Routine Removal of Orthopaedic Implants in Pediatric Trauma Patients With Fracture Union: Who, When, and Why

Area of Science:

• Orthopaedic surgery
• Pediatric trauma
• Implant removal

Background:

• Routine removal of metallic implants in pediatric fracture treatment is controversial.
• Limited randomized trials exist to guide decisions on implant retention versus removal.
• Previous studies explored general preferences but lacked specifics on timing, location, and patient age.

Purpose of the Study:

• To survey members of the Pediatric Orthopaedic Society of North America (POSNA) regarding their practices for routine removal of orthopaedic implants after fracture union.
• To gather data on specific factors influencing implant removal decisions, including patient age, implant type, and timing.

Main Methods:

• An IRB-approved online survey was distributed to POSNA members.
• The questionnaire covered demographics, implant removal practices based on patient age and time since implantation, reasons for removal, and common complications.
• Data from 285 POSNA members were analyzed.

Main Results:

• Flexible nails were most frequently removed (84.6%-90.8%), while clavicle plates and screws were least likely (31.6%).
• Implant removal likelihood decreased in patients older than nine years.
• Upper extremity implants were removed earlier (7-9 months) than lower extremity implants (10-12 months).

Conclusions:

• Routine implant removal rates in pediatric trauma patients vary significantly, from over 90% for flexible nails to 31.6% for clavicle plates.
• Implant removal timing ranges from 7 to 12 months post-implantation, with less frequent removal in older children.
• There is a lack of consensus among surgeons regarding the rationale for routine implant removal.