Refracture risk after plate removal in the forearm

Area of Science:

• Orthopedic surgery
• Biomaterials engineering
• Trauma surgery

Background:

• Plate fixation is common for forearm fractures.
• Hardware removal is a subsequent procedure.
• Understanding refracture risk after removal is crucial for patient outcomes.

Purpose of the Study:

• To evaluate refracture rates after forearm plate removal.
• To identify specific plating systems associated with increased refracture risk.

Main Methods:

• Retrospective analysis of 459 plate removals from 401 patients across seven studies.
• Data collected via questionnaires on plating hardware and refracture events.
• Analysis of plate design (DCP, semi-tubular, one-third tubular), material (stainless steel, titanium), and screw size.

Main Results:

• 37 refractures occurred in 29 patients.
• No refractures observed with stainless steel, one-third tubular plates (0.0% rate).
• Refracture rates: 5.6% for small-fragment DCP, 6.6% for semi-tubular, and 21% for narrow, large-fragment DCP.
• Narrow, large-fragment DCP showed significantly higher refracture risk compared to small-fragment DCP and one-third tubular systems.

Conclusions:

• The type of plating system significantly impacts refracture risk after hardware removal.
• Narrow, large-fragment dynamic compression plates (DCP) are associated with a substantially higher risk of refracture.
• Further investigation into titanium/titanium alloy plates is warranted due to insufficient data.