Implants Unnecessary After Fractures Heal, Research Concludes

Patients with fractures – particularly those repaired with plates, pins and screws – often suffer pain and limited mobility upon healing. But new research from the Netherlands concludes that such nuisances easily are eradicated by removing the hardware.

Doctoral candidate Dagmar Vos at the University Medical Center (UMC) in Utrecht studied the consequences of surgically removing implants in nearly 300 patients from five Dutch hospitals (UMC Utrecht, Amphia Hospital in Breda, St. Elisabeth Hospital in Tilburg, Diakonessenhuis in Utrecht and Medisch Spectrum Twente in Enschede). Most patients reported an improvement in pre-surgical complaints of pain and restricted mobility, though complications such as hemorrhaging, infection and sensory impairment occurred in roughly 30 percent of the procedures, Vos’ research shows. Nearly all patients – more than 95 percent – would remove future implants if they ever were needed again..

Vos also researched the effect of removing pediatric implants. In those cases, 10 percent of implant removals resulted in complications, but they generally were mild and transitory. Nonetheless, Vos recommends removing the osteosynthesis materials in children, regardless of whether the child suffers from its adverse effects.

“With children, the discussion rather concerns the potential future problems and not necessarily any symptoms that might be present at that moment,” she explained. “Even though we have no reason to believe that plates, pins and screws are harmful in the long term, we still think that, in children, we should remove these materials as a precaution.”

Practitioners believe the presence of osteosynthesis materials causes the pain and limited mobility experienced by many fracture victims. In the Netherlands, doctors remove the osteosynthesis materials after fracture healing in 30-40 percent of the cases, resulting in about 18,000 surgical procedures annually.

Prof. Dr Yolanda van der Graaf and Prof. Dr Chris van der Werken supervised Vos’ research, which was in part made possible by a subsidy from the AO Foundation in Switzerland. Vos works as a trauma surgeon at Amphia Hospital in Breda.