Implant removal associated complications in children with limb fractures due to trauma

PURPOSE: The purpose of this study was to analyze the number and type of complications that occurred after fracture implant removal and to investigate whether implant removal should be performed routinely in children. METHODS: In a retrospective study, patient records were used for the analyses of patient characteristics, surgery reports, and complications. Children under the age of 16 years with a limb fracture due to trauma, treated with either Kirschner wires (K-wires), elastic stable intramedullary nails (ESIN), or screw fixation between 2000 and 2007, were included. Exclusion criteria were as follows: refracture, pathological fracture, fracture of the hands and feet, or polytrauma patients (Injury Severity Score [ISS] > 15). RESULTS: Three-hundred and nine fractures were analyzed. All K-wires (173) and ESIN (96) were removed as per standard procedure, resulting in 17/173 and 7/96 complications after removal, respectively. In 19/40 patients with screw fixation treatments, it was decided to remove the material after fracture consolidation, resulting in 4/19 complications. The decision in 21 treatments to leave the screw in situ led to four complications. No significant difference in complication rates could be found for the three groups after removal surgery (17/173, 7/96, and 4/19) or between hardware removal (4/19) and retention (4/21) in the case of screw fixation. CONCLUSIONS: The removal of K-wires, ESIN, and screws is considered to be a safe procedure in children and is, by definition, indicated for K-wires and ESIN after fracture healing.