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Complication profile and risk patterns following elective implant removal in pediatric fractures: a 10-year
Taner Alıç1, Seniye Burcu Torumtay Alıç2, Soner Gürel3
1Faculty of Medicine, Department of Orthopaedics and Traumatology, Hitit University, Çorum, Turkey. taneralic@gmail.com.
Insights
Pediatric implant removal (IR) is generally safe, but early refracture risk, particularly in the forearm, necessitates careful planning and post-removal protection. Surgeons should discuss risks and timing with families.
Area of Science:
- Pediatric Orthopedics
- Surgical Outcomes
- Fracture Management
Background:
- Optimal timing and necessity of pediatric implant removal (IR) after fracture healing lack consensus.
- IR, typically recommended 1-12 months post-osteosynthesis, carries risks like refracture and infection.
- This study evaluated IR indications, timing, and complications in pediatric patients.
Purpose of the Study:
- To assess the reasons for implant removal (IR) in children.
- To determine the optimal timing for implant removal.
- To analyze complications associated with implant extraction in pediatric fracture treatment.
Main Methods:
- Retrospective analysis of 115 pediatric patients (ages 2-17) undergoing IR.
- Data collected on implant retention duration, type, removal indication, and complications.
- Statistical analysis to identify factors associated with adverse outcomes.
Main Results:
- Most IRs (90.4%) were elective, often for forearm fractures, driven by parental request.
- Common implants removed included titanium elastic nails and plate-screw systems.
- Post-removal complications: refracture (4.3%), infection (1.7%), incomplete removal (1.7%), nerve injury (0.9%), wound issues (0.9%).
- Forearm refractures occurred early (5-18 days post-op); no significant link found between implant type/duration and refracture.
- Highlights need for patient-specific planning and post-removal protection, especially for forearm fractures.
Conclusions:
- Pediatric implant removal is generally safe but carries a risk of early refracture, particularly in the forearm.
- Short-term activity restrictions and splinting are recommended post-removal.
- Open communication between surgeons and families regarding IR risks and timing is crucial.
Background:
There is no clear consensus regarding the optimal timing and necessity of implant removal (IR) following fracture healing in children. Although generally recommended between 1 and 12 months after osteosynthesis, IR carries risks such as refracture, infection, and neurovascular injury. This study aimed to evaluate the indications for IR, the timing of removal, and the complications observed during and after implant extraction in pediatric patients.
Methods:
This retrospective study included 115 pediatric patients (mean age: 10.8 years, range: 2-17) who underwent IR following fracture treatment. Data on implant retention duration, type of implant, indication for removal, and post-removal complications were recorded and analyzed.
Results:
IR was most commonly performed in asymptomatic cases upon parental request (90.4%), particularly for forearm fractures. Titanium elastic nails and plate-screw systems were the most frequently removed implants. Post-removal complications included refracture (4.3%), infection (1.7%), incomplete removal (1.7%), radial nerve neuropraxia (0.9%), and wound problems (0.9%). Refractures occurred within 5 to 18 days postoperatively, with the forearm being the most frequently affected region (7.5% of forearm IR cases). No statistically significant association was found between implant type, retention duration, and the occurrence of refracture (p > 0.05). These findings underscore the importance of patient-specific planning and postoperative protective strategies, especially for forearm IR.
Conclusion:
Implant removal in pediatric patients is generally safe; however, the risk of early refracture, especially in the forearm, highlights the need for short-term activity restrictions and splint immobilization post-removal. Surgeons should clearly communicate the risks and timing of IR with families during the decision-making process.
