REVIEW OF REMOVAL OF METALWORK IN PAEDIATRIC ORTHOPAEDIC TRAUMA DURING ONE YEAR PERIOD

Abstract

Aim: Controversy remains regarding the complications/necessity for removal of metalwork used in the fixation of paediatric orthopaedic surgery owing to potential complications of removal. It was the aim of this study to review all cases of metalwork removal performed in a prescribed year in order to ascertain the reasons for removal and complications of these surgeries.

Methods: All cases of metalwork removal performed under GA, from 1st January 2006 until 31st December 2006 in a regional paediatric orthopaedic unit, were reviewed. Data were obtained from case notes, computer and theatre records and radiographs. Details were obtained regarding demographic details, anatomic site, implant used, reasons for removal, problems of initial fixation and complications after removal.

Results: 34 buried kirschner wires were removed under general anaesthetic. Of other metal work, 38 implants were removed; 22 in males and 16 in females. The commonest age distribution was the 11–15 age groups. The most common anatomic site for removal was the forearm (42%) followed by the femur (18%) and ankle (18%). The most common implant removed was plate (53%), followed by Nancy nails (18%). Problems following initial insertion were found in 4 patients (10.5%) including re-fracture distal to forearm plates (both in patients with co-existing osteopaenia), bowing of forearm and decreased sensation over the thumb. Metal work was removed for symptoms in 13 cases (34%) and the rest for patient request or clinical indications. Complications after metalwork removal occurred in 8 (21%) patients and included re-fracture of forearm (2), hypertrophic scar, abscess, skin reaction, wound breakdown, excessive bruising and discomfort.

Conclusion: As routine removal of metalwork is generally considered not necessary, metalwork removal is often carried out for symptoms, at patient request as well as in patients with osteopaenia who have risk of fracture at the ends of metalwork. Parents need to be made aware of possible complications shown in the study, in order to give informed consent.