, the tissue responses associated with polylactic acid (PLLA or PDLLA) are much less common5.
From June 2005 to December 2009, seventy-eight distal radial fractures were treated with these implants at our hospital. Three patients (4%) had a late foreign-body reaction twenty-one months after fixation. Debridement and removal of the remaining implant was curative in all three patients. Histopathological examination showed a nonspecific foreign-body reaction, and the retrieved particles were confirmed as polylactic acid polymers with use of Fourier transform infrared spectroscopy. The patients were informed that data concerning their cases would be submitted for publication, and they consented.
Case 1. A forty-eight-year-old woman sustained a closed, left distal radial fracture with intra-articular involvement when she slipped and fell in December 2005. She had no known systemic diseases and reported no allergies. Two weeks after the injury, she underwent open reduction and internal fixation with a bioabsorbable plate and screws (Inion OTPS Volar Radius Plates; Inion Oy, Tampere, Finland) (Fig. 1) through a volar radial (Henry) approach between the flexor carpi radialis tendon and the …
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