The burden of hardware removal in ankle fractures: How common is it, why do we do it and what is the cost? A ten-year review

Fenelon, Christopher; Murphy, Evelyn P.; Galbraith, John G.; Kearns, Stephen

doi:10.1016/j.fas.2018.05.006

Cited by 30 publications

(32 citation statements)

References 18 publications

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“…This variation might be due to cultural and treatment policy differences and may also be attributed to the different lengths of observation periods or analytic methods between studies. The recent lowest hardware removal rates (13%) were reported by Fenelon et al (2019). However, the authors suggest that their results were an underestimation because of the retrospective nature of their study that could have led to a larger loss to follow-up.…”

Section: Discussionmentioning

confidence: 83%

“…Furthermore, the complication rate for routine syndesmotic screw removal is about 20% (Schepers et al 2011). Fenelon et al (2019) showed in their study that 6% of all patients underwent planned hardware removal and that the majority of procedures were for the removal of a syndesmosis screw after a median time of 3 months. Our register study could not separate all hardware removals from only syndesmotic screw removal, but we assume that most removals within 3 months were of syndesmotic screws.…”

Section: Discussionmentioning

confidence: 99%

“…The total economic cost of removal is difficult to evaluate due to the multifactorial nature and financing of the Finnish healthcare system. However, Fenelon et al (2019) reported the cost of hardware removal to be €1,113 per patient in Ireland. A study by Lalli et al (2015) from the United States found the average cost of syndesmosis screw removal to be $3,579 ($287 to $9,981).…”

Section: Discussionmentioning

confidence: 99%

“…To reduce the costs of occupational disability, an early return to previous activities and the avoidance of secondary operations is crucial. In a recent study, Fenelon et al (2019) found that 13% of patients who had had ankle fracture surgery in Ireland underwent hardware removal. The most common reason was planned removal (6%) followed by symptomatic hardware (6%), and infection (0.5%).…”

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confidence: 99%

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Reduced incidence and economic cost of hardware removal after ankle fracture surgery: a 20-year nationwide registry study

et al. 2020

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Background and purpose — Open reduction and internal fixation (ORIF) is a treatment method for unstable ankle fractures. During recent years, scientific evidence has shed light on surgical indications as well as on hardware removal. We assessed the incidence and trends of hardware removal procedures following ORIF of ankle fractures. Patients and methods — The study covered all patients 18 years of age and older who had an ankle fracture treated with ORIF in Finland between the years 1997 and 2016. Patient data were obtained from the Finnish National Hospital Discharge Register. Results — 68,865 patients had an ankle fracture treated with ORIF in Finland during the 20-year study period between 1997 and 2016. A hardware removal procedure was performed on 27% of patients (n = 18,648). The incidence of hardware removal procedures after ankle fracture decreased from 31 (95% CI 29–32) per 100,000 person-years in the highest year 2001 (n = 1,247) to 13 (CI 12–14) per 100,000 person-years in 2016 (n = 593). Moreover, the proportion and number of removal operations performed within the first 3 months also decreased. The costs of removal procedures decreased from approximately €994,000 in 2001 to €472,600 in 2016. Interpretation — Removal of hardware after ankle surgery (ORIF) is a common operation with substantial costs. However, the incidence and cost of removals decreased during the study period, with a particular decrease in hardware removal operations within 3 months.

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Reduced incidence and economic cost of hardware removal after ankle fracture surgery: a 20-year nationwide registry study

et al. 2020

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“…Moreover it is important to note the high rate of re-intervention to remove the screws from the medial malleolus presented in the study; Leumann et al suggest that optimal location for medial malleolar osteotomy is at the medial ankle edge (17). Clinical results using this location showed low mid-term morbidity and only little long-term morbidity, but hardware removal is a common procedure with significant costs (17,18).…”

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confidence: 94%