Pediatric fractures following implant removal: A systematic review

Padgett, Anthony M; Howie, Cole M; Sanchez, Thomas; Momaya, Amit; Williams, Kevin; Gilbert, Shawn R.; Conklin, Michael

doi:10.1177/18632521221138376

Cited by 4 publications

(2 citation statements)

References 72 publications

(132 reference statements)

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“…Our fracture rate does fall within the expected 0 to 14% rate found in a recent systematic review. 17…”

Section: Discussionmentioning

confidence: 99%

No Value Found With Routine Early Postoperative Radiographs after Implant Removal in Pediatric Patients

Garner,

Ibanez,

Erkilinc

et al. 2024

J Am Acad Orthop Surg

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Background: Implants are routinely removed in pediatric patients. Fracture through the prior implant site is a common worry after implant removal. Early post–implant removal radiographs are routinely used to evaluate the prior implant removal sites and to assess when a patient may return to normal activities. To our knowledge, the value of early, routine postoperative radiographs after elective implant removal in pediatric patients has not been studied. Methods: A retrospective patient cohort of pediatric patients who had implant removal from an extremity from 2017 to 2019 was used in this study. Data were collected for patient demographics, implant site, reason for primary surgery, complications, number of postoperative radiographs, radiation exposure, cost of imaging, and whether the postoperative plan was changed by imaging. Results: Two hundred ninety patients were included in the study. Postoperative plans were changed only in 0.69% of patients (n = 2) because of abnormal 2-week radiographs and 1.72% (n = 5) because of abnormal 6-week radiographs. However, the event's proportion difference (change of management) was not statically significant (P = 0.182) between those who had a radiograph obtained and those who did not. The mean follow-up time was 16 months. The mean number of postoperative radiographs obtained was 3.74, the mean cost per radiograph was $103, and the mean postoperative radiation exposure was 1.34 mSv. No fractures were observed after implant removal. Discussion: A retrospective review of the value of early, postoperative radiographs after routine orthopaedic implant removal found that postoperative radiographs at 2 and 6 weeks did not change the postoperative plan for most of the patients. Postoperative radiographs have an average cost of $103, and radiation exposure equal to approximately 6 months of natural background radiation. Level of Evidence: Level III

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“…Our fracture rate does fall within the expected 0 to 14% rate found in a recent systematic review. 17…”

Section: Discussionmentioning

confidence: 99%

No Value Found With Routine Early Postoperative Radiographs after Implant Removal in Pediatric Patients

Garner,

Ibanez,

Erkilinc

et al. 2024

J Am Acad Orthop Surg

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“…The stability of a single intramedullary KW-R fixation is limited, and a well-placed trans-cortical KW-R fixation through the physis requires repeated insertion and multiple fluoroscopies, increasing the radiation exposure, tendon injury, and PPC ( 12 , 17 ). In addition, the tail of the K-ware is exposed, which may cause infection.…”

Section: Discussionmentioning

confidence: 99%

Comparison of three fixation methods in paediatric metaphyseal-diaphysis junction fracture of the distal radius: a retrospective study in two centres

Jianyi,

Chaoyu,

Lian

et al. 2023

Front. Pediatr.

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BackgroundThe distal radial metaphyseal-diaphysis junction fractures (DRMDJ) have various treatment methods and are easily lead to complications. This study aims to compare the anterograde elastic stable intramedullary nailing (ESIN-A), retrograde K-wire fixation (KW-R), and retrograde precision-shaping elastic intramedullary nailing (ESIN-RPS) for the treatment of pediatric DRMDJ fractures.Materials and methodsA total of 113 patients with DRMDJ fractures (36 in the ESIN-A group, 52 in the KW-R group, and 25 in the ESIN-RPS group) from two centres were retrospectively analysed. Perioperative operation time, intraoperative bleeding, fluoroscopy times, alignment rate and angulation on radiography were compared among the three groups. Forearm rotation, healing, wrist function, and complications were compared at the last follow-up.ResultsThe mean operation times of the three groups were as follows: KW-R (72 ± 13 min) > ESIN-A (65 ± 18 min) > ESIN-RPS (52 ± 11 min), with a significant difference (P < 0.01). The incision length and intraoperative blood loss of ESIN-A (1.8 ± 0.2 cm; 8.3 ± 3.7 ml) were significantly higher than ESIN-RPS (1.4 ± 0.8 cm; 5.5 ± 2.7 ml) (P < 0.05), respectively. The postoperative alignment rate on the anteroposterior (AP) and the lateral plane of ESIN-RPS (93.1 ± 4.4%; 95.01 ± 2.8%) was significantly greater than that of KW-R (82.1 ± 6.8%; 88.5 ± 4.5%) and ESIN-A (79.2 ± 5.2%; 83.2 ± 2.5%) (P < 0.01). The residual angulation of ESIN-RPS (3.3 ± 1.2°; 2.9 ± 0.8°) was significantly greater than that for ESIN-A (5.1 ± 1.7°; 4.9 ± 2.1°) and KW-R (6.6 ± 2.8°; 7.5 ± 1.6°) (P < 0.05). The excellent and good ratio of ESIN-RPS (95.8%) was significantly higher than that of ESIN-A (86.5%) and KW-R (86.1%) according to the Gartland-Werley standard. There was a significant difference in delayed union between the KW-R and ESIN-A (P < 0.05). Additionally, there were two cases of radial nerve injury in the ESIN-A group, one case of tendon rupture in the ESIN-RPS group, and one case of tendon rupture in the KW-R group. The ESIN-RPS group had significantly fewer complications than the KW-R group (P < 0.05). The ESIN-A group also had significantly fewer complications than the KW-R group (P < 0.05).ConclusionCompared with ESIN-A and KW-R, ESIN-RPS has the advantages of a shorter operation time, less intraoperative blood loss, less radiation, better alignment, and fewer complications. The ESIN-RPS was suggested as an optimal choice for paediatric DRMDJ fractures.

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Reuse of orthopedic implants in a peri-implant fracture of both forearm bones in an adolescent: A case report

Aguilar-Chavez,

Jorba-Elguero,

Cruz-Cortés

et al. 2023

JMSR

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Fractures of both forearm bones in adolescents are common. Many of these fractures are surgically fixed with internal fixation. However, among the complications that can occur are peri-implant fractures, which are somewhat infrequent. They are due mainly to high-energy injuries. Therefore, not much information about them is found in the literature. Reusing implants is not a frequent or well-documented practice, and it is carried out only when the necessary resources are unavailable, particularly in developing countries. We are reporting a 16-year-old male patient who suffered a peri-implant fracture distal to plates that were placed 3 years earlier in both left forearm bones. The material was removed successfully and reused, achieving an adequate reduction and fixation with one dynamic compression plate (DCP) plate for the radius and one reconstruction plate for the ulna. The patient recovered successfully. This case report aimed to understand the lack of resources in a developing country and a possible solution for this problem in this type of scenario.

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Pediatric fractures following implant removal: A systematic review

Cited by 4 publications

References 72 publications

No Value Found With Routine Early Postoperative Radiographs after Implant Removal in Pediatric Patients

No Value Found With Routine Early Postoperative Radiographs after Implant Removal in Pediatric Patients

Comparison of three fixation methods in paediatric metaphyseal-diaphysis junction fracture of the distal radius: a retrospective study in two centres

Reuse of orthopedic implants in a peri-implant fracture of both forearm bones in an adolescent: A case report

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