Determinants of implant removal in isolated Weber type B and C ankle fractures: A retrospective cohort study

This retrospective cohort study aimed to identify demographic, clinical, and functional factors influencing the decision to remove implants in patients who underwent surgical treatment for isolated Weber type B and C lateral malleolar fractures. A total of 211 patients who underwent open reduction and internal fixation between 2014 and 2022 and had at least one year of follow-up were included. Patients were divided into two groups: those who underwent implant removal (n = 67) and those who did not (n = 144). Functional status was assessed using the physical functioning and mental health subscales of the Short Form-36 (SF-36), and multivariate logistic regression was used to identify independent predictors of implant removal. Patients in the implant removal group were significantly younger, had a higher proportion of males, and longer follow-up periods. Postoperative SF-36 scores were significantly and clinically higher in the non-removal group. Multivariate analysis revealed that male sex, younger age, and lower postoperative physical and mental health scores were independently associated with implant removal. The most common reason for removal was peri-implant pain (40.3 %). These findings suggest that implant removal decisions are influenced not only by physical symptoms but also by demographic and functional health factors, underscoring the importance of a patient-centered approach in orthopedic decision-making.