Hardware removal rate following femur fracture fixation could depend upon gender, age

Lovald S. J Trauma. 2011. doi: 10.1097/TA.0b013e318219fea9

Gender, age and insurance status could impact the chances of hardware removal following a fracture fixation of the femur, according to this study. The research team quantified all patients in the 2007 Nationwide Inpatient Sample who underwent open reduction and internal fixation for a fracture of the femur, as well as all those patients who had implanted devices removed from the femur. Statistical methods were used to pinpoint the differences between both groups.

According to the authors, 30,943 patients were found to have undergone internal fixation of the femur, with 4,886 of these patients undergoing hardware removals — an estimated removal rate of 15.8%.

The authors noted mechanical complications (18.7%), osteoarthritis (14.3%), nonunion (13.9%), refracture (10.9%) and other implant-oriented complications (10.1%) were the most frequent causes of treatment failure, with younger patients and male patients making up a higher percentage of removal procedures than fixation procedures.

“Given that removal was more likely in males and younger patients, and most often because of mechanical and implant-oriented complications, patient activity and weight bearing are likely leading factors in implant removal,” the authors wrote.

The authors also found self-pay and Medicare patients demonstrated lower removal rates, with Medicaid and private insurance or HMO patients demonstrating higher removal rates.