Skin Symptoms That Appeared after Fixation with a Titanium Plate in a Jaw Deformity Patient Suffering from Palmoplantar Pustulosis: A Case Report

Palmoplantar pustulosis (PPP) is a stubborn skin disease involving repeated aseptic small pustules on the palms and soles of the feet, which is triggered and exacerbated by metals and dental focal infections. There are few reports of an exacerbation of PPP symptoms after orthognathic surgery. The patient is a 40-year-old female who consulted an orthodontist at our hospital, complaining of a protruding maxilla and malocclusion. Under the diagnosis of skeletal prognathism, she underwent surgery for jaw deformity. Although no allergic symptoms were observed during the orthodontic treatment prior to surgery, postoperative scaling on the palms and soles of her feet worsened, and itching was observed on the skin, especially on the titanium plate used to secure the bone fragments. Under the diagnosis of metal allergy, treatment with steroids and vitamin D ointment failed to improve the condition, so surgery was performed to replace the metal plate with a non-metallic absorbable plate in the third postoperative month. Afterwards, the pruritus resolved, and erythema and scale on the palms and soles nearly disappeared. In the present case, though, oral bacterial infection, a past history of smoking, and stress from surgery were also considered to be possible causes of PPP exacerbation, and we concluded that one of the causes of PPP exacerbation was metal allergy from the plates or screws used to fix the bone fragments.

Clinical outcomes of absorbable plates (hydroxyapatite-poly-l-lactide composites) for phalangeal fractures - case reports

We report two cases of the basal phalanx fractures of the thumb treated with absorbable mesh plates. In both cases, the mesh plates specifically tailored for each fracture were effective in obtaining bone union and healing. We conclude that absorbable mesh plates could be a practical option for phalangeal fractures, especially where proprietary pre-molded metallic plates do not neatly fit the reduced fracture area.

Successful Surgical Fixation Using Bio-Absorbable Plates for Frail Chest in a Severe Osteoporotic Octogenarian

We present a case of a severe osteoporotic octogenarian who sustained serious flail chest from a traffic accident. The 3rd–9th ribs of the right chest wall were fractured. Non- operative management was unsuccessful. We performed a surgical fixation using a bio- absorbable and bio-active mini-plating set. This plating set is unsintered hydroxyapatite (u-HA) particles/poly-L-lactide (PLLA) composite osteosynthesis device commonly used for cranial, oral, and maxillofacial surgeries. The use of the u-HA/PLLA device for chest wall reconstruction has previously been reported, but no long-term results have been included. This case showed several advantages of the procedure with 4-year follow-up over other reported methods, especially in an osteoporotic elderly patient.