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

  • Clinical Applications of Biomaterials
  • Original Research
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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.

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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.

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Authors and Affiliations

  1. Orthopedic and Trauma Surgery, Policlinico Gemelli, Clinica Ortopedica, Fondazione Policlinico Universitario Gemelli, Universita’ Cattolica del Sacro Cuore, Largo Gemelli 8, 00168, Rome, Italy

    Antonio Merolli

  2. Orthopedic and Hand Surgery, Fondazione Policlinico Universitario Gemelli, Universita’ Cattolica del Sacro Cuore, Rome, Italy

    Lorenzo Rocchi, Alessandro Morini, Luigi Mingarelli & Francesco Fanfani

  3. Central Laboratory for Microscopy, Fondazione Policlinico Universitario Gemelli, Universita’ Cattolica del Sacro Cuore, Rome, Italy

    Marco De Spirito

  4. Service for Histopathology, Fondazione Policlinico Universitario Gemelli, Universita’ Cattolica del Sacro Cuore, Rome, Italy

    Francesco Federico

Authors
  1. Antonio Merolli
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  2. Lorenzo Rocchi
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  3. Marco De Spirito
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  4. Francesco Federico
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  5. Alessandro Morini
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  6. Luigi Mingarelli
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  7. Francesco Fanfani
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Correspondence to Antonio Merolli.

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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.

Additional information

This paper was a podium presentation at the European Society for Biomaterials Congress 2015 and at the European Federation of Societies for Surgery of the Hand 2015.

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Merolli, A., Rocchi, L., De Spirito, M. et al. Debris of carbon-fibers originated from a CFRP (pEEK) wrist-plate triggered a destruent synovitis in human. J Mater Sci: Mater Med 27, 50 (2016). https://doi.org/10.1007/s10856-015-5664-3

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  • DOI: https://doi.org/10.1007/s10856-015-5664-3

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