Could a Titanium Ulnar Shortening Plate Trigger a Metal Allergy? A Case Report.

 With the growing use of metallic implants, increased research has focused on metal hypersensitivity. The purpose of this case report is to describe a patient with a suspected metal allergy to a titanium plate and to review the literature behind this controversial topic.  A 45-year-old woman underwent ulnar shortening osteotomy for ulnocarpal abutment. One year later, the patient continued to have chronic pain at the site of the implant, with negative work-up for infection, hardware loosening, or failure. During hardware removal, intraoperative findings revealed titanium particle wear in the surrounding tissues, and subsequent allergy testing revealed a new diagnosis of nickel allergy. Following hardware removal, the patient had complete resolution of her symptoms at 3 months without any recurrence after 12 months from the date of surgery.  Metals are the most common cause of allergic contact dermatitis. With the increased use of metallic implants, it is no surprise that metal implant allergies have become a cause for concern. While there are multiple tests to try and diagnose a metal implant allergy, there is no gold standard, and results are often difficult to interpret. Physicians need to be cognizant of metal allergies with there often vague symptoms as we continue to search for more reliable and affordable testing.  Metal implant allergies can be difficult to diagnose. It is often a diagnosis of exclusion but requires a heightened sense of awareness in the face of a negative work-up with persistent symptoms.