Debris of carbon-fibers originated from a CFRP (pEEK) wrist-plate triggered a destruent synovitis in human
- 308 Downloads
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.
KeywordsCarbon Fiber UHMWPE Flexor Tendon Asbestosis CFRP Plate
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.
- 2.Planell J, Best S, Lacroix D, Merolli A, editors. Bone repair biomaterials. Cambridge: Woodhead Publishing Ltd; 2009.Google Scholar
- 3.Xin-ye N, Xiaobin T, Changran G, Da C. The prospect of carbon fiber implants in radiotherapy. J Appl Clin Med Phys. 2012;13(4):3821.Google Scholar
- 4.Tayton K, Phillips G, Ralis Z. Long term effects of carbon fibre on soft tissues. J Bone Joint Surg. 1982;64B(1):112–4.Google Scholar
- 10.Ali MS, French TA, Hastings GW, Rae T, Rushton N, Ross ERS, Wynn-Jones CH. Carbon fibre composite bone plates. Development, evaluation and early clinical experience. J Bone Joint Surg Br. 1990;72(4):586–91.Google Scholar
- 11.Wexler P, editor. Encyclopedia of toxicology, vol. 1. 2nd ed. San Diego: Elsevier; 2005. p. 179–82.Google Scholar
- 12.Rosenthall L. Radiophosphate visualization of the foreign body reaction to wear debris from total knee prosthesis. J Nucl Med. 1987;28(5):915–7.Google Scholar
- 13.Sudanese A, Ciappetti G, Baldini N, Stea S, Ciaroni D, Dallari D, Toni A, Giunti A. An evaluation of the “in vivo” and “in vitro” biological reaction and mechanical features of carbon fibre composites. Chir Organi Mov. 1990;75(2):171–6.Google Scholar
- 20.Hacking SA, Pauyo T, Lim L, Legoux JG, Bureau MN. Tissue response to the components of a hydroxyapatite-coated composite femoral implant. J Biomed Mater Res A. 2010;94(3):953–60.Google Scholar