Hardware Related Pain and Hardware Removal after Open Reduction and Internal Fixation of Ankle Fractures

Abstract

Objectives: To assess the incidence of hardware related pain after open reduction and internal fixation (ORIF) after ankle fractures through functional outcomes scores in patients with or without hardware related pain. Design: Retrospective study. Setting: Regional trauma center. Patients: One hundred and seventy six patients undergoing ORIF of an ankle fracture with a minimal follow up of 18 months were sent questionnaires. In total, 80 responding patients were available for analysis. Main Outcome Measurements: Visual Analog Pain Score, Foot and Ankle Outcome Score (FAOS). Results: In seventeen patients (21%), the hardware was removed because of pain. In another seventeen patients (21%), the hardware was not removed, but pain was reported. Patients with hardware related pain had significantly worse functional outcome scores than patients without hardware related pain. After elective hardware removal, pain reduction was achieved in 71 % of the patients. Mean Visual Analog Score was 7.0 before and 3.9 after elective hardware removal for pain. Conclusions: Hardware related pain is a significant issue after ORIF of ankle fractures. Patients with hardware related pain have significantly worse functional outcome scores. Although pain reduction is achieved in 71% of the patients after elective hardware removal, a substantial number of patients have persistent complaints. Patients should be well informed about the expectations and risks of elective hardware removal.

Incidence and risk factors for removal of an internal fixation following surgery for ankle fracture: A retrospective cohort study of 997 patients

“…The reported incidence of implant removal has ranged from 26% to 80% for studies of complications following ORIF for ankle fracture [5,6,8,22]. These incidences are higher than that found in the present study, which may reflect differences in policy or practice, or may be attributed to differences in populations, lengths of observation periods, or analytic methods between studies.…”

“…Implant removal can also lead to complications such as pain and superficial infections [8,23]. Therefore, some authors claim that hardware removal after ORIF of ankle fractures should not be a routine procedure [8,33,34], and that many procedures involving implant removal are probably unnecessary, with their only outcome being the generation of unnecessary costs [5,6,33,34].…”

“…There is little information in the literature regarding the incidence and indications for implant removal exclusively for unstable ankle fractures treated with ORIF, although previous reports indicate that hardware-related complaints constitute the most common indication [5][6][7][8]. Removal due to infection varies from 1.3% to 4.8% [9][10][11].…”

Indications for Implant Removal Following Intra-articular Calcaneal Fractures and Subsequent Complications

“…For ankle fractures, implant removal is performed in 21% to 27% of patients. 5,19,24 Improvement in implant-related complaints following implant removal in ankle fracture patients ranges between 50% and 90%. 5,13,16,19,26 Little information is available about implant removal following the operative treatment of a displaced intra-articular calcaneal fracture.…”

“…5,19,24 Improvement in implant-related complaints following implant removal in ankle fracture patients ranges between 50% and 90%. 5,13,16,19,26 Little information is available about implant removal following the operative treatment of a displaced intra-articular calcaneal fracture. The main reasons for implant removal following a calcaneal fracture are discomfort (pain, peroneal tendon irritation, or at patients' request), implant-related causes (malpositioned screws, implant breakage, planned removal in bridge plating), or because of a persistent infection (fistula or osteomyelitis).…”