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Removal of orthopedic implants in children: morbidity and postoperative radiologic changes
M E Lovell1, C S Galasko, N B Wright
1Royal Manchester Children's Hospital, Pendlebury, England.
Insights
Pediatric metalwork removal showed low morbidity. Dynamic compression plates caused greater bone indentation than tubular fixation, suggesting early removal for implants with high stress-rising characteristics.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Biomechanical Engineering
Background:
- Surgical removal of orthopedic fixation devices is common in pediatric patients.
- Understanding postoperative outcomes and skeletal changes is crucial for optimizing treatment.
- Previous studies have not extensively compared different fixation methods regarding skeletal response in children.
Purpose of the Study:
- To evaluate postoperative morbidity following metalwork removal in children.
- To assess radiographic skeletal changes, specifically cortical assimilation, after fixation device removal.
- To compare the skeletal response to dynamic compression plating versus third tubular fixation in pediatric orthopedic procedures.
Main Methods:
- Retrospective analysis of 121 metalwork removal procedures in 110 children (aged 1-15 years).
- Assessment of postoperative morbidity, including refracture rates.
- Radiographic evaluation of cortical assimilation of implants, comparing dynamic compression plates and third tubular fixation.
Main Results:
- Low postoperative morbidity observed (0.9% refracture rate), lower than in adult cohorts.
- Dynamic compression plating showed significantly higher cortical indentation (41.6%) compared to third tubular fixation (7.3%).
- Cortical indentation correlated with the duration the fixation device remained in situ.
Conclusions:
- Metalwork removal in children has a low complication rate.
- Dynamic compression plates exhibit greater cortical assimilation, potentially due to high stress-rising properties.
- Early removal and limited indications for high stress-rising plates are recommended in pediatric orthopedic practice.
Abstract:
One hundred twenty-one procedures for the removal of metalwork performed on 110 children aged 1-15 years is reported, with a focus on postoperative morbidity and radiographic skeletal changes. The removals were for a variety of acute and chronic pediatric orthopedic conditions. The level of postoperative morbidity was lower than in adult study groups with only one refracture (0.9%). Only four removals were considered to be difficult. All patients had a postoperative radiograph taken. The skeletal response to the fixation device was assessed by measuring the degree of cortical assimilation of the implant. Dynamic compression plating was compared with third tubular fixation. Overall cortical indentation was 7.3% in the third tubular group and 41.6% in the dynamic compression plating group; similar results were found in forearm fracture and hip osteotomy subgroups (P < 0.01, Wilcoxon unpaired test). The degree of indentation was related to the length of time for which the plate was left in situ. It is postulated that plates with high stress-rising characteristics are incorporated with growth and should both be removed early and have strictly limited indications for their use.
