Hardware Removal: Indications and Expectations

Busam, Matthew; Esther, Robert J.; Obremskey, William T.

doi:10.5435/00124635-200602000-00006

Cited by 252 publications

(209 citation statements)

References 40 publications

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“…After fracture healing, the nail usually remains but under certain circumstances such as pain or the need for another implant, removal of the intramedullary nail might become necessary [4,5]. Thus, biodegradable materials, including Mg-alloys, are promising alternatives that could obviate the need for implant removal [8,9,13,20].…”

Section: Discussionmentioning

confidence: 99%

“…The intramedullary stabilization usually remains since implant removal in general and extraction of a nail in particular can be very time-consuming, cumbersome and may cause further tissue damage, refracture and other subsequent problems [4][5][6]. Thus, the second surgery imposes a potential risk to the patient and causes additional costs.…”

Section: Introductionmentioning

confidence: 99%

“…For instance, Mg-Calcium alloys are biocompatible but degrade quite rapidly [21,22]. Mg-Fluoride coating has been reported to reduce the in vivo degradation rate of Mg implants and rare earth metals that are frequently used 4 as alloy materials for Mg can cause cytotoxic effects [23,24]. Recently, members of our consortium reported a novel Mg alloy containing 2% silver (Mg2Ag), which was cast and treated by a solidification cooling process, resulting in appropriate mechanical properties and a rather low degradation rate.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Intramedullary Mg2Ag nails augment callus formation during fracture healing in mice

Jähn¹,

Saito

Taipaleenmäki

et al. 2016

Acta Biomaterialia

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Intramedullary stabilization is frequently used to treat long bone fractures. Implants usually remain unless complications arise. Since implant removal can become technically very challenging with the potential to cause further tissue damage, biodegradable materials are emerging as alternative options. Magnesium (Mg)-based biodegradable implants have a controllable degradation rate and good tissue compatibility, which makes them attractive for musculoskeletal research. Here we report for the first time the implantation of intramedullary nails made of an Mg alloy containing 2% silver (Mg2Ag) into intact and fractured femora of mice. Prior in vitro analyses revealed an inhibitory effect of Mg2Ag degradation products on osteoclast differentiation and function with no impair of osteoblast function. In vivo, Mg2Ag implants degraded under non-fracture and fracture conditions within 210 days and 133 days, respectively. During fracture repair, osteoblast function and subsequent bone formation were enhanced, while osteoclast activity and bone resorption were decreased, leading to an augmented callus formation. We observed a widening of the femoral shaft under steady state and regenerating conditions, which was at least in part due to an uncoupled bone remodeling. However, Mg2Ag implants did not cause any systemic adverse effects. These data suggest that Mg2Ag implants might be promising for intramedullary fixation of long bone fractures, a novel concept that has to be further investigated in future studies.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Intramedullary Mg2Ag nails augment callus formation during fracture healing in mice

Jähn¹,

Saito

Taipaleenmäki

et al. 2016

Acta Biomaterialia

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“…In addition, the implant has to be removed surgically in some symptomatic patients. In our practice, most patients want the metallic implants removed following fracture healing, which increases treatment costs, may be challenging, and can lead to complications [40]. For these reasons, we used absorbable screws and rods as devices for limited internal fixation.…”

Section: Discussionmentioning

confidence: 99%

Treatment of distal tibial shaft fractures by three different surgical methods: a randomized, prospective study

Jiang

Guo

et al. 2014

International Orthopaedics (SICOT)

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“…23 In general, implant removal in adults is mainly reserved for failure or complications of the implant or in case of complaints. 3 However, implant removal after ankle fractures has been associated with high wound complication rates of up to 15 percent 22 and secondly resolution of complaints can be expected in only half of the patients. 2 To date, considering complications after syndesmotic screw removal, there is only information on recurrent diastasis.…”

Section: Introductionmentioning

confidence: 99%

Complications of Syndesmotic Screw Removal

et al. 2011

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Background: Currently, the metallic syndesmotic screw is the gold standard in the treatment of syndesmotic disruption. Whether or not this screw needs to be removed remains debatable. The aim of the current study was to determine the complications which occur following routine removal of the syndesmotic screw following operative treatment of unstable ankle fractures. Methods: This was a retrospective study with consecutive cases in a Level-2 Trauma center. All patients with routine removal of a syndesmotic screw, following the treatment of an unstable ankle fracture, between January 1, 2004 and November 30, 2010 were included. Complications recorded were: 1) minor or major wound infection following removal of the syndesmotic screw, 2) recurrent syndesmotic diastasis, and 3) unnecessary removal of a broken screw, not recognized during preoperative planning prior to surgery. Results: A total of 76 patients were included. A wound infection occurred in 9.2% (N=7) of which 2.6% (N=2) were deep infections requiring reoperation. Recurrent syndesmotic diastasis was found in 6.6% (N=5) of patients, and in 6.6% (N=5) screws were broken at the time of implant removal. In the group with recurrent diastasis the screws were removed significantly earlier compared with the group without recurrent diastasis (Mann- Whitney U-test; p= 0.011) and the group with screw breakage had their screws significantly longer in place compared with the group without breakage ( p = 0.038). Conclusion: A total of 22.4% complications occurred upon routine removal of the syndesmotic screw. Removal might therefore be considered only in selected cases with complaints, after a minimum of eight to twelve weeks and using antibiotic prophylaxis during removal. Level of Evidence: IV, Retrospective Case Study

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Hardware Removal: Indications and Expectations

Cited by 252 publications

References 40 publications

Intramedullary Mg2Ag nails augment callus formation during fracture healing in mice

Intramedullary Mg2Ag nails augment callus formation during fracture healing in mice

Treatment of distal tibial shaft fractures by three different surgical methods: a randomized, prospective study

Complications of Syndesmotic Screw Removal

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