Intense Granulomatous Inflammatory Lesions Associated With Absorbable Internal Fixation Devices Made of Polyglycolide in Ankle Fractures

Abstract

Since absorbable internal fracture fixation devices made of polyglycolide have been increasingly used clinically, a peculiar type of complication has emerged. After an initially uneventful course, a local nonbacterial inflammatory reaction appears two to four months after the operation, resulting in a copiously discharging sinus on the skin. A series of 286 patients with unimalleolar or bimalleolar fractures were treated by open reduction and internal fixation using cylindrical rods made of polyglycolide. Among these there occurred 18 nonbacterial inflammatory tissue responses (6.3% of the total) requiring surgical drainage. Six patients had an intense reaction necessitating repeated surgical measures and inpatient management. The hospital stay of these patients averaged 18 days. The mean duration of the discharge from the lesions was 10.8 weeks. Microscopic examination of biopsy specimens showed a nonspecific foreign-body reaction composed mainly of neutrophilic polymorphonuclear leukocytes and foreign-body giant cells phagocytizing the polymer debris left behind by the decomposing implants. On roentgenograms, osteolytic increase of the diameter of the implant channels was observed, but the bony union of the fracture seemed not to be disturbed. Thus the factors increasing the susceptibility of some individuals to this complication remain unknown.