Outcomes analysis after routine removal of implants in healthy pediatric patients

Chu, Alice; Madou, Maura; Sala, Debra A.; Chorney, Gail S; Feldman, David S.

doi:10.1097/bpb.0b013e32832d5da2

Cited by 9 publications

(20 citation statements)

References 10 publications

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“…The literature search identi ed 13 eligible studies.) (22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) The studies were conducted in Germany, (26)(27)(28) the USA, (29,30,32,33) Switzerland, (22,34) Singapore, (23) New Zealand,(24) the UK, (31) and Japan. (35) Moreover we identi ed a protocol on an ongoing RCT regarding syndesmotic screw removal conducted in the Netherlands (36) and an entry on clinicaltrials.gov about an RCT regarding removal/retaining material in Lisfranc fractures conducted in Canada.…”

Section: Synthesis Of Resultsmentioning

confidence: 99%

“…(26,29,31) Furthermore we identi ed eight before-after studies, comparing the same patients before implant removal and after implant removal. (22,27,28,30,(32)(33)(34)(35)…”

Section: Synthesis Of Resultsmentioning

confidence: 99%

“…We identi ed ve studies analysing pain, three of them used VAS (24,26,29) and the other reported pain as a count. (23,32) Pain was measured similar in the retention and the removal groups of the cohort studies as in the before removal/after removal study from Chu et al. (32) Except for Briceno et al (33) all studies measured general functioning, some in various ways, Functioning was assessed with a (speci c) score, for example the OMAS for studies analysing syndesmotic screws, except in both studies from Gosling et al.…”

Section: Results Of Individual Sources Of Evidencementioning

confidence: 99%

“…(36) Three studies were conducted in Germany, (26)(27)(28) four in the USA. (29,30,32,35) The other studies were conducted in Switzerland, (22,34) Singapore,(23) New Zealand, (24)the UK (31) and Japan. (35) The ongoing RCTs will be performed in the Netherlands and Canada.…”

Section: Summary Of Evidencementioning

confidence: 99%

“…Four before after studies show a statistical signi cant effect in favour of removal regarding functional and/or clinical measures after removal. (22,30,32,34) So far the approach of asymptomatic removal of implants is based on either the wish of the patient or on habits of the surgeon/hospital policies. To help making more standardized decisions in the future, more research is needed especially considering the variety of patients and indications.…”

Section: Summary Of Evidencementioning

confidence: 99%

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Elective removal vs. retaining of hardware after osteosynthesis in asymptomatic patients – A scoping review.

Prediger

Mathes

Probst

et al. 2020

Preprint

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BackgroundOsteosynthesis is the internal fixation of fractures or osteotomy by mechanical devices (also called hardware). After bone healing, there are two options: One is to remove the hardware, the other is to leave it in place. The removal of the hardware in patients without medical indication (elective) is controversially discussed. We performed a scoping review to identify evidence on the elective removal of hardware in asymptomatic patients compared to retaining of the hardware to check feasibility of performing a health technology assessment. In addition, we wanted to find out which type of evidence is available.MethodsA systematic literature search was performed in Pubmed, Embase, EconLit and Cinahl (11/2019). We included studies comparing asymptomatic patients with an internal fixation in the lower or upper extremities whose internal fixation was electively (without medical indication) removed or retained. We did not restrict inclusion to any effectiveness/safety outcome and considered any comparative study design as eligible. Study selection and data extraction was performed by two reviewers. ResultsWe identified 13476 titles/abstracts. Of these we obtained 115 full-text publications which were assessed in detail against the inclusion criteria. We included 13 studies (1 RCT, 4 cohort studies, 8 before-after studies) and identified two ongoing RCTs. Nine assessed the removal of the internal fixation in the lower extremities (six of these syndesmotic screws in ankle fractures only) and two in the upper extremities. One study analysed the effectiveness of hardware removal in children in all types of extremity fractures. Outcomes reported included various scales measuring functionality, pain and clinical assessments (e.g. range of motion) and health-related quality of life.ConclusionsWe identified 13 studies that evaluated the effectiveness/safety of hardware removal in the extremities. The follow up times were short, the patient groups small and the ways of measurement differed. In general clinical heterogeneity was high. Evidence on selected topics e.g. syndesmotic screw removal is available nevertheless not sufficient to allow a meaningful assessment of effectiveness.

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Section: Synthesis Of Resultsmentioning

confidence: 99%

“…(26,29,31) Furthermore we identi ed eight before-after studies, comparing the same patients before implant removal and after implant removal. (22,27,28,30,(32)(33)(34)(35)…”

Section: Synthesis Of Resultsmentioning

confidence: 99%