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European Journal of Trauma and Emergency Surgery

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Open Access 02-08-2021 | Refracture | Original Article

Implant removal associated complications after ESIN osteosynthesis in pediatric fractures

Authors: Justus Lieber, Markus Dietzel, Simon Scherer, Jürgen F. Schäfer, Hans-Joachim Kirschner, Jörg Fuchs

Published in: European Journal of Trauma and Emergency Surgery | Issue 5/2022

Abstract

Purpose

ESIN (elastic stable intramedullary nailing) is considered the gold standard for various pediatric fractures. The aim of this study was to analyze the incidence and type of complications during or after TEN (titanium elastic nail) removal.

Methods

A retrospective data analysis was performed. Metal removal associated complications and preoperative extraosseous length/outlet angle of TENs as possible causes of complications were assessed.

Results

The complication rate in 384 TEN removals was 3.1% (n = 12). One major complication (rupture of M. extensor pollicis brevis) was documented. One refracture at the forearm occurred, however, remodeling prior TEN removal was completed. Ten minor complications were temporary or without irreversible restrictions (3 infections, 5 scaring/granuloma, 2 temporary paraesthesia).

In 38 cases (16 forearms, 10 femora, 9 humeri, 3 lower legs), intra-operative fluoroscopy had to be used to locate the implants. In patients with forearm fractures, extraosseous implant length was relatively shorter than in cases without fluoroscopy (p = 0.01), but outlet angle of TENs was not significantly different in these two groups (28.5° vs 25.6°). In patients with femur fractures, extraosseous implant length and outlet angle were tendentially shorter, respectively, lower, but this did not reach statistical significance.

Conclusion

Removal of TENs after ESIN is a safe procedure with a low complication rate. Technically inaccurate TEN implantation makes removal more difficult and complicated. To prevent an untimely removal and patient discomfort, nail ends must be exactly positioned and cut. Intraoperative complications may be minimized with removal of TENs before signs of overgrowth.

Evidence

Level III, retrospective.

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Title: Implant removal associated complications after ESIN osteosynthesis in pediatric fractures
Authors: Justus Lieber
Markus Dietzel
Simon Scherer
Jürgen F. Schäfer
Hans-Joachim Kirschner
Jörg Fuchs
Publication date: 02-08-2021
Publisher: Springer Berlin Heidelberg
Keywords: Refracture
Elastic-Stable Intramedullary Nailing
Published in: European Journal of Trauma and Emergency Surgery / Issue 5/2022
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-021-01763-4

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Springer Medicine

Implant removal associated complications after ESIN osteosynthesis in pediatric fractures

Abstract

Purpose

Methods

Results

Conclusion

Evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Evidence

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