Background: Many patients request nail extraction or question the long-term effects of hardware retention. Systemic titanium degradation products may influence the timing of such decisions. The orthopedic literature provides no data regarding systemic titanium in patients undergoing intramedullary nail fixation with titanium implants. The purpose of this study was to determine the systemic level of serum titanium in patients who had undergone femoral nailing.
Methods: Patients who underwent antegrade locked femoral nailing utilizing a reamed technique with a titanium implant were eligible to participate. Eight patients were recruited for each of four time points: 6 weeks, 3 months, 6 months, and 1 year. Blood samples were collected from each subject. Serum titanium levels were analyzed through inductively coupled plasma/mass spectrometry (ELAN DRC II, Perkin Elmer, SCIEX, Inc, Shelton, CT). Test sensitivity was 0.2 microg/L. Normal serum titanium levels are <150 microg/L.
Results: Thirty-two patients were enrolled. The study group included 10 women and 22 men with average age of 32 (range 19-63) years. The most common fracture pattern was 32-A3 (n = 12), followed by 32-B2 (n = 9). No patients showed an elevated serum titanium level. Mean titanium levels were 49.38, 58.25, 49.38, and 50.63 microg/L at 6 weeks, 3 months, 6 months, and 12 months cohorts, respectively. No statistically significant differences were found (p = 0.207).
Conclusions: Standard intramedullary nail fixation of femur fractures did not result in elevated levels of serum titanium in the first year after surgery. Differences in serum titanium did not differ significantly across time since implantation.