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C OPYRIGHT
2020 BY T HE J OURNAL OF B ONE AND J OINT S URGERY, I NCORPORATED

Biohackers and Self-Made Problems: Infection of an

Implanted RFID/NFC Chip
A Case Report
Alain Schiffmann, MD, Martin Clauss, MD, and Philipp Honigmann, MD

Investigation performed at Kantonsspital Baselland, Liestal, Switzerland

Abstract
Case: We describe the case of a 26-year-old man with an infected Radio-Frequency-Identification/Near Field Communication
(RFID/NFC) chip in the middle finger. The RFID/NFC chip was removed, the soft tissue debrided, and a pan-sensitive
Downloaded from http://journals.lww.com/jbjscc by BhDMf5ePHKbH4TTImqenVAPwFBsBoeDVspUzcFtbCS/RJBioEdhZHtspYvKf8Yhn on 05/31/2020

staphylococcus aureus was detected by sonication of the RFID/NFC chip. The patient was postoperatively treated with
amoxicillin and clavulanic acid (24 hours iv, total 11 days) and an intrinsic plus splint which led to complete recovery.
Conclusion: Modern body modifications can lead to infections which shouldn't be underestimated. Interdisciplinary
treatment is a key to success.

R
FID/NFC chips (Radio-Frequency-Identification/Near
Field Communication) are wireless devices working at
short distance. The most common uses are contactless
payment chips on credit cards or badge systems in hospitals and
other institutions (keys and payment solutions). The chips rely
on an external electrical source to communicate with devices.1
In 1998, British researcher Kevin Warwick described the
first implantation of a microchip in humans, using himself as
the subject2. He laid the foundation for further implantations
of chips and contributed to the recent trend of “biohackers” or
“grinders,” a movement in which individuals experiment with
enhancing the human body with electronic devices. A rough esti-
mation counted 50,000 to 100,000 individual participants3. Com-
mon objects implanted in the hand are neodymium magnets,
microchips, and light emitting diode chips. Most implants are
embedded in a coating to reduce the reaction of the immune
system (bioproofing). Coating can consist of glass, medical grade
borosilicate, silicone, or titanium4. Some implants are placed by
subdermal needles, others by minor surgeries.5
In PubMed and the Cochrane Library, there are many
articles about implant-associated infections, however none con-
cerning body modifications such as microchips. Many publications
thereof are found in the Institute of Electrical and Electronics
Engineers-Explore—the engineers’ counterpart of PubMed and the
Cochrane Library—but none regarding infections6. The following
keywords were used to search the databases: “Infection,” “Hand,”
“RFID,” “NFC,” “Implant,” “Chip,” “Tag,” “Transhumanist,” “Bio- Fig. 1
hack,” “Grinder” and “Body modification.” This report aims to Hand with epifocal inflammation and orifice.

Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/
JBJSCC/B120).

JBJS Case Connect 2020;10:e0399 d http://dx.doi.org/10.2106/JBJS.CC.19.00399

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Fig. 2 Fig. 3

Fig. 2 x-ray of the middle finger with visible RFID chip

and another chip beside the second metacarpal bone.
Fig. 3 Implant. Fig. 4 Middle finger clinically.

Fig. 4
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Fig. 5-A
Figs. 5-A and 5-B x-ray at the 15-month follow-up.
draw the attention of the hand surgical community to this recent
trend of biohacking, its complications and to the lack of evidence in
this field. The patient was informed that data concerning the case
would be submitted for publication, and he provided consent.
Case Report
I n February 2018, the 26-year-old Swiss patient travelled to
the Netherlands for the implantation of an RFID/NFC chip.
He already had an RFID/NFC chip implanted next to the second
metacarpal bone several months before. The patient described
the environment in which the implantation took place as clean
and sterile. Furthermore, he mentioned that the implant was
immersed in chlorhexidine before implantation. He was able to
watch the entire procedure.
BIO HACK ERS AND S E L F -M A D E P R O B L E M S
Fig. 5-B
Soon after the implantation, the patient noticed a continuous
secretion of a clear fluid from the wound. After removal of the sutures
and daily change of dressing, he was able to use his hand without
limitations for 3 months while reporting an ongoing secretion. With
sudden onset of pain, red, and warm swelling, he reported to the
emergency department 3 months after the implantation (Fig. 1).
On admission, the wound was mostly dry with epifocal
inflammation and lymphangitis proximal to the elbow joint.
No palpable lymph nodes. On pressure, there was a secretion of
pus through the orifice. We found a c-reactive protein of 7 mg/L
and a leukocytosis of 12.5 G/L.
The chip was removed under regional anesthesia (plexus).
The implant size was 22 · 8 mm, coated with USP class VI, ISO
10993 tested biopolymer (flexNT NFC Tag [NTAG216])7 and
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was located directly at the peritendineum of the common
extensor (Figs. 2 and 3).
Three biopsies for microbiological and 3 for histological
analyses were obtained. The chip was processed by sonication.
Histologically, acute and chronic inflammation with a foreign-
body reaction (giant cells) was found. A pan-sensitive staph-
ylococcus aureus could be isolated in the microbiological analysis.
After the reduction of the bacterial load by debridement, the treat-
ment was continued with intravenous amoxicillin/clavulanic acid (3
· 2.2 g) for 24 hours, followed by oral therapy (3 · 1 g/d) for another
10 days based on the interdisciplinary treatment scheme. An intrinsic
plus splint was applied for the first 7 days of wound healing, followed
by occupational therapy to initiate finger movement. The patient
recovered completely. At the 15-month follow-up, the patient pre-
sented with normal values for active range of motion and without
any clinical and radiological signs of chronic infection (Figs. 4 and 5).
Discussion
A recent publication by Koshy et al. focused on hand infections
unfortunately does not mention any foreign body–associated
infections in the hand8. There are no publications on how many
chips are being implanted, how many complications occur, or
how complications were managed. The result of the microbio-
logical analysis of this case revealed S. aureus.
Staphylococci are the most common causative organisms
in orthopaedic implant–associated infections. Although S. aureus
normally presents with a virulent course of infection, S. epidermidis
is often associated with unspecific symptoms such as pain, hyper-
trophic scares, and scare contractures.9,10
Although body modifications have an ancient tradition,
new implants will create new challenges for surgeons. With more
References
1. Shobha NSS, Aruna KSP, Bhagyashree MDP, Sarita KSJ. NFC and NFC pay-
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Government (ICTBIG). Indore, India: IEEE; 2016:1-7.
2. BBC. Sci/Tech Technology Gets Under the Skin. 1998. Available at: http://
news.bbc.co.uk/2/hi/science/nature/158007.stm. Accessed January 6,
2019.
3. Grauer Y. A Practical Guide to Microchip Implants. 2018. Ars Technica. Available
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implants/. Accessed January 22, 2019.
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BIO HACK ERS AND S E L F -M A D E P R O B L E M S
frequent implantations and different locations, a new spectrum of
bacteria and a multitude of complications may arise.
National registries of medical implants are mandatory in
many countries. Establishing a mandatory international registry
on implanted microchips and statistic evaluation of complications
would reveal the true number of otherwise unreported cases. This
would help to know more about the used materials and their
microbiological colonization, which in return could help improve
therapy. n
Alain Schiffmann, MD1
Martin Clauss, MD2,3
Philipp Honigmann, MD1,4
1Hand Surgery, Kantonsspital Baselland, Liestal, Switzerland
2Interdisciplinary
septic Surgical Unit, Department of Orthopaedics,
Kantonsspital Baselland, Liestal, Switzerland
3Department for Orthopaedics and Trauma Surgery, University Hospital
Basel, Basel, Switzerland
4MedicalAdditive Manufacturing Research Lab, Department of
Biomedical Engineering, University of Basel, Basel, Switzerland
E-mail address for P. Honigmann: philipp.honigmann@ksbl.ch
ORCID iD for A. Schiffmann: 0000-0003-1170-7928
ORCID iD for M. Clauss: 0000-0002-1598-2209
ORCID iD for P. Honigmann: 0000-0002-4743-5082
6. Masters A, Michael K. Humancentric applications of RFID implants: the usability
contexts of control, convenience and care. In: Second IEEE International Workshop
on Mobile Commerce and Services. Munich, Germany: IEEE; 32-41.
7. flexNT NFC Tag [NTAG216]. Available at: https://dangerousthings.com/shop/
flexnt/#more-details. Accessed January 21, 2019.
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biofilm load of K wires in toe surgery: titanium versus stainless steel. Clin Orthop
Relat Res. 2013;471(7):2312-7.
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implant-related infections of the hand and fingers: results from a twelve-year
observational study. Surg Infect (Larchmt). 2018;19(7):729-34.