Abstract text (incl. references and figure legends)
Introduction. Today, there is no uniform approach to the removal of implants after bone fusion. Doubtless, implants must be removed due to infection, nonunion, motion discomfort, conflicts between metal devices and soft tissues, protruding of implants under the skin, or peri-implant fractures.
However, its expediency is discussible in other cases. Although removing implants looks like an easy procedure, even experienced surgeons may have difficulties extracting an implant. This operation could be even more traumatic than the osteosynthesis itself.
Materials and methods. Implant removal in 250 patients after successful fusions without infection, treated with IM nailing (IMN) and LCP plating (LCP). The mean age of the patients was 44 years old (a standard deviation of 15 years); 56% (n=140) of patients were women. The fractures most frequently occurred to a tibia/condyles – 48% (LCP – 98.8%, IMN – 1.2%), less frequent to clavicles – 23.8% (LCP – 100%), shoulder 12.4% (LCP- 100%), femur – 9.2% (LCP – 17,3%, IMN – 82,7%), and forearm – 6.6% (LCP – 100%). On average, the implants got removed in 18.2 months (8.1 to 76.7 months) after the surgical osteosynthesis. The main indications were irritation of the skin and soft tissues, pain and discomfort, and a patient's wish.
Results. For 72 patients (28.8%), technical difficulties have been reported. The most frequent problems were: a crew head jamming in an LCP plate, stripped screw heads unmanageable for a screwdriver, and their combinations. In 56 patients (22.4%), we failed to remove the metal structure completely, and broken screws remained in the intramedullary channel.
Conclusions: A decision to remove an implant should be made exceptionally after a thorough study of the medical, social, and economic consequences of this surgical procedure. Young inexperienced surgeons shall not carry out removals of orthopaedic implants.
Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.)
No