Metalwork removal can lead to a number of complications in pediatric patients

Researchers found complications in more than 20% of patients who had metalwork removed.

Issue: Issue 6 2009

Complications following the routine removal of metalwork in pediatric trauma patients are more common than might be expected, and patients and their parents need to be aware of these complications in order to give properly informed consent, investigators said.

The study, presented by Raghuram Thonse, MS, FRCS, at the 10th EFORT Congress, involved the review of metalwork removal cases performed from Jan. 1 through Dec. 31, 2006.

Thonse said the removal of metalwork used in pediatric orthopaedic surgery is controversial.

Removal numbers

The study was based in a regional pediatric orthopaedic unit, and all metalwork removals were performed with patients under general anaesthesia. Data were collected through case notes, computer records and radiographs. Other details collected involved demographics, anatomic sites, implants used, reasons for removal, fixation problems and post-removal complications.

Thirty-four buried Kirschner wires and 38 implants were removed. According to the study abstract, the most common anatomic site for removal was the forearm (42%), followed by the femur (18%) and ankle (18%). The most commonly removed implants were plates (53%), followed by Nancy nails (18%).

Post-removal complications

Thonse reported that problems following the initial insertion of metalwork were found in four patients (10.5%), including refracture of the distal forearm (two occurrences) both in patients with coexisting osteopenia.

Symptoms led to the removal of metalwork in 13 cases (34%), with the remaining removals being at patient request or due to clinical indications.

Complications following metalwork removal occurred in eight patients (21%) and included re-fracture of the forearm, hypertrophic scarring, abscess, skin reaction, wound breakdown, excessive bruising and discomfort.

The results point to a need for parents and patients to be better informed about the potential dangers of metalwork removal. Routine removal, according to Thonse, is generally unnecessary and should only be done if the patients meet a certain criteria.

“Removal of metalwork should only be done in patients who are either at high risk for osteopenia or with symptoms originating from the metalwork,” Thonse said.

A member of the audience asked Thonse if the two refractures occurred in patients with osteopenic bones. He confirmed that was the case.

For more information:

Raghuram Thonse, MS, FRCS, can be reached at Musgrave Park Hospital, 20 Stockman’s Lane, Belfast BT9 7JB, Northern Ireland; +44-28-90902000; e-mail: thonser@yahoo.co.uk. He has no direct financial interest in any company or product mentioned in this article.

Reference:

Thonse R, McConnell L, Rankin A. Review of removal of metalwork in paediatric orthopaedic trauma during one-year period. Paper F635. Presented at the 10th EFORT Congress. June 3-6, 2009. Vienna.