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Titanium Alloy Intramedullary Nails and Plates Affect Serum Metal Ion Levels within the Fracture Healing Period

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Abstract

Titanium alloy implants are the most used materials for the fixation of lower extremity fractures. Although these implants were thought to be inert materials in vitro, several studies have shown increased serum and remote tissue metal ion levels due to wear of implants and friction of the bone-implant interface in vivo. The aim of this study was to investigate the alteration of serum metal ion levels that are released from intramedullary nails and plates used for the fixation of lower extremity fractures, within the fracture healing period. The study included 20 adult patients, who were treated with intramedullary nail or plate osteosynthesis due to closed lower extremity fractures. Alterations of serum titanium, aluminum, molybdenum, and vanadium levels were evaluated at 6, 12, 18, and 24 weeks postoperatively. A statistically significant increase was determined in serum titanium, aluminum, molybdenum, and vanadium ion levels in the intramedullary nail and plate groups at the end of the follow-up period. Pairwise comparisons of metal ion levels between implant groups revealed no significant difference during a 24-week follow-up period. Compared to the control group, statistically significant increased levels of serum titanium, aluminum, vanadium, and molybdenum ions were determined in the implant groups used for the fixation of lower extremity fractures at the end of 24 weeks. In the current literature, the potential toxic effects of prolonged exposure to low levels of these metal ions are still unknown. It can be predicted that long-term metal ion exposure could result in vivo pathological processes in the future.

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Funding

This research was funded by the Turkish Society of Orthopaedics and Traumatology (TSOT) and Turkish Orthopaedics Research Council (TORC).

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Authors and Affiliations

  1. Faculty of Medicine, Department of Orthopedics and Traumatology, Erzincan Binali Yıldırım University, Erzincan, Turkey

    Oğuzhan Tanoğlu

  2. Faculty of Medicine, Department of Orthopedics and Traumatology, Ondokuz Mayıs University, Samsun, Turkey

    Ferhat Say

  3. Faculty of Medicine, Department of Orthopedics and Traumatology, Pamukkale University, Denizli, Turkey

    Mehmet Yücens

  4. Department of Orthopedics and Traumatology, SBU Ankara Research and Training Hospital, Ankara, Turkey

    Kadir Bahadır Alemdaroğlu & Serkan İltar

  5. Faculty of Medicine, Department of Orthopedics and Traumatology, Muğla Sıtkı Koçman University, Muğla, Turkey

    Nevres Hürriyet Aydoğan

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  1. Oğuzhan Tanoğlu
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  2. Ferhat Say
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  3. Mehmet Yücens
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  4. Kadir Bahadır Alemdaroğlu
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  5. Serkan İltar
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  6. Nevres Hürriyet Aydoğan
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Correspondence to Oğuzhan Tanoğlu.

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Tanoğlu, O., Say, F., Yücens, M. et al. Titanium Alloy Intramedullary Nails and Plates Affect Serum Metal Ion Levels within the Fracture Healing Period. Biol Trace Elem Res 196, 60–65 (2020). https://doi.org/10.1007/s12011-019-01913-1

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  • DOI: https://doi.org/10.1007/s12011-019-01913-1

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