Cutaneous metal sensitivity in patients with orthopaedic injuries

Marc F Swiontkowski, Julie Agel, John Schwappach, Patrick McNair, Marshall Welch

Research output: Contribution to journalArticle

54 Citations (Scopus)

Abstract

Background: Manufactures of orthopaedic fracture implants have turned to titanium in a pure form and an alloy during the past ten to fifteen years. Although primarily because of the biomechanical properties of this metal, concern for allergy to nickel and chromium ions in stainless steel was a factor in these decisions. Objectives: To document the incidence of baseline sensitivity to metal ions and the incidence of conversion to sensitivity to one of three ions in stainless steel in a population of trauma patients at a Level I trauma center. Design: Prospective, consecutive patient series. Setting: Level I trauma center. Patients: Patients eighteen years of age and older with no history of metallic implants were recruited for this study between October 1995 and July 1997. Four hundred ninety-three patients had a Finn chamber device with chromium, nickel, and cobalt ions, which were read using a photographic scale on day three. Two hundred forty-two of these patients had placement of a second patch, at a mean interval of 187 days (range 45 to 589 days). Intervention: Internal fixation of fracture or osteotomy with metal implant. Main Outcome Management: Cutaneous reactivity to metal ions. Results: Prevalence of sensitivity to chromium was 0.2 percent, to nickel 1.3 percent, and to cobalt 1.8 percent. Rates for conversion from a negative to positive status were 2.7 percent for chromium, 3.8 percent for nickel, and 3.8 percent for cobalt. Rates for desensitization (i.e., converting from a positive to negative status) were 2.1 percent for nickel and 3.8 percent for cobalt. Conclusion: The prevalence of sensitivity to nickel, cobalt, and chromium is apparently low. Similarly, internal fixation devices composed of stainless steel appear to result in an equal incidence of conversion to metal ionic sensitivity and desensitization to metal ions. It is conceivable that cutaneous sensitivity is not representative of deep immune response.

Original languageEnglish (US)
Pages (from-to)86-89
Number of pages4
JournalJournal of Orthopaedic Trauma
Volume15
Issue number2
DOIs
StatePublished - Feb 1 2001

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Nickel
Orthopedics
Chromium
Cobalt
Metals
Ions
Skin
Stainless Steel
Wounds and Injuries
Trauma Centers
Incidence
Internal Fixators
Internal Fracture Fixation
Osteotomy
Titanium
Hypersensitivity
Equipment and Supplies
Population

Keywords

  • Allergic reaction
  • Internal fixation
  • Metal sensitivity
  • Skin testing

Cite this

Cutaneous metal sensitivity in patients with orthopaedic injuries. / Swiontkowski, Marc F; Agel, Julie; Schwappach, John; McNair, Patrick; Welch, Marshall.

In: Journal of Orthopaedic Trauma, Vol. 15, No. 2, 01.02.2001, p. 86-89.

Research output: Contribution to journalArticle

Swiontkowski, Marc F ; Agel, Julie ; Schwappach, John ; McNair, Patrick ; Welch, Marshall. / Cutaneous metal sensitivity in patients with orthopaedic injuries. In: Journal of Orthopaedic Trauma. 2001 ; Vol. 15, No. 2. pp. 86-89.
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AB - Background: Manufactures of orthopaedic fracture implants have turned to titanium in a pure form and an alloy during the past ten to fifteen years. Although primarily because of the biomechanical properties of this metal, concern for allergy to nickel and chromium ions in stainless steel was a factor in these decisions. Objectives: To document the incidence of baseline sensitivity to metal ions and the incidence of conversion to sensitivity to one of three ions in stainless steel in a population of trauma patients at a Level I trauma center. Design: Prospective, consecutive patient series. Setting: Level I trauma center. Patients: Patients eighteen years of age and older with no history of metallic implants were recruited for this study between October 1995 and July 1997. Four hundred ninety-three patients had a Finn chamber device with chromium, nickel, and cobalt ions, which were read using a photographic scale on day three. Two hundred forty-two of these patients had placement of a second patch, at a mean interval of 187 days (range 45 to 589 days). Intervention: Internal fixation of fracture or osteotomy with metal implant. Main Outcome Management: Cutaneous reactivity to metal ions. Results: Prevalence of sensitivity to chromium was 0.2 percent, to nickel 1.3 percent, and to cobalt 1.8 percent. Rates for conversion from a negative to positive status were 2.7 percent for chromium, 3.8 percent for nickel, and 3.8 percent for cobalt. Rates for desensitization (i.e., converting from a positive to negative status) were 2.1 percent for nickel and 3.8 percent for cobalt. Conclusion: The prevalence of sensitivity to nickel, cobalt, and chromium is apparently low. Similarly, internal fixation devices composed of stainless steel appear to result in an equal incidence of conversion to metal ionic sensitivity and desensitization to metal ions. It is conceivable that cutaneous sensitivity is not representative of deep immune response.

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