Foreign-Body Granuloma after Metacarpal Fracture Treatment with Absorbable Implants

The treatment of unstable fractures or complex injuries of the hand frequently requires the implementation of rigid internal fixation. Traditionally, metallic implants have been used to achieve stability. However, the complication rates of metallic implants are high, with major complications reported in 36% of the patients considered in a series [1]. These complications included nonunion, delayed union, stiffness, plate palpation, infection, and tendon rupture. Therefore, bioabsorbable implants have been introduced to reduce these problems. The firstgeneration bioabsorbable implants showed a high complication rate due to weak mechanical properties and rapid degradation. This led to the development of stronger devices with improved durability. However, recently developed implants have raised concerns about late-occurring adverse reactions such as foreign body reactions. Herein, a case of foreign body granuloma after the use of an absorbable implant will be presented with a brief literature review. A 30-year-old male visited Bucheon St. Mary’s hospital with a swelling on his left hand after a slipand-fall injury. He was diagnosed with a left fifth metacarpal bone fracture by hand computed tomography (CT) and X-rays (Fig. 1). The first operation was performed 8 days after the injury, and open reduction was performed. To stabilize the fracture segments, a bioabsorbable plate and screws (Linvatec Biomaterials Ltd., Tampere, Finland) were used for internal fixation. Although the 1-year followup was uneventful, the patient visited us with swelling on the previous operation site. Physical exam showed just the swelling of the soft tissue of the operation site without any fluctuation, heat, or erythema. We recommended further evaluation such as an imaging study, but the patient refused to undergo it. Therefore, we decided to observe the patient without administering any medication because there was no evidence of infection. Four months later, the patient visited us again because of another trauma at the same site. Physical examination, CT, and X-rays were conducted, and the patient was diagnosed with a refracture of the fifth metacarpal bone with increased soft tissue swelling as compared to when we first noticed it 4 months previously (Figs. 2, 3). We