The removal of metalwork in children
E R Jago1, C J Hindley, R D Jago
1Royal Liverpool Children's Hospital (Alder Hey), UK.
Insights
Post-operative complications from pediatric metalwork removal occurred in 14% of cases. Hip surgery for slipped capital epiphysis removal had a higher 27% complication rate, leading to a change in fixation methods.
Area of Science:
- Pediatric Orthopedics
- Surgical Complications
- Medical Device Removal
Background:
- Metalwork removal is common in pediatric orthopedic surgery.
- Complications can arise from implant removal, impacting patient outcomes.
- Specific procedures, like those for slipped upper femoral epiphysis, may carry unique risks.
Purpose of the Study:
- To report the incidence and types of post-operative complications in children undergoing metalwork removal.
- To analyze complication rates based on the grade of the operating surgeon.
- To identify specific high-risk procedures and inform practice changes.
Main Methods:
- Retrospective review of 57 pediatric patients (<16 years) undergoing metalwork removal over 12 months.
- Data collection on complication types, severity, and association with surgical procedures.
- Analysis of complication rates, including subgroup analysis for hip procedures.
Main Results:
- Overall complication rate was 14%, with minor complications (scarring, superficial infection) at 7%.
- One intermediate complication involved scar revision after Knowles pin removal.
- Major complications (7%) included fractures during removal of pins used for slipped upper femoral epiphysis, with a 27% rate in this subgroup.
Conclusions:
- Metalwork removal in children has a generally low complication rate.
- Removal of fixation devices for slipped upper femoral epiphysis presents a significant risk of major complications.
- The study prompted a change in fixation technique for slipped upper capital epiphysis to partially threaded single cannulated screws.
Abstract:
The post-operative complications in 57 children under the age of 16 years requiring removal of metalwork during a 12-month period are presented. The grade of surgeon performing the operation is also discussed. The overall complication-rate was 14 per cent. Minor complications such as transiently painful scars and superficial infection occurred in 7 per cent of cases. There was one intermediate complication following removal of Knowles pins of an unacceptable scar requiring revision by a plastic surgeon. The major complication (7 per cent of all cases) involved fracture with retention of the distal part of the screws during attempted removal of Knowles, Crawford-Adams or Moores pins used for the management of slipped upper femoral epiphysis. When considering this sub-group of patients, the actual complication rate for removal of metalwork from the hip was 27 per cent. So significant was this finding that the authors changed their practice to the use of a partially threaded single cannulated screw for the fixation of slipped upper capital epiphyses.
Related Concept Videos
01:27Fractures: Bone Repair
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the procedure...
01:19Masking and Demasking Agents
There are many masking agents, such as cyanide, fluoride, triethanolamine, thiourea, and 2,3-bis(sulfanyl)propan-1-ol (formerly 2,3-dimercapto-1-propanol), with the masking agent chosen based on the metal...