Background: After fracture healing, the obvious question after primary implant surgery both for the patient and surgeon is whether, when & why to remove the implant fixed during index surgery. This is a pprospective study of 310 patients who underwent implant removals at our institution. The aim of our study is to establish clear indication & timing for removal of implants after fracture union.
Materials & Methods: The study protocol included pre operative data collection like nature of fracture & which bone was involved, date of index surgery, type of implant used, recording intraoperative findings & monitoring of the post operative course up to 1 yr following implant removal.
Inclusion criteria: Removal of the following metallic implants used in the index surgery – K wires, screws alone,Intra medullary devices, different types of plates with screws & prosthesis. Biodegradable screws were excluded.
Results: In all the other studies reviewed, no study specifically separated the absolute from the relative indications. We included absolute indications in our audit in order to answer our first research question. Over all 155 implants were removed for the absolute indications like exposed k wires, Painful implants & / or implants causing local symptoms, broken implants, implants site infection, secondary surgeries being done in the same anatomical region mentioned above which constitutes 50 percentage of the total study group.Timing of Implant removals were assessed in different types of implants at different anatomical sites.
Conclusions: 1.Routine removal of asymptomatic implants in young individuals carries a low rate of complications & yields good functional results. However, implants in the vicinity of nerves are with anticipated major difficulties in their removal are better left alone. 2. The optimal timing for removal of Intramedullary nails & plates in the lower limb 18-36 months, in upper limb is minimum of 24 months since this is associated with the least rate of complications.
