Complications of implant removal in ankle fractures

Although the complications of internal fixation in ankle fractures are well-known in a number of reports, there have been few reports revealing the complications of implant removal in ankle fractures. The aim of this study was to investigate the perioperative complications of implant removal in ankle fractures and analyze the associated factors of such complications.

Patients who underwent open reduction and internal fixation using metal implants for ankle fractures and had their implants removed between 2010 and 2015 were enrolled in the study. We investigated the rate and details of perioperative complications and collected information on the possible risk factors including the age, comorbidities, fracture type, number of skin incisions, operative time, and surgeon's grade from the medical charts.

A total of 80 patients were included for analysis. Perioperative complications occurred in 11 patients (14%) including arterial injury in one patient, blistering in three, nerve injuries in three, skin necrosis in two, and infection in two. In patients with perioperative complications, the rate of patients with peripheral vascular disease and multiple skin incision was significantly higher (18% vs 3%, p = 0.031 and 64% vs 32%, p = 0.042, respectively) and the operative time was significantly longer (102 min vs 57 min, p < 0.001) than those without perioperative complications.

The indication of implant removal in ankle fractures should be considered carefully, especially in patients with possible risk factors and without implant-related symptoms, due to the high incidence of perioperative complications.