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

Abstract

While the indications and options expand for treatment of pediatric fractures with metallic implants, routine removal of implants remains controversial. There is a paucity of randomized prospective trials to determine the risk of retention versus removal. Prior studies provided insight into the preferences of POSNA members versus their nonpediatric counterparts; however, they did not capture specifics regarding timing, anatomic location, implant type, or patient age. This study aims to report POSNA members' practice habits regarding the routine removal of orthopaedic implants after fracture union. This is an IRB-approved online survey of POSNA members regarding the routine removal of orthopaedic trauma implants after fracture union. The questionnaire consisted of 6 parts: demographics, implant removal with consideration of patient age and time since implantation, the most common reason for removal, the most common complications of removal, and a comment section. Two hundred eighty-five POSNA members responded to at least 1 implant-related question. Flexible nails were the most commonly removed implants (90.8% for the forearm, 87.3% for the femur, 86.3% for the tibia, and 84.6% for the humerus), followed by femur plates and screws (79.9%). The least likely implants to be routinely removed were clavicle plates and screws (31.6%), femur rigid nails (32.6%), and tibial tubercle screws (37.1%). There was a lower likelihood of implant removal in patients older than nine. Upper extremity implants tended to be removed earlier than lower extremity implants (between 7 and 9 mo vs. 10 and 12 mo postimplantation). The most cited reasons for removal included routine practice (mean 43%) and symptomatic hardware (mean 32%), while the least selected reason was evidence-based research (mean 10%). Rates of routine implant removal in pediatric trauma patients after fracture union range from 90.8% for flexible forearm nails to 31.6% for clavicle plates and screws. Removal typically occurs between 7 and 12 months postimplantation. As patients age, surgeons are less inclined to remove implants. There was minimal consensus on the rationale for routine removal. Level V.