Removal of forearm plate leads to a high risk of refracture: decision regarding implant removal after fixation of the forearm and analysis of risk factors of refracture

Yao, Chi-Kuo; Lin, Kai-Cheng; Tarng, Yih-Wen; Chang, Wei‐Ning; Renn, Jenn-Hui

doi:10.1007/s00402-014-2079-4

Cited by 41 publications

(23 citation statements)

References 20 publications

(44 reference statements)

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“…In human medicine, timing of plate removal has been shown to be a critical factor in the occurrence of refracture with early removal significantly increasing the risk. 8,18,44,45 In contrast, the mean interval from osteosynthesis to plate removal in the horses that suffered refracture in this case series (7.2 months) was similar to that of the overall study population (8.3 months), and longer than in the group of horses presented with infected plates (6.4 months) but earlier than in the group presented because of lameness (13.1 months). This finding underlines the conflict between the desire to leave the implant in place until the bone is stable enough for weight-bearing and the need for early removal to resolve infection.…”

Section: Discussionsupporting

confidence: 68%

“…In human medicine, the frequency of refracture has been shown to be as high as 30%, 44 and many refractures occur at the site of the original fracture and in the absence of major trauma. 8,[44][45][46] Some refractures do not run through the region of the original fracture line but instead originate in the area of the plate ends and are called periprosthetic fractures. 5 In the present study, one horse suffered a periprosthetic fracture of the radius after removal of the first plate with the horse sedated and standing (►Fig.…”

Section: Discussionmentioning

confidence: 99%

“…In human medicine, routine removal of implants has been extensively questioned because of safety and financial concerns. [5][6][7][8] Many surgeons believe that removal of implants should not be a routine procedure and only patients with clear indications should undergo implant removal. 9 Common indications for implant removal in humans include implant-associated pain, implant failure, metal allergy, risk of periprosthetic fracture, functional limitations and infection.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Plate Removal after Internal Fixation of Limb Fractures: A Retrospective Study of Indications and Complications in 48 Horses

Donati

Fürst

Chicca

et al. 2020

Vet Comp Orthop Traumatol

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Objectives The aim of this study was to determine the indications for, and complications of, plate removal surgery in horses that underwent internal fixation of limb fractures. Study Design Medical records of horses presented to our hospital between 1990 and 2015 for the removal of plates after treatment of limb fractures were reviewed. Data collected at the time of initial presentation, including signalment, history, fracture features and treatment and information about the indications, timing and complications of implant removal were reviewed. Results The most common bones involved were the ulna (n = 19) and third metacarpal and metatarsal bones (n = 14). A total of 63 plates were removed from 48 horses during 53 separate surgeries, and the complication rate was 6/48; six horses had complications related to implant removal, which included persistent infection (n = 1) and refracture (n = 5). Complications related to implant removal were associated with comminuted fractures (p = 0.002), age > 3 years (p = 0.016) and the presence of surgical site infection (p = 0.001). Conclusion Plate removal after fracture healing is necessary in patients with implant-associated clinical signs. There is a strong relationship between the complication rate and the degree of comminution of the original fracture, increasing age and the presence of surgical site infection. The surgeon must be aware of these risk factors when planning plate removal.

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Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Plate Removal after Internal Fixation of Limb Fractures: A Retrospective Study of Indications and Complications in 48 Horses

Donati

Fürst

Chicca

et al. 2020

Vet Comp Orthop Traumatol

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“…We expected higher torsional stiffness of the plate constructs in our study because of the lower distance of the locking screws to the osteotomy gap. Due to the primary bone healing without callus formation and due to periosteal damage by the plate, a relevant risk of refracture after plate removal is described [34]. We do not expect the same rate of refractures after nailing like shown for clavicle fractures [30,35].…”

Section: Discussionmentioning

confidence: 89%

Nailing of diaphyseal ulna fractures in adults—biomechanical evaluation of a novel implant in comparison with locked plating

et al. 2020

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Background: Adult forearm fractures require surgical treatment in most cases. Open reduction and internal fixation with plate osteosynthesis is the therapy of choice. Intramedullary fixation offers several advantages compared to plate fixation but is not routinely used. The aim of our study was to compare a newly designed ulna nail with angular stable plating in a biomechanical testing setup of an ulna shaft fracture with a diaphyseal defect. Methods: Ten pairs of sawbones with a defect osteotomy of the ulna shaft (OTA 2U2C3) were fixed with an interlocked nail or locked plate osteosynthesis. The constructs were tested under four-point bending, torsional loading and axial loading in a servo-pneumatic testing machine to compare the stiffness of both stabilization methods.Results: The nail constructs show lower yet sufficient bending stiffness (62.25 ± 6.64 N/mm) compared to the plate constructs (71.2 ± 5.98 N/mm, p = 0.005). The torsional loading test shows superior stiffness of the plate constructs (0.24 ± 0.03 Nm/deg vs. 0.1 ± 0.01 Nm/deg; p < 0.001), while the axial loading shows superior stiffness of the nail constructs (1028.9 ± 402.1 N/mm vs. 343.9 ± 112.6 N/mm; p < 0.001).Conclusions: Intramedullary nailing of ulna shaft fractures obtains sufficient but lower stability in bending and torsional loading when compared to rigid angular stable plating and could be an alternative technique to plate fixation. The lower stability and the closed stabilization technique allow for a rapid periosteal healing, which is not present in stiffer constructs.

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“…And consolidation of fracture was con rmed 15 weeks after second surgery. Regarding the refracture, there are several common risk factors: comminuted fracture pattern and bone defects [32,33], inadequate compression between fractures [32], microfracture occurred during removal of screws or wires [34]. Recently, Tsai et al [35] claimed that female and low BMI were another two risk factors associated with refracture post plate removal for midshaft clavicle fractures.…”

Section: Discussionmentioning

confidence: 99%

The comparison of Nice knots and traditional methods as an auxiliary reduction-fixation technique in pre-contoured locking plate fixation for comminuted Robinson type 2B clavicle fracture: a retrospective study

Hong

Wang

Guo

et al. 2020

Preprint

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Background: Open reduction and pre-contoured locking plate fixation is a popular treatment option for displaced midshaft clavicle fracture. Lag screw and cerclage are two main intraoperative techniques to reduce and fix fragments. However, both lag screw and metallic cerclage have disadvantages. The doubled-suture Nice knot has been reported in many areas of orthopedic surgery for its effectiveness. This study aims to compare the outcomes of comminuted mid-shaft clavicle fractures reduced by Nice knots versus traditional techniques (lag screw or/and metallic cerclage) when bridged with pre-contoured locking plates.Methods: We retrospectively reviewed 101 patients (65 females and 36 males) diagnosed with midshaft clavicle fractures with at least one wedge fragment reduced by either Nice knots or traditional methods and bridged with pre-contoured locking plates between December 2016 and April 2019. Operation time, functional outcomes, pain, patient satisfaction, fracture healing and complications were assessed at a follow-up of 12 to 40 months.Results: The mean age of all the patients was 50.8 years. There were 52 and 49 patients in Nice knot group and traditional group respectively, and no differences between two groups was found in general patient characteristics, fracture type, follow up and injury-to-surgery duration. The Nice knot group had significant less operation time (p < 0.01) than the traditional group (mean and standard deviation [SD], 78.6±19.0 compared with 94.4±29.9 minutes, respectively). For healing time, functional score, pain, satisfaction and complications, there was no significant differences between groups, despite the Nice knot group had slightly better results.Conclusions: Both Nice knots and traditional methods treated for comminuted Robinson type 2B clavicle fractures were effective and safe. And the Nice knots seemed to be superior with significant less operation time.

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Removal of forearm plate leads to a high risk of refracture: decision regarding implant removal after fixation of the forearm and analysis of risk factors of refracture

Abstract: The incidence of refracture was significantly lower in the group that retained the implant. Routine implant removal after bone union in adult forearm fractures is not recommended due to the higher refracture rate.

Cited by 41 publications

References 20 publications

Plate Removal after Internal Fixation of Limb Fractures: A Retrospective Study of Indications and Complications in 48 Horses

Plate Removal after Internal Fixation of Limb Fractures: A Retrospective Study of Indications and Complications in 48 Horses

Nailing of diaphyseal ulna fractures in adults—biomechanical evaluation of a novel implant in comparison with locked plating

The comparison of Nice knots and traditional methods as an auxiliary reduction-fixation technique in pre-contoured locking plate fixation for comminuted Robinson type 2B clavicle fracture: a retrospective study

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