Complications of hardware removal in pediatric upper limb surgery: A retrospective single-center study of 317 patients

Previous studies indicated that hardware removal may lead to increased morbidity and therefore, at least in adults, remains questionable for certain indications. However, risks such as corrosion or local reactions may be less likely in younger patients with current, improved hardware materials. We sought to retrospectively determine complication rates of hardware removal in pediatric upper limb surgery, and establish potential risk factors for increased morbidity. All children and adolescents who underwent inpatient hardware removal under anesthesia after previous upper limb surgery between 2002 and 2016 were retrospectively evaluated. The following details were extracted at the latest follow-up: demographics, implant location, hardware material, duration of surgery, duration of hardware in situ, and any complications graded according to Goslings et al (grade 0–5) and Sink et al (grade 1–5), respectively. Correlations were calculated to establish potential relationships between specific outcome parameters (e.g., location, duration of surgery etc.) and complication grades. A total of 2089 children were evaluated of whom 317 patients with 449 interventions (mean age 9.4 years) fulfilled the inclusion criteria for this study. Overall, 203 K-wires (46%), 97 plates (22%), 102 external fixators (23%), 32 intramedullary nails (7%), 6 screws (1%), 4 cerclages (1%) and 1 pin (0.2%) were removed; most common locations were the forearm (34%) and humerus (24%). The mean duration of surgery was 40 minutes (± 50.9), mean time in situ was 194 days (± 319.6). Complication rates were low overall, with most being grade 0 (n = 372; 83%) or 1 (n = 60; 13%) according to Goslings et al and grade 1 (n = 386; 86%) and 2 (n = 42; 9%) according to Sink et al. No severe complications were observed. The following predictors were related to the severity of the complications in linear regression analysis: more distal localizations, external fixators, longer duration of surgery and female sex. Hardware removal under anesthesia in the pediatric upper extremity has produced a low complication rate with no severe complications and can thus be considered to be safe. Increased morbidity occurred in more distal localizations, external fixators, longer surgeries and females. Level of Evidence: Therapeutic, Level IV.