Removal of Metal Fixators after Consolidation of Bone Fractures: To Do or Not to Do? (Literature Review)
ARTICLE PDF (Українська)

Keywords

analysis of literature; removal of metal fixators; expediency of surgical treatment.

How to Cite

Kalashnikov, A., Verkhovskyi, O., Kalashnikov, O., & Procenko, V. (2022). Removal of Metal Fixators after Consolidation of Bone Fractures: To Do or Not to Do? (Literature Review). TERRA ORTHOPAEDICA, (3(114), 55-60. https://doi.org/10.37647/0132-2486-2022-114-3-55-60

Abstract

Summary. Removal of metal fixators today is one of the most common surgical interventions in developed countries. According to many European researchers, surgeries performed to remove metal fixators account for almost 30% of all planned surgical interventions and 15% of the total number of surgeries performed in trauma departments. This certainly indicates the great social significance of the problem. An analytical review of the literature has shown that the surgery of removing metal fixators in the consolidation of bone fractures is not a routine procedure; it requires experience and training of the surgeon. The problem of removal of metal fixators in some individual cases and localizations is not completely solved and requires further clinical and experimental studies.

https://doi.org/10.37647/0132-2486-2022-114-3-55-60
ARTICLE PDF (Українська)

References

Bostman O, Pihlajamaki H. Routine implant removal after fracture surgery: a potentially reducible consumer of hospital resources in trauma units. J. Trauma, 1996; 41: 846-849. DOI: 10.1097/00005373-199611000-00013.

Molster A, Behring J, Gjerdet NR, Ekeland A. Removal of osteosynthetic implants. Tidsskr. Nor Laegeforen, 2002; 122: 2274-2276. PMID: 25452945

Watson-Jones R. Fractures and joint damage M.: Medicine, 1972: 672 p.

McGarry S, Morgan S J, Grosskreuz R M, Williams A E, Smith W R. Serum titanium levels in individuals undergoing intramedullary femoral nailing with a titanium implant. J. Trauma, 2008; 64(2): 430-433. DOI: 10.1097/01.ta.0000240445.20220.54.

Загородний НВ, Волна AA, Панин МА. Удаление металлоконструкций в травматологии: учебно-методическое пособие. М.: РУДН, 2009: 22. Zagorodniy NV, Volna AA, Panin MA. Removal of metal structures in traumatology: teaching aid. M.: RUDN, 2009: 22. [in Russian].

Linder L. Osseointegration of metallic implants. I. Light microscopy in the rabbit. Acta Orthopaedica Scandinavica, 1989; 60(2):129-134. DOI: 10.3109/17453678909149239.

Seebauer CJ, van Scherpenzeel KM, Haas NP, Bail HJ. Tibia fracture following removal of the ETN (Expert Tibia Nail): a case report. Arch. Orthop. Trauma Surg, 2009;129 (7):949-53. DOI: 10.1007/s00402-008-0805-5.

Ehlinger M, Adam P, Simon P, Bonnomet F. Technical difficulties in hardware removal in titanium compression plates with locking screws. Rev. Chir. Orthop. Traumatol, 2009; 95 (5): 373-6. DOI: 10.1016/j.otsr.2009.03.020.

Hamilton P, Doig S, Williamson O. Technical difficulty of metal removal after LISS plating. Injury, 2004; 35(6): 626-8.

Bae J H, Oh J K, Oh C W, Hur C R. Technical difficulties of removal of locking screw after locking compression plating. Arch. Orthop. Trauma Surg, 2009; 129(1):91-5. DOI: 10.1007/s00402-008-0769-5.

Pagnani M J, Lyden J P. Postoperative femoral fracture after intramedullary fixation with a Gamma nail: case report and review of the literature. J. Trauma, 1994; 37(1):133-37. DOI: 10.1097/00005373-199407000-00025.

Yang K H , Byun Y S, Park H W, Park S J. Failure on attempted removal of a Gamma nail in two young patients. J. Orthop. Trauma, 2003; 17: 379-82. DOI: 10.1097/00005131-200305000-00010.

Sanderson PL, Ryan W, Turner PG. Complications of metalwork removal. Injury, 1992;23: 29-30. doi. 10.1016/0020-1383(92)90121-8

Олекса А.П. Травматологія Підручник для лікарів травматологів-ортопедів та хірургів.2-ге вид. Львів: Афіша, 2006: 406.

Oleksa AP Traumatology Textbook for traumatologists, orthopedists and surgeons. 2nd ed. Lviv: Afisha, 2006: 406. [in Ukrainian].

Скляренко Є.Т. Травматологія і ортопедія. Київ: Здоров’я, 2005:384. Sklyarenko ET Traumatology and orthopedics. Kyiv: Zdorovya, 2005: 384. [in Ukrainian].

Gosling T, Htifner T, Hankemeier S, Zelle BA, Muller-Heine A, Krettek C. Femoral nail removal should be restricted in asymptomatic patients. Clin. Orthop. Relat. Res, 2004; 14:222-6. DOI: 10.1097/01.blo.0000130208.90879.67.

Kirchhoff C, Braunstein V, Kirchhoff S, Sprecher CM, Ockert B, Fischer F, Leidel BA, Biberthaler P. Outcome analysis following removal of locking plate fixation of the proximal humerus. BMC Musculoskeletal Disorders, 2008; 9: 138-45. DOI: 10.1186/1471-2474-9-138

Richards RH, Palmer JD, Clarke NM. Observations on removal of metal implants. Injury, 1992; 23: 25-28. DOI: 10.1016/0020-1383(92)90120-h.

Evers B, Habelt R, Gerngross H. Indication, timing and complications of plate removal after forearm fractures: results of a metaanalysis including 635 cases. J. Bone Joint Surg. Br, 2004; 86:289-93.

Toms AD, Morgan-Jones RL, Spencer-Jones R. Intramedullary femoral nailing: removing the nail improves subjective outcome. Injury, 2002; 33(3):247-249. DOI: 10.1016/s0020-1383(01)00145-0.

Bachoura A, Yoshida R, Lattermann C, Kamineni S. Late Removal of Titanium Hardware from the Elbow Is Problematic. Orthopedics, 2012; 26: 239-43. DOI: 10.5402/2012/256239

Müller-Färber J. Metal removal after osteosyntheses. Indications and risks. Orthopäde, 2003; 32 (11): 1039-57. DOI: 10.1007/s00132-003-0577-0.

Robinson CM, Royds M, Abrahamm A, McQueen MM, Court-Brown CM, Christie J. Refractures in patients at least forty-five years old. J. Bone Joint Surgery, 2002; 84-A (9):1528-33. DOI: 10.2106/00004623-200209000-00004.

Minkowitz RB, Bhadsavle S, Walsh M, Egol KA. Removal of painful orthopaedic implants after fracture union J. Bone Joint Surg. Am, 2007; 89(9):1906-1912. DOI: 10.2106/JBJS.F.01536.

Brown RM, Wheelwright EF, Chalmers JJ. Removal of metal implants after fracture surgery - indications and complications. R. Coll. Surg. Edinb, 1993; 38(2): 96-100.

Kahle WK. The case against routine metal removal J. Pediatr. Orthop,1994; 14(2):229-37.

Davison BL. Refracture following plate removal in supracondylar-intercondylar femur fractures Orthopedics, 2003; 26 (2):157-159. DOI: 10.3928/0147-7447-20030201-17.

Tu Z, Li Y, Wu F. Pathological observation of femoral refracture after removal of plates Zhongguo Gu Shang, 2010; 23(8): 609-11. PMID: 20860138

Haentjens Р, Magaziner J, Соlбп-Еmегiс CS. Meta-analysis: excess mortality after hip fracture among older women and mеп. Аnn Intem Med 2010; 152: 380. DOI: 10.7326/0003-4819-152-6-201003160-00008

Moulton LS, Green NL, Sudahar T, Makwana NK, Whittaker JP. Outcome after conservatively managed intracapsular fractures of the femoral neck. Ann R Coll Surg Engl 2015; 97(4):279-82. DOI: 10.1308/003588415X14181254788809.

Bjorkelund K B, Hommel A, Thorngren K G, Lundberg D, Larsson S. Factors at admission associated with 4 months outcome in elderly patients with hip fracture. Aana J., 2009; 77: 49-58. PMID: 19263829

Johnston A T, Barnsdale L, Smith R, Duncan K, Hutchison J D. Change in long-term mortality associated with fractures of the hip: evidence from the Scottish hip fracture audit. J. Bone Joint Surg. Br, 2010; 92: 989993. DOI: 10.1302/0301-620X.92B7.23793.

Soderqvist A, Ekstrom W, Ponzer S, Pettersson H, Cederholm T, Dalen N, Hedstrom M, Tidermark J. Prediction of mortality in elderly patients with hip fractures: a two-year prospective study of 1,944 patients. Gerontology, 2009; 55: 496-504. DOI: 10.1159/000230587.

Fox KM, Magaziner J, Hebel JA. et al. Intertrochanteric versus femoral neck fractures: differential characteristics, treatment and sequelae. J. Gerontol. A. Biol.Sci. Med. Sci,1999; 54: 635-40. DOI: 10.1093/gerona/54.12.m635.

Mahaisavariya B, Sitthiseripratip K, Suwanprateeb J. Finite element study of the proximal femur with retained trochanteric gamma nail and after removal of nail. Injury, 2006; 37: 778-85. DOI: 10.1016/j.injury.2006.01.019.

Kukla C, Pichl W, Prokesch R, Jacyniak W, Heinze G, Gatterer R, Heinz T. Femoral neck fracture after removal of the standard gamma interlocking nail: a cadaveric study to determine factors influencing the biomechanical properties of the proximal femur. J. Biomech, 2001; 34 (12):1519-26. DOI: 10.1016/s0021-9290(01)00157-9.

Buciuto R, Hammer R, Herder A. Spontaneous subcapital femoral neck fracture after healed trochanteric fracture. Clin. Orthop. Relat. Res, 1997; 342: 156-9. PMID: 9308538.

Yang Kyu-Hyun, Yoo-Wang Choi, Jung-Hoon Won, Je-Hyun Yoo. Subcapital femoral neck fracture after removal of Gamma/Proximal Femoral nails: report of two cases. Injury Extra, 2005; 36 (7):245-8.

George B, Gaheer RS, Ratnam A. Spontaneous femoral neck fracture after removal of Dynamic Hip Screw. J.Orthopaedics, 2007; 4:147-53.

Hesse B, Gachter A. Complications following the treatment of trochanteric fractures with the gamma nail. Arch. Orthop. Trauma Surg, 2004;124(10): 692-8. DOI: 10.1007/s00402-004-0744-8.

Strauss EJ, Pahk B, Kummer FJ, Egol K. Calcium phosphate cement augmentation of the femoral neck defect created after dynamic hip screw removal. J. Orthop. Trauma, 2007; 21: 295-300.

Mattsson P, Larsson S. Calcium phosphate cement for augmentation did not improve results after internal fixation of displaced femoral neck fractures: a randomized study of 118 patients. Acta Orthop, 2006; 77: 251-6. DOI: 10.1080/17453670610045984.

Eberle S, Wutte C, Bauer C, Oldenburg G, Augat P. Should extramedullary fixations for the hip fractures be removed after bone union? Clinical biomechanics, 2011; 26: 410-4. DOI: 10.1016/j.clinbiomech.2010.12.002.

Busam ML, Esther RJ, Obremskey WT. Hardware removal: indications and expectations. J. Am. Acad. Orthop. Surg, 2006; 14 (2):113120. DOI: 10.5435/00124635-200602000-00006.

Husain A, Pollak AN, Moehring HD. Removal of intramedullary nails from the femur: a review of 45 cases. J. Orthop. Trauma, 1996;10:560562. DOI: 10.1097/00005131-199611000-00009

Court-Brown CM, Gustilo T, Shaw AD. Knee pain after intramedullary tibial nailing: its incidence, etiology, and outcome. J. Orthop. Trauma, 1997; 11:103-5. DOI: 10.1097/00005131-199702000-00006.

Sidky A, Buckley RE. Hardware removal after tibial fracture has healed. Can. J. Surg, 2008; 51(4): 263-8. PMID: 18815648

Boerger TO, Patel G, Murphy JP. Is routine removal of intramedullary nails justified? Injury, 1999; 30(2): 79-81. DOI: 10.1016/s0020-1383(98)00200-9.

Karladani AH, Ericsson PA, Granhed H, Karlsson L, Nyberg P. Tibial intramedullary nails - should they be removed? A retrospective study of 71 patients. Acta Orthop, 2007; 78(5):668-71. DOI: 10.1080/17453670710014374.

Beaupre GS, Csongradi JJ. Refracture risk after plate removal in the forearm. J. Orthop. Trauma, 1996; 10 (2): 87-92. DOI: 10.1097/00005131-199602000-00003.

Chia J, Soh CR, Wong HP, Low YP. Complications following metal removal: a follow-up of surgically treated forearm fractures. Singapore Med. J, 2000; 37: 268-9. PMID: 8942225.

Arjan GJ, Bot Job N, Doornberg N, Anneluuk LC. Long-Term Outcomes of Fractures of Both Bones of the Forearm. The Journal of Bone Joint Surgery, 2011; 93:527-32. DOI: 10.2106/JBJS.J.00581.

Kettunen J, Kroger H, Bowditch, Suomalainen O. Bone mineral density after removal of rigid plates from forearm fractures: preliminary report. J. Orthopaedic Science, 2009; 11(2): 118-26. DOI: 10.1007/s00776-003-0718-7.

Rosson JW, Petley GW, Shearer JR. Bone structure after removal of internal fixation plates. J.Bone Joint Surg. (Br.), 1991; 73 (1): 6567. DOI: 10.1302/0301-620X.73B1.1991777.

Evers B, Habelt R, Gerngross H. Indication, timing and complications of plate removal after forearm fractures: results of a metaanalysis including 635 cases. J. Bone Joint Surg. Br, 2004; 86: 289-93.

Bednar DA, Grandwilewski W. Complications of forearm-plate removal. Can. J. Surg., 1992; 35(4): 428-431.

Brown OL, Dirschl DR, Obremskey WT. Incidence of hardware related pain and its effect on functional outcomes after open reduction and internal fixation of ankle fractures. J. Orthop. Trauma, 2001;15:271-274. DOI: 10.1097/00005131-200105000-00006.

Dodenhoff RM, Dainton JN, Hutchins PM. Proximal thigh pain after femoral nailing. Causes and treatment. J. Bone Joint Surg. Br., 1997;79: 738-41. DOI: 10.1302/0301-620x.79b5.7345.

Gosling T, Hufner T, Hankemeier S, Miiller U, Richter M, Krettek C. Indikation zur Entfernung von Tibiamarknageln Chirurg., 2005; 76: 789-94.

Jacobsen S, Honnens L, Jensen CM, Torholm C. Removal of internalfixation-the effect on patients' complaints: a study of 66 cases of removal of internal fixation after malleolar fractures. Foot Ankle Int., 1994; 15:170-1. DOI: 10.1177/107110079401500402.

Keating JF, Orfaly R, O'Brien PJ. Knee pain after tibial nailing. J. Orthop. Trauma, 1997; 11:10-3. DOI: 10.1097/00005131-199701000-00004.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.