Removal Versus Retention of Orthopaedic Trauma Implants

Abstract

Most options for the surgical treatment of orthopaedic trauma involve the application of some type of implant or device in order to permanently or temporarily restore the anatomy or function of a joint or other skeletal anatomic structure. Symptomatic implants should be removed only after being ascertained as the source of symptoms, and although asymptomatic implants that are not the source of unwanted effects can be left in place for long periods, the timely removal of an implant that has accomplished its purpose has the benefit of reducing the potential for risks of its retention, such as infection, osteopenia, bone weakening and fracture, and in rare instances carcinogenesis. Standing against these benefits of implant removal are the risks that accompany it, which include possible refracture of the bone or other structure treated with the implant, difficulty in removing the implant, and infection or other complications of the surgery needed for its removal. This article reviews the literature and discusses recommendations pertaining to the decision to retain or remove an internal fixation device that has achieved its purpose, with identification of techniques for effective removal and methods by which to avoid complications.

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