Severe Metal Hypersensitivity Following Internal Fixation of an Ankle Fracture: A Case Report

A 67-year-old woman underwent internal fixation of an ankle fracture. Ten days postoperatively, the patient developed systemic hives, difficulty breathing, and oral swelling. At 8 weeks postoperatively, the hardware was removed because of a suspected metal hypersensitivity. Despite experiencing perioral edema and difficulty breathing after the hardware removal, she had complete resolution of the symptoms at the 2-week, 6-week, and 12-month follow-up appointments.

Hypersensitivities to metal-based implants can develop and cause local and systemic reactions. Orthopaedic surgeons should inquire about a history of metal allergies, and possibly perform allergy testing for patients with a history suggestive of metal hypersensitivities. Consideration should be given for hospital admission following hardware removal for patient monitoring.