EC Orthopaedics

Background: Persistent wound complications following ankle open reduction and internal fixation (ORIF) are typically attributed to infection, soft-tissue compromise, or mechanical irritation. Metal hypersensitivity is an uncommon and often overlooked cause of delayed wound healing, representing a diagnosis of exclusion.

Case Presentation: A 44-year-old woman with asthma, but no history of diabetes, smoking, or known metal allergy, underwent ORIF for a distal fibular fracture. Despite radiographic fracture union, she developed a chronic non-healing wound with distal wound dehiscence and exposed hardware for approximately six months postoperatively. Clinical examination, laboratory investigations, and intraoperative findings demonstrated no evidence of infection, implant loosening, or tissue necrosis. Following confirmation of fracture union, the plate and screws were removed. The wound healed uneventfully within three weeks, with complete resolution of symptoms and restoration of function.

Discussion: This case highlights suspected implant-related metal hypersensitivity as a potential cause of persistent wound complications after ankle ORIF when common etiologies have been excluded. The absence of infection, normal inflammatory markers, and rapid clinical improvement after implant removal support this diagnosis. Although definitive diagnostic testing was not performed, the clinical course is consistent with previous reports describing metal hypersensitivity as a delayed type IV immune reaction to orthopedic implants.

Conclusion: Metal hypersensitivity should be considered in patients with unexplained chronic wound dehiscence following fracture fixation after exclusion of infection and mechanical causes. Implant removal after confirmed fracture union may provide both diagnostic confirmation and definitive treatment, leading to successful wound healing.

Keywords: Ankle Fracture; Open Reduction and Internal Fixation; Metal Hypersensitivity; Wound Dehiscence; Implant Removal; Orthopedic Implants; Case Report

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