Skip to main content
Top
Published in: European Journal of Trauma and Emergency Surgery 4/2013

01-08-2013 | Review Article

Indications for implant removal after fracture healing: a review of the literature

Authors: D. I. Vos, M. H. J. Verhofstad

Published in: European Journal of Trauma and Emergency Surgery | Issue 4/2013

Login to get access

Abstract

Introduction

The aim of this review was to collect and summarize published data on the indications for implant removal after fracture healing, since these are not well defined and guidelines hardly exist.

Methods

A literature search was performed.

Results

Though there are several presumed benefits of implant removal, such as functional improvement and pain relief, the surgical procedure can be very challenging and may lead to complications or even worsening of the complaints. Research has focused on the safety of metal implants (e.g., risk of corrosion, allergy, and carcinogenesis). For these reasons, implants have been removed routinely for decades. Along with the introduction of titanium alloy implants, the need for implant removal became a subject of debate in view of potential (dis)advantages since, in general, implants made of titanium alloys are more difficult to remove. Currently, the main indications for removal from both the upper and lower extremity are mostly ‘relative’ and patient-driven, such as pain, prominent material, or simply the request for removal. True medical indications like infection or intra-articular material are minor reasons.

Conclusion

This review illustrates the great variety of view points in the literature, with large differences in opinions and practices about the indications for implant removal after fracture healing. Since some studies have described asymptomatic patients developing complaints after removal, the general advice nowadays is to remove implants after fracture healing only in symptomatic patients and after a proper informed consent. Well-designed prospective studies on this subject are urgently needed in order to form guidelines based on scientific evidence.
Literature
1.
go back to reference Hanson B, van der Werken C, Stengel D. Surgeons’ beliefs and perceptions about removal of orthopaedic implants. BMC Musculoskelet Disord. 2008;9:73.PubMedCrossRef Hanson B, van der Werken C, Stengel D. Surgeons’ beliefs and perceptions about removal of orthopaedic implants. BMC Musculoskelet Disord. 2008;9:73.PubMedCrossRef
2.
go back to reference Busam ML, Esther RJ, Obremskey WT. Hardware removal: indications and expectations. J Am Acad Orthop Surg. 2006;14(2):113–20.PubMed Busam ML, Esther RJ, Obremskey WT. Hardware removal: indications and expectations. J Am Acad Orthop Surg. 2006;14(2):113–20.PubMed
3.
go back to reference Loder RT, Feinberg JR. Orthopaedic implants in children: survey results regarding routine removal by the pediatric and nonpediatric specialists. J Pediatr Orthop. 2006;26(4):510–9.PubMedCrossRef Loder RT, Feinberg JR. Orthopaedic implants in children: survey results regarding routine removal by the pediatric and nonpediatric specialists. J Pediatr Orthop. 2006;26(4):510–9.PubMedCrossRef
4.
go back to reference Böstman O, Pihlajamäki H. Routine implant removal after fracture surgery: a potentially reducible consumer of hospital resources in trauma units. J Trauma. 1996;41(5):846–9.PubMedCrossRef Böstman O, Pihlajamäki H. Routine implant removal after fracture surgery: a potentially reducible consumer of hospital resources in trauma units. J Trauma. 1996;41(5):846–9.PubMedCrossRef
5.
go back to reference Mølster A, Behring J, Gjerdet NR, Ekeland A. Removal of osteosynthetic implants. Tidsskr Nor Laegeforen. 2002;122(23):2274–6.PubMed Mølster A, Behring J, Gjerdet NR, Ekeland A. Removal of osteosynthetic implants. Tidsskr Nor Laegeforen. 2002;122(23):2274–6.PubMed
6.
go back to reference Jamil W, Allami M, Choudhury MZ, Mann C, Bagga T, Roberts A. Do orthopaedic surgeons need a policy on the removal of metalwork? A descriptive national survey of practicing surgeons in the United Kingdom. Injury. 2008;39(3):362–7.PubMedCrossRef Jamil W, Allami M, Choudhury MZ, Mann C, Bagga T, Roberts A. Do orthopaedic surgeons need a policy on the removal of metalwork? A descriptive national survey of practicing surgeons in the United Kingdom. Injury. 2008;39(3):362–7.PubMedCrossRef
8.
go back to reference Black J. Does corrosion matter? J Bone Joint Surg Br. 1988;70(4):517–20.PubMed Black J. Does corrosion matter? J Bone Joint Surg Br. 1988;70(4):517–20.PubMed
9.
go back to reference Levine DL, Staehle RW. Crevice corrosion in orthopedic implant metals. J Biomed Mater Res. 1977;11(4):553–61.PubMedCrossRef Levine DL, Staehle RW. Crevice corrosion in orthopedic implant metals. J Biomed Mater Res. 1977;11(4):553–61.PubMedCrossRef
10.
go back to reference Thomas KA, Cook SD, Harding AF, Haddad RJ Jr. Tissue reaction to implant corrosion in 38 internal fixation devices. Orthopedics. 1988;11(3):441–51.PubMed Thomas KA, Cook SD, Harding AF, Haddad RJ Jr. Tissue reaction to implant corrosion in 38 internal fixation devices. Orthopedics. 1988;11(3):441–51.PubMed
11.
go back to reference Grogan CH. Experimental studies in metal cancerigenesis. VIII. On the etiological factor in chromate cancer. Cancer. 1957;10(3):625–38.PubMedCrossRef Grogan CH. Experimental studies in metal cancerigenesis. VIII. On the etiological factor in chromate cancer. Cancer. 1957;10(3):625–38.PubMedCrossRef
12.
go back to reference Hallab N, Merritt K, Jacobs JJ. Metal sensitivity in patients with orthopaedic implants. J Bone Joint Surg Am. 2001;83-A(3):428–36.PubMed Hallab N, Merritt K, Jacobs JJ. Metal sensitivity in patients with orthopaedic implants. J Bone Joint Surg Am. 2001;83-A(3):428–36.PubMed
13.
14.
go back to reference Müller A, Allgöwer M, Schneider R, Willenegger H, editors. Manual of internal fixation. 2nd ed. New York: Springer; 1979. Müller A, Allgöwer M, Schneider R, Willenegger H, editors. Manual of internal fixation. 2nd ed. New York: Springer; 1979.
15.
go back to reference Kettunen J, Kröger H, Bowditch M, Joukainen J, Suomalainen O. Bone mineral density after removal of rigid plates from forearm fractures: preliminary report. J Orthop Sci. 2003;8(6):772–6.PubMedCrossRef Kettunen J, Kröger H, Bowditch M, Joukainen J, Suomalainen O. Bone mineral density after removal of rigid plates from forearm fractures: preliminary report. J Orthop Sci. 2003;8(6):772–6.PubMedCrossRef
16.
go back to reference Rosson JW, Petley GW, Shearer JR. Bone structure after removal of internal fixation plates. J Bone Joint Surg Br. 1991;73(1):65–7.PubMed Rosson JW, Petley GW, Shearer JR. Bone structure after removal of internal fixation plates. J Bone Joint Surg Br. 1991;73(1):65–7.PubMed
17.
go back to reference Rosson J, Murphy W, Tonge C, Shearer J. Healing of residual screw holes after plate removal. Injury. 1991;22(5):383–4.PubMedCrossRef Rosson J, Murphy W, Tonge C, Shearer J. Healing of residual screw holes after plate removal. Injury. 1991;22(5):383–4.PubMedCrossRef
18.
go back to reference du Preez LA, Bütow KW, Swart TJ. Implant failure due to titanium hypersensitivity/allergy?—Report of a case. SADJ. 2007;62(1):22, 24–5.PubMed du Preez LA, Bütow KW, Swart TJ. Implant failure due to titanium hypersensitivity/allergy?—Report of a case. SADJ. 2007;62(1):22, 24–5.PubMed
19.
go back to reference Krischak GD, Gebhard F, Mohr W, Krivan V, Ignatius A, Beck A, et al. Difference in metallic wear distribution released from commercially pure titanium compared with stainless steel plates. Arch Orthop Trauma Surg. 2004;124(2):104–13.PubMedCrossRef Krischak GD, Gebhard F, Mohr W, Krivan V, Ignatius A, Beck A, et al. Difference in metallic wear distribution released from commercially pure titanium compared with stainless steel plates. Arch Orthop Trauma Surg. 2004;124(2):104–13.PubMedCrossRef
20.
go back to reference Serhan H, Slivka M, Albert T, Kwak SD. Is galvanic corrosion between titanium alloy and stainless steel spinal implants a clinical concern? Spine J. 2004;4(4):379–87.PubMedCrossRef Serhan H, Slivka M, Albert T, Kwak SD. Is galvanic corrosion between titanium alloy and stainless steel spinal implants a clinical concern? Spine J. 2004;4(4):379–87.PubMedCrossRef
21.
go back to reference Ehlinger M, Adam P, Simon P, Bonnomet F. Technical difficulties in hardware removal in titanium compression plates with locking screws. Orthop Traumatol Surg Res. 2009;95(5):373–6.PubMedCrossRef Ehlinger M, Adam P, Simon P, Bonnomet F. Technical difficulties in hardware removal in titanium compression plates with locking screws. Orthop Traumatol Surg Res. 2009;95(5):373–6.PubMedCrossRef
22.
go back to reference Richards RG. The effect of surface roughness on fibroblast adhesion in vitro. Injury. 1996;27(Suppl 3):SC38–43.PubMed Richards RG. The effect of surface roughness on fibroblast adhesion in vitro. Injury. 1996;27(Suppl 3):SC38–43.PubMed
23.
go back to reference Meredith DO, Riehle MO, Curtis AS, Richards RG. Is surface chemical composition important for orthopaedic implant materials? J Mater Sci Mater Med. 2007;18(2):405–13.PubMedCrossRef Meredith DO, Riehle MO, Curtis AS, Richards RG. Is surface chemical composition important for orthopaedic implant materials? J Mater Sci Mater Med. 2007;18(2):405–13.PubMedCrossRef
24.
go back to reference Hayes JS, Seidenglanz U, Pearce AI, Pearce SG, Archer CW, Richards RG. Surface polishing positively influences ease of plate and screw removal. Eur Cell Mater. 2010;19:117–26.PubMed Hayes JS, Seidenglanz U, Pearce AI, Pearce SG, Archer CW, Richards RG. Surface polishing positively influences ease of plate and screw removal. Eur Cell Mater. 2010;19:117–26.PubMed
25.
go back to reference Pearce AI, Pearce SG, Schwieger K, Milz S, Schneider E, Archer CW, et al. Effect of surface topography on removal of cortical bone screws in a novel sheep model. J Orthop Res. 2008;26(10):1377–83.PubMedCrossRef Pearce AI, Pearce SG, Schwieger K, Milz S, Schneider E, Archer CW, et al. Effect of surface topography on removal of cortical bone screws in a novel sheep model. J Orthop Res. 2008;26(10):1377–83.PubMedCrossRef
26.
go back to reference Hayes JS, Vos DI, Hahn J, Pearce SG, Richards RG. An in vivo evaluation of surface polishing of TAN intermedullary nails for ease of removal. Eur Cell Mater. 2009;18:15–26.PubMed Hayes JS, Vos DI, Hahn J, Pearce SG, Richards RG. An in vivo evaluation of surface polishing of TAN intermedullary nails for ease of removal. Eur Cell Mater. 2009;18:15–26.PubMed
27.
28.
go back to reference Richards RH, Palmer JD, Clarke NM. Observations on removal of metal implants. Injury. 1992;23(1):25–8.PubMedCrossRef Richards RH, Palmer JD, Clarke NM. Observations on removal of metal implants. Injury. 1992;23(1):25–8.PubMedCrossRef
29.
go back to reference Minkowitz RB, Bhadsavle S, Walsh M, Egol KA. Removal of painful orthopaedic implants after fracture union. J Bone Joint Surg Am. 2007;89(9):1906–12.PubMedCrossRef Minkowitz RB, Bhadsavle S, Walsh M, Egol KA. Removal of painful orthopaedic implants after fracture union. J Bone Joint Surg Am. 2007;89(9):1906–12.PubMedCrossRef
30.
go back to reference Müller-Färber J. Metal removal after osteosyntheses. Indications and risks. Orthopade. 2003;32(11):1039–57. quiz 58.PubMedCrossRef Müller-Färber J. Metal removal after osteosyntheses. Indications and risks. Orthopade. 2003;32(11):1039–57. quiz 58.PubMedCrossRef
31.
go back to reference Krettek C, Müller C, Meller R, Jagodzinski M, Hildebrand F, Gaulke R. Is routine implant removal after trauma surgery sensible? Unfallchirurg. 2012;115(4):315–22.PubMedCrossRef Krettek C, Müller C, Meller R, Jagodzinski M, Hildebrand F, Gaulke R. Is routine implant removal after trauma surgery sensible? Unfallchirurg. 2012;115(4):315–22.PubMedCrossRef
32.
go back to reference Raney EM, Freccero DM, Dolan LA, Lighter DE, Fillman RR, Chambers HG. Evidence-based analysis of removal of orthopaedic implants in the pediatric population. J Pediatr Orthop. 2008;28(7):701–4.PubMedCrossRef Raney EM, Freccero DM, Dolan LA, Lighter DE, Fillman RR, Chambers HG. Evidence-based analysis of removal of orthopaedic implants in the pediatric population. J Pediatr Orthop. 2008;28(7):701–4.PubMedCrossRef
33.
go back to reference Morshed S, Humphrey M, Corrales LA, Millett M, Hoffinger SA. Retention of flexible intramedullary nails following treatment of pediatric femur fractures. Arch Orthop Trauma Surg. 2007;127(7):509–14.PubMedCrossRef Morshed S, Humphrey M, Corrales LA, Millett M, Hoffinger SA. Retention of flexible intramedullary nails following treatment of pediatric femur fractures. Arch Orthop Trauma Surg. 2007;127(7):509–14.PubMedCrossRef
34.
go back to reference Gorter EA, Vos DI, Sier CF, Schipper IB. Implant removal associated complications in children with limb fractures due to trauma. Eur J Trauma Emerg Surg. 2011;37(6):623–7.PubMedCrossRef Gorter EA, Vos DI, Sier CF, Schipper IB. Implant removal associated complications in children with limb fractures due to trauma. Eur J Trauma Emerg Surg. 2011;37(6):623–7.PubMedCrossRef
35.
go back to reference Berkes M, Obremskey WT, Scannell B, Ellington JK, Hymes RA, Bosse M; Southeast Fracture Consortium. Maintenance of hardware after early postoperative infection following fracture internal fixation. J Bone Joint Surg Am. 2010;92(4):823–8.PubMedCrossRef Berkes M, Obremskey WT, Scannell B, Ellington JK, Hymes RA, Bosse M; Southeast Fracture Consortium. Maintenance of hardware after early postoperative infection following fracture internal fixation. J Bone Joint Surg Am. 2010;92(4):823–8.PubMedCrossRef
36.
go back to reference Rightmire E, Zurakowski D, Vrahas M. Acute infections after fracture repair: management with hardware in place. Clin Orthop Relat Res. 2008;466(2):466–72.PubMedCrossRef Rightmire E, Zurakowski D, Vrahas M. Acute infections after fracture repair: management with hardware in place. Clin Orthop Relat Res. 2008;466(2):466–72.PubMedCrossRef
37.
go back to reference Trampuz A, Widmer AF. Infections associated with orthopedic implants. Curr Opin Infect Dis. 2006;19(4):349–56.PubMedCrossRef Trampuz A, Widmer AF. Infections associated with orthopedic implants. Curr Opin Infect Dis. 2006;19(4):349–56.PubMedCrossRef
38.
go back to reference Trampuz A, Zimmerli W. Diagnosis and treatment of infections associated with fracture-fixation devices. Injury. 2006;37(Suppl 2):S59–66.PubMedCrossRef Trampuz A, Zimmerli W. Diagnosis and treatment of infections associated with fracture-fixation devices. Injury. 2006;37(Suppl 2):S59–66.PubMedCrossRef
39.
go back to reference Vos D, Hanson B, Verhofstad M. Implant removal of osteosynthesis: the Dutch practice. Results of a survey. J Trauma Manag Outcomes. 2012;6(1):6.PubMedCrossRef Vos D, Hanson B, Verhofstad M. Implant removal of osteosynthesis: the Dutch practice. Results of a survey. J Trauma Manag Outcomes. 2012;6(1):6.PubMedCrossRef
40.
go back to reference Hidaka S, Gustilo RB. Refracture of bones of the forearm after plate removal. J Bone Joint Surg Am. 1984;66(8):1241–3.PubMed Hidaka S, Gustilo RB. Refracture of bones of the forearm after plate removal. J Bone Joint Surg Am. 1984;66(8):1241–3.PubMed
41.
go back to reference Deluca PA, Lindsey RW, Ruwe PA. Refracture of bones of the forearm after the removal of compression plates. J Bone Joint Surg Am. 1988;70(9):1372–6.PubMed Deluca PA, Lindsey RW, Ruwe PA. Refracture of bones of the forearm after the removal of compression plates. J Bone Joint Surg Am. 1988;70(9):1372–6.PubMed
42.
go back to reference Rumball K, Finnegan M. Refractures after forearm plate removal. J Orthop Trauma. 1990;4(2):124–9.PubMedCrossRef Rumball K, Finnegan M. Refractures after forearm plate removal. J Orthop Trauma. 1990;4(2):124–9.PubMedCrossRef
43.
go back to reference Labosky DA, Cermak MB, Waggy CA. Forearm fracture plates: to remove or not to remove. J Hand Surg Am. 1990;15(2):294–301.PubMedCrossRef Labosky DA, Cermak MB, Waggy CA. Forearm fracture plates: to remove or not to remove. J Hand Surg Am. 1990;15(2):294–301.PubMedCrossRef
44.
go back to reference Langkamer VG, Ackroyd CE. Removal of forearm plates. a review of the complications. J Bone Joint Surg Br. 1990;72(4):601–4.PubMed Langkamer VG, Ackroyd CE. Removal of forearm plates. a review of the complications. J Bone Joint Surg Br. 1990;72(4):601–4.PubMed
45.
go back to reference Rosson JW, Shearer JR. Refracture after the removal of plates from the forearm. an avoidable complication. J Bone Joint Surg Br. 1991;73(3):415–7.PubMed Rosson JW, Shearer JR. Refracture after the removal of plates from the forearm. an avoidable complication. J Bone Joint Surg Br. 1991;73(3):415–7.PubMed
46.
go back to reference Chia J, Soh CR, Wong HP, Low YP. Complications following metal removal: a follow-up of surgically treated forearm fractures. Singapore Med J. 1996;37(3):268–9.PubMed Chia J, Soh CR, Wong HP, Low YP. Complications following metal removal: a follow-up of surgically treated forearm fractures. Singapore Med J. 1996;37(3):268–9.PubMed
47.
go back to reference Gyuricza C, Carlson MG, Weiland AJ, Wolfe SW, Hotchkiss RN, Daluiski A. Removal of locked volar plates after distal radius fractures. J Hand Surg Am. 2011;36(6):982–5.PubMedCrossRef Gyuricza C, Carlson MG, Weiland AJ, Wolfe SW, Hotchkiss RN, Daluiski A. Removal of locked volar plates after distal radius fractures. J Hand Surg Am. 2011;36(6):982–5.PubMedCrossRef
48.
go back to reference Lovald S, Mercer D, Hanson J, Cowgill I, Erdman M, Robinson P, et al. Complications and hardware removal after open reduction and internal fixation of humeral fractures. J Trauma. 2011;70(5):1273–7. discussion 1227–8.PubMedCrossRef Lovald S, Mercer D, Hanson J, Cowgill I, Erdman M, Robinson P, et al. Complications and hardware removal after open reduction and internal fixation of humeral fractures. J Trauma. 2011;70(5):1273–7. discussion 1227–8.PubMedCrossRef
49.
go back to reference Boerger TO, Patel G, Murphy JP. Is routine removal of intramedullary nails justified. Injury. 1999;30(2):79–81.PubMedCrossRef Boerger TO, Patel G, Murphy JP. Is routine removal of intramedullary nails justified. Injury. 1999;30(2):79–81.PubMedCrossRef
50.
go back to reference Husain A, Pollak AN, Moehring HD, Olson SA, Chapman MW. Removal of intramedullary nails from the femur: a review of 45 cases. J Orthop Trauma. 1996;10(8):560–2.PubMedCrossRef Husain A, Pollak AN, Moehring HD, Olson SA, Chapman MW. Removal of intramedullary nails from the femur: a review of 45 cases. J Orthop Trauma. 1996;10(8):560–2.PubMedCrossRef
51.
go back to reference Brumback RJ, Ellison TS, Poka A, Bathon GH, Burgess AR. Intramedullary nailing of femoral shaft fractures. Part III: long-term effects of static interlocking fixation. J Bone Joint Surg Am. 1992;74(1):106–12.PubMed Brumback RJ, Ellison TS, Poka A, Bathon GH, Burgess AR. Intramedullary nailing of femoral shaft fractures. Part III: long-term effects of static interlocking fixation. J Bone Joint Surg Am. 1992;74(1):106–12.PubMed
52.
go back to reference Toms AD, Morgan-Jones RL, Spencer-Jones R. Intramedullary femoral nailing: removing the nail improves subjective outcome. Injury. 2002;33(3):247–9.PubMedCrossRef Toms AD, Morgan-Jones RL, Spencer-Jones R. Intramedullary femoral nailing: removing the nail improves subjective outcome. Injury. 2002;33(3):247–9.PubMedCrossRef
53.
go back to reference Dodenhoff RM, Dainton JN, Hutchins PM. Proximal thigh pain after femoral nailing. causes and treatment. J Bone Joint Surg Br. 1997;79(5):738–41.PubMedCrossRef Dodenhoff RM, Dainton JN, Hutchins PM. Proximal thigh pain after femoral nailing. causes and treatment. J Bone Joint Surg Br. 1997;79(5):738–41.PubMedCrossRef
54.
go back to reference Gösling T, Hufner T, Hankemeier S, Zelle BA, Muller-Heine A, Krettek C. Femoral nail removal should be restricted in asymptomatic patients. Clin Orthop Relat Res. 2004;423:222–6.PubMedCrossRef Gösling T, Hufner T, Hankemeier S, Zelle BA, Muller-Heine A, Krettek C. Femoral nail removal should be restricted in asymptomatic patients. Clin Orthop Relat Res. 2004;423:222–6.PubMedCrossRef
55.
go back to reference Hui C, Jorgensen I, Buckley R, Fick G. Incidence of intramedullary nail removal after femoral shaft fracture healing. Can J Surg. 2007;50(1):13–8.PubMed Hui C, Jorgensen I, Buckley R, Fick G. Incidence of intramedullary nail removal after femoral shaft fracture healing. Can J Surg. 2007;50(1):13–8.PubMed
56.
go back to reference Kukla C, Gaebler C, Mousavi M, Vécsei V, Heinz T. Indications for implant removal in healed proximal femoral fractures. Acta Chir Austriaca. 2000;32:196–8. Kukla C, Gaebler C, Mousavi M, Vécsei V, Heinz T. Indications for implant removal in healed proximal femoral fractures. Acta Chir Austriaca. 2000;32:196–8.
57.
go back to reference Krettek C, Mommsen P. Implant removal after intramedullary osteosyntheses. Literature review, technical details, and tips and tricks. Unfallchirurg. 2012;115(4):299–314.PubMedCrossRef Krettek C, Mommsen P. Implant removal after intramedullary osteosyntheses. Literature review, technical details, and tips and tricks. Unfallchirurg. 2012;115(4):299–314.PubMedCrossRef
58.
go back to reference Keating JF, Orfaly R, O’Brien PJ. Knee pain after tibial nailing. J Orthop Trauma. 1997;11(1):10–3.PubMedCrossRef Keating JF, Orfaly R, O’Brien PJ. Knee pain after tibial nailing. J Orthop Trauma. 1997;11(1):10–3.PubMedCrossRef
59.
go back to reference Karladani AH, Ericsson PA, Granhed H, Karlsson L, Nyberg P. Tibial intramedullary nails—should they be removed? A retrospective study of 71 patients. Acta Orthop. 2007;78(5):668–71.PubMedCrossRef Karladani AH, Ericsson PA, Granhed H, Karlsson L, Nyberg P. Tibial intramedullary nails—should they be removed? A retrospective study of 71 patients. Acta Orthop. 2007;78(5):668–71.PubMedCrossRef
60.
go back to reference Leliveld MS, Verhofstad MH. Injury to the infrapatellar branch of the saphenous nerve, a possible cause for anterior knee pain after tibial nailing? Injury. 2012;43(6):779–83.PubMedCrossRef Leliveld MS, Verhofstad MH. Injury to the infrapatellar branch of the saphenous nerve, a possible cause for anterior knee pain after tibial nailing? Injury. 2012;43(6):779–83.PubMedCrossRef
61.
go back to reference Sidky A, Buckley RE. Hardware removal after tibial fracture has healed. Can J Surg. 2008;51(4):263–8.PubMed Sidky A, Buckley RE. Hardware removal after tibial fracture has healed. Can J Surg. 2008;51(4):263–8.PubMed
62.
go back to reference Gösling T, Hüfner T, Hankemeier S, Müller U, Richter M, Krettek C. Indication for removal of tibial nails. Chirurg. 2005;76(8):789–94.PubMedCrossRef Gösling T, Hüfner T, Hankemeier S, Müller U, Richter M, Krettek C. Indication for removal of tibial nails. Chirurg. 2005;76(8):789–94.PubMedCrossRef
63.
go back to reference Im GI, Lee KB. Difficulties in removing ACE tibial intramedullary nail. Int Orthop. 2003;27(6):355–8.PubMedCrossRef Im GI, Lee KB. Difficulties in removing ACE tibial intramedullary nail. Int Orthop. 2003;27(6):355–8.PubMedCrossRef
64.
go back to reference Seligson D, Howard PA, Martin R. Difficulty in removal of certain intramedullary nails. Clin Orthop Relat Res. 1997;340:202–6.PubMedCrossRef Seligson D, Howard PA, Martin R. Difficulty in removal of certain intramedullary nails. Clin Orthop Relat Res. 1997;340:202–6.PubMedCrossRef
65.
go back to reference Brown OL, Dirschl DR, Obremskey WT. Incidence of hardware-related pain and its effect on functional outcomes after open reduction and internal fixation of ankle fractures. J Orthop Trauma. 2001;15(4):271–4.PubMedCrossRef Brown OL, Dirschl DR, Obremskey WT. Incidence of hardware-related pain and its effect on functional outcomes after open reduction and internal fixation of ankle fractures. J Orthop Trauma. 2001;15(4):271–4.PubMedCrossRef
66.
go back to reference Williams AA, Witten DM, Duester R, Chou LB. The benefits of implant removal from the foot and ankle. J Bone Joint Surg Am. 2012;94(14):1316–20.PubMedCrossRef Williams AA, Witten DM, Duester R, Chou LB. The benefits of implant removal from the foot and ankle. J Bone Joint Surg Am. 2012;94(14):1316–20.PubMedCrossRef
67.
go back to reference Georgiadis GM. Percutaneous removal of buried antegrade femoral nails. J Orthop Trauma. 2008;22(1):52–5.PubMedCrossRef Georgiadis GM. Percutaneous removal of buried antegrade femoral nails. J Orthop Trauma. 2008;22(1):52–5.PubMedCrossRef
68.
Metadata
Title
Indications for implant removal after fracture healing: a review of the literature
Authors
D. I. Vos
M. H. J. Verhofstad
Publication date
01-08-2013
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 4/2013
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-013-0283-5

Other articles of this Issue 4/2013

European Journal of Trauma and Emergency Surgery 4/2013 Go to the issue

ESTES News 4.2013

Estes News