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Coldsteel24
04-15-2009, 13:45
I've searched for anything to do with metal plates/pins/screws and allergies related to them, and found nothing, if I missed something, I'll knock out 50. If I'm out of line posting this question, I'll apologize if necessary. On to the question:
My wife broke her right ankle last year, and they placed titanium screws and a plate in her ankle to support the bones as they healed. shortly after, she started getting a strange skin rash localized to the surgery that resembles chicken pox, rather small sores that itch and don't seem to go away no matter what she tries. My question is has any of you ever heard of this before, could it be an allergy to the metal? I'm guessing the screws and plate aren't 100% titanium as it is a soft metal, and I'm guessing its an alloy. The only known allergies she has are to Sulfa drugs. Any help would be greatly appreciated.

FMF DOC
04-15-2009, 14:31
This is not my field of expertise at all, but sounds like this has been going on for awhile and if it was anything serious such as a reaction to the screws I'd think it be a lot worse by now and more symptoms. I suggest an appointment with a dermatologist and go from there.

Coldsteel24
04-15-2009, 14:51
Thank you for the suggestion sir. I've shown her what you wrote and it seems you are better at convincing her to see a doctor than I am :D

Team Sergeant
04-15-2009, 20:45
Stand by,

HEY Physicians,

I thought this was a good question!!!!! I had some strange rash after a surgical procedure and I never got an answer to what it might have been. ;)

Team Sergeant

olhamada
04-15-2009, 21:01
The short answer is, yes, it certainly could be an allergy or a sensitivity to the titanium or one of the other metals in the alloy such as aluminum or vanadium.

Initially, these "breakouts" are usually diagnosed as skin infections, but if persistent, a metal allergy should be considered.

Titanium and titanium alloys are generally considered to be more biocompatible (i.e. - less likely to cause an allergic reaction) than other materials such as stainless steel (primarily because of the nickel in stainless), but still can cause a reaction.

This is from the Zimmer website (a company that manufactures orthopaedic surgical instruments and implants):

Titanium Alloys

Titanium alloys are considered to be biocompatible. They are the most flexible of all orthopaedic alloys. They are also lighter weight than most other orthopaedic alloys. Consisting mostly of titanium, they also contain varying degrees of other metals, such as aluminum and vanadium.

Titanium

Pure titanium may also be used in some implants where high strength is not required. It is used, for example, to make fiber metal, which is a layer of metal fibers bonded to the surface of an implant to allow the bone to grow into the implant, or cement to flow into the implant, for a better grip.

There was also a very good paper from March 2001 in the Journal of Bone and Joint Surgery that addressed this issue. http://www.ejbjs.org/cgi/reprint/83/3/428.pdf

Hope this helps!

Coldsteel24
04-17-2009, 08:34
Thank you for the link olhamada, the new knowledge is appreciated greatly.

Pete
04-17-2009, 10:19
As a side note why does it seem like cuts from Aluminium seem to fester more than a regular cut from something else?

olhamada
04-21-2009, 07:30
As a side note why does it seem like cuts from Aluminium seem to fester more than a regular cut from something else?

No clue. If I find out - I'll let you know. :)

Sacamuelas
04-22-2009, 22:05
I deal with titanium implant integration into human bone as well as the soft tissure response to titanium alloys in my profession very frequently. Titanium allergies are very uncommon, but they are not to be disregarded in your particular circumstances.

From most of the studies I have read, the allergy testing to Ti and its medical grade alloys ranges from .6% up to about 3% of the population.

It is generally not accepted as the standard of care for pre-op allergy testing of patients for Ti allergies. However, in someone with known history of metal allergies or in an unexplained potential allergic reaction, the allergy testing ought to be considered. This is, of course, after all more likely etiologies of the symptoms have been ruled out.

I have never had to deal with this personally, but there are several different testing methods available. I would discuss the options with your orthopod or at the very least her general practitioner. Postop radiographs of her ankle ought to show a lack of osseointegration(bone attachment to implant screws) by this time (over 1 year postop) if her symptoms were related to either a failing screw, infection, etc.

Good luck

Boomer-61
04-23-2009, 12:22
I know the question is about metal allergies but, when you mention redness, blisters etc, my mind first goes to infection. I've been putting metal alloy implants in patients for about 20 years and have yet to RECOGNIZE any metal alloy reactions. Ankle repairs are know for breaking down. Does your wife have: diabetes, coronary artery disease, obesity, a history of immuno compromise disease, or does she smoke? If any of the above are true, think about having a sedimentation rate, C-reative protein and complete blood count drawn to rule out infection. I'm sure she has an excellent orthopedist who is thinking about these things too.
Boomer

Coldsteel24
04-23-2009, 12:43
I would like to sincerely thank those of you who have posted replies and insight into this question; it's what makes this forum great.



I know the question is about metal allergies but, when you mention redness, blisters etc, my mind first goes to infection. I've been putting metal alloy implants in patients for about 20 years and have yet to RECOGNIZE any metal alloy reactions. Ankle repairs are know for breaking down. Does your wife have: diabetes, coronary artery disease, obesity, a history of immuno compromise disease, or does she smoke? If any of the above are true, think about having a sedimentation rate, C-reative protein and complete blood count drawn to rule out infection. I'm sure she has an excellent orthopedist who thinking about these things too.
Boomer

She does smoke. none of the rest of the issues you mention are present. I will relay your thoughts to her orthopedist, and everything else I've gotten from this question, hopefully we'll figure it out.

The spots I'm refering to are hard to explain, I'm no where near a doctor, 14 years of CLS doesn't infer I know anything deeper than the ABC's of life saving, but they look like mosquito bites that you itch until they scab over, then itch the scab off.. that's the best way I know how to describe them. They do itch, apparently. She is constantly scratching at them.

Again, Physicians, thank you very much for the thoughts