Femoral Nail Removal Should Be Restricted in Asymptomatic Patients

Gösling, Thomas; Hüfner, T.; Hankemeier, Stefan; Zelle, Boris A.; Muller-Heine, Assia; Krettek, Christian

doi:10.1097/01.blo.0000130208.90879.67

Cited by 58 publications

(60 citation statements)

References 9 publications

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“…Though pain seemed to decrease in all symptomatic patients, the advise was only to remove femur nails in symptomatic patients [49][50][51][52][53]. Gösling et al showed, in a retrospective study analysing the removal of 164 femoral nails after fracture healing, that 78% of the patients with existing local complaints improved postoperatively [54]. However, 10 out of 51 patients who were asymptomatic preoperatively reported long-term complaints after removal.…”

Section: What Are the Specific Indications For Implant Removal From Tmentioning

confidence: 99%

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

Vos

Verhofstad²

2013

Eur J Trauma Emerg Surg

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Section: What Are the Specific Indications For Implant Removal From Tmentioning

confidence: 99%

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

Vos

Verhofstad²

2013

Eur J Trauma Emerg Surg

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“…However, controversy surrounds the indications for its removal (Toms et al, 1996;Boerger et al, 1999;Gösling et al, 2004;Karladani et al, 2007;Morshed et al, 2007). Removal of an IM nail in symptomatic patients is primarily due to pain experienced by the patient or infection of the device and adjacent tissues (Husain et al, 1996;Luhmann et al, 2003;Flynn et al, 2004;Hui et al, 2007).…”

Section: Introductionmentioning

confidence: 99%

An in vivo evaluation of surface polishing of TAN intermedullary nails for ease of removal

Di²,

Hahn³

et al. 2009

eCM

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Fractures of the tibia and femoral diaphysis are commonly repaired by intra-medullary (IM) nailing. Currently IM nails are available in either electropolished stainless steel (SS) or in Titanium-Aluminium-Niobium (TAN). After healing, removal of the nails still is common but removal of TAN IM nails often has complications whereas SS IM nails of the same design are less often associated with problems. We believe the differences in removal are due to the ability of TAN to promote strong bone on-growth. We have previously shown in vivo that polishing cortical screws reduces removal torque and the percentage of bone-implant contact. Therefore, we postulate that bony on-growth onto IM nails can be reduced by means of surface polishing, for ease of removal. Here we aim to compare the pull-out forces for removal of standard TAN (TAN-S) compared to experimental paste polished TAN (TAN-PP) IM nails from a bilateral non-fracture sheep tibia model after 12 months implantation. Histological analysis was also performed to assess tissue on-growth to the nails. We show that polishing significantly reduces (p=0.05) the extraction force required for TAN IM nail removal. This effect in part is attributable to the distinct tissue-material reaction produced. For TAN-S nails direct bone contact was observed while for TAN-PP nails a fibrous tissue interface was noted. Since TAN is preferred over SS for IM nailing due to superior biocompatibility and mechanical properties, we believe these findings could be used to recommend changes to current surface technologies of intramedullary nails to reduce complications seen with nail removal especially in rapidly growing bone in children.

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“…We were unable to find any previous reports on cases of the femoral fracture that occurred during removal of the intramedullary femoral nail [12][13][14]. Husain et al [12] reviewed their 45 cases of femoral nail removal, and did not find particular difficulties in late removal of titanium nails as well as stainless steel nails.…”

Section: Aizawa Et Al J Med Cases 2015;6(3):105-108mentioning

confidence: 90%

“…Although some previous studies have indicated that the removal of intramedullary femoral nails should be restricted in asymptomatic patients [13,14], the nail removal might be useful for symptomatic patients [15]. In Asian countries, patients prefer the removal of metallic hardware also for cultural reasons [1,4].…”

Section: Aizawa Et Al J Med Cases 2015;6(3):105-108mentioning

confidence: 99%

Femoral Fracture Caused by Removal of Femoral Intramedullary Nail Made of Stainless Steel

Aizawa¹,

Jinno

Nanke

et al. 2015

J Med Cases

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This is to report a case of femoral fracture caused by removal of a femoral intramedullary nail. The patient was a 28-year-old male. We performed intramedullary nailing for his femoral shaft fracture with an interlocking femoral nail made of stainless steel with fluted structure and roughened surface. The nail was removed 2 years and 5 months later, and fresh fracture lines were found in the postremoval radiograph. We suspected there existed problems with the structure of the intramedullary nail as well as late removal of the nail.

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Femoral Nail Removal Should Be Restricted in Asymptomatic Patients

Cited by 58 publications

References 9 publications

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

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

An in vivo evaluation of surface polishing of TAN intermedullary nails for ease of removal

Femoral Fracture Caused by Removal of Femoral Intramedullary Nail Made of Stainless Steel

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