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Debris of carbon-fibers originated from a CFRP (pEEK) wrist-plate triggered a destruent synovitis in human

  • Antonio MerolliEmail author
  • Lorenzo Rocchi
  • Marco De Spirito
  • Francesco Federico
  • Alessandro Morini
  • Luigi Mingarelli
  • Francesco Fanfani
Clinical Applications of Biomaterials Original Research
Part of the following topical collections:
  1. Clinical Applications of Biomaterials

Abstract

Application of carbon-fiber-reinforced-polymer (CFRP) artifacts in humans has been promoted in Orthopedic and Trauma Surgery. Literature documents the biocompatibility of materials used, namely carbon fibers (CF) and poly-ether thermoplastics, like poly-ether-ether-ketone (PEEK). A properly designed and accurately implanted composite artifact should not expose its fibers during or after surgery: however this may happen. A white Caucasian woman came to our attention 11 months after surgery for a wrist fracture. She had a severe impairment, being unable to flex the thumb; index finger and distal phalanx of third finger. We retrieved a correctly positioned plate and documented an aggressive erosive flexor tendons synovitis with eroded stumps of flexor tendons. The plate and soft tissues were analyzed by Visible Light and Scanning Electron Microscopy. Histopathology showed granulomatous fibrogenic process with CF engulfed inside multinucleated giant cells. Fibers were unmasked and disrupted inside the holes where screws were tightened and corrugation of the polymer coating led to further unmasking. The mechanism of foreign-body reaction to CF has not been studied in depth yet, particularly at the ultrastructural level and in Humans. This case documents a damage occurred in a clinical application and which was theoretically possible. Our opinion is that a proper way to promote the use of CRFP in the Clinic in the short term is to direct Research towards finding a better way to prevent CF debris to be exposed and released. In the longer term, the biological response to CF deserves a deeper understanding.

Keywords

Carbon Fiber UHMWPE Flexor Tendon Asbestosis CFRP Plate 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

Lorenzo Rocchi MD PhD is co-Author of this paper. A special thank to Mr. Mario Amici for his highly valuable assistance in preparing and analyzing SEM specimens.

Compliance with ethical standards

Conflict of interest

The Authors have no conflict of interest and no adverse attitude towards the manufacturer of the implant, which was given early notice of the results via his regional representatives.

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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Antonio Merolli
    • 1
    Email author
  • Lorenzo Rocchi
    • 2
  • Marco De Spirito
    • 3
  • Francesco Federico
    • 4
  • Alessandro Morini
    • 2
  • Luigi Mingarelli
    • 2
  • Francesco Fanfani
    • 2
  1. 1.Orthopedic and Trauma Surgery, Policlinico Gemelli, Clinica Ortopedica, Fondazione Policlinico Universitario GemelliUniversita’ Cattolica del Sacro CuoreRomeItaly
  2. 2.Orthopedic and Hand Surgery, Fondazione Policlinico Universitario GemelliUniversita’ Cattolica del Sacro CuoreRomeItaly
  3. 3.Central Laboratory for Microscopy, Fondazione Policlinico Universitario GemelliUniversita’ Cattolica del Sacro CuoreRomeItaly
  4. 4.Service for Histopathology, Fondazione Policlinico Universitario GemelliUniversita’ Cattolica del Sacro CuoreRomeItaly

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