RT Journal
A1 Thomas, Peter
A1 Thomas, Manfred
A1 Summer, Burkhard
A1 Dietrich, Karin
A1 Zauzig, Melanie
A1 Steinhauser, Erwin
A1 Krenn, Veit
A1 Arnholdt, Hans
A1 Flaig, Michael J.
T1 Impaired Wound-Healing, Local Eczema, and Chronic Inflammation Following Titanium Osteosynthesis in a Nickel and Cobalt-Allergic PatientA Case Report and Review of the Literature
JF The Journal of Bone & Joint Surgery
JO The Journal of Bone & Joint Surgery
YR 2011
FD June 1
VO 93
IS 11
SP e61 1
OP 5
DO 10.2106/JBJS.J.00317
UL http://dx.doi.org/10.2106/JBJS.J.00317
AB 

			Patients known to develop allergic reactions to nickel (Ni), cobalt (Co), or chromium (Cr) often develop eczema in association with items of daily use such as jewelry, earrings, or watchbands. The overall sensitization rates to these metals may range between 1.1% (chromium) and 13% (nickel) in the general population, with further differences based on age and sex1. Chromium-cobalt alloys and stainless steel are widely used as orthopaedic implants and may release nickel, chromium, or cobalt into the surrounding tissues as a consequence of either wear or corrosion2. Some patients with a metal allergy may develop dermatitis in association with orthopaedic implants, and the prevalence of dermal sensitivity in patients with a joint replacement, particularly a failed implant, is higher than that in the general population3. Metal sensitivity rates to nickel, cobalt, or chromium may be as high as 43% in orthopaedic patients with well-functioning implants and as high as 71% in patients with poorly functioning implants3. In contrast, because of their excellent biocompatibility, titanium (Ti)-based materials are not considered to provoke allergic reactions. Our patient developed eczema and impaired wound-healing following the fixation of an ankle fracture with titanium-based implants. Histological analysis of the tissue around the implant demonstrated inflammation primarily with lymphocytes, and a contact allergy to nickel and cobalt was found in the absence of titanium hyperreactivity, raising the question of a prior unknown nickel exposure as the source of the complications. The patient was informed that data concerning this case would be submitted for publication, and she consented.