Does implant removal of superior clavicle plate osteosynthesis affect the functional outcome: a prospective trial

Markus Wurm, Marc Beirer, Michael Zyskowski, Christopher Völk, Arthur Schwarz, Peter Biberthaler, Chlodwig Kirchhoff, Moritz Crönlein, Markus Wurm, Marc Beirer, Michael Zyskowski, Christopher Völk, Arthur Schwarz, Peter Biberthaler, Chlodwig Kirchhoff, Moritz Crönlein

Abstract

Background: Elective implant removal (IR) accounts for up to 30% of all orthopaedic surgeries. While there is general acceptance about the need of implant removal for obvious reasons, such as infections or implant failure, little is known about the beneficial aspects in cases of minor reasons such as patients' wish for IR. Therefore, we initiated this study to define patients' benefit of elective implant removal following plate osteosynthesis of displaced clavicle fractures.

Patients and methods: Prospective evaluation of patients was conducted before implant removal and 6 weeks postoperative. Subjective and objective criteria included pain rating on a visual analogue scale (VAS) and active range of motion (ROM) pre- and 6 weeks postoperative. Functional scoring included Constant-Murley Score, DASH (Disabilities of Arm, Shoulder and Hand Score), MSQ (Munich Shoulder Questionnaire) and SPADI (Shoulder Pain and Disability Index).

Results: 37 patients were prospectively enrolled in this study and implant removal was performed after 16 ± 6.1 months. No re-fractures nor other complications were detected during routine follow up. Functional outcome increased through all scores (Constant score 73.3 ± 14.6 preoperative to 87.4 ± 12.0 postoperative (p = 0.000), MSQ 85.0 ± 7.3 preoperative to 91.8 ± 9.0 postoperative (p = 0.005), DASH Score 7.4 ± 8.2 preoperative to 5.7 ± 9.5 postoperative (p = 0.414), SPADI 93.4 ± 6.6 preoperative to 94.0 ± 10.1 postoperative (p = 0.734).

Conclusions: Discomfort during daily activities or performing sports as well as limited range of motion were the main reasons for patients' wish for implant removal. We found increased functional outcome parameters and decreased irritation after implant removal. Therefore we suggest implant removal in case of patients' wish and completed fracture consolidation.

Trial registration: Trial registration no: NCT04343118, Retrospective registered: www.clinicaltrials.gov .

Keywords: Clavicle fractures; Disturbing implants; Elective surgery; Hardware removal; Implant removal; Irritation.

Conflict of interest statement

All authors declare no competing interests with respect to the nature of this article.

© 2020. The Author(s).

Figures

Fig. 1
Fig. 1
Midshaft clavicle fracture (OTA 15.C2) preoperative (a), after osteosynthesis using a preformed distal end clavicle plate (Arthrex ®) (b) and after implant removal with remaining 2.0 mm cortical screw (c)

References

    1. Huttunen TT, Launonen AP, Berg HE, Lepola V, Fellander-Tsai L, Mattila VM. Trends in the incidence of clavicle fractures and surgical repair in Sweden: 2001–2012. J Bone Joint Surg Am. 2016;98:1837–1842. doi: 10.2106/JBJS.15.01284.
    1. Fuglesang HFS, Flugsrud GB, Randsborg PH, Oord P, Benth JS, Utvag SE. Plate fixation versus intramedullary nailing of completely displaced midshaft fractures of the clavicle: a prospective randomised controlled trial. Bone Joint J. 2017;99-B:1095–1101. doi: 10.1302/0301-620X.99B8.BJJ-2016-1318.R1.
    1. Zehir S, Zehir R, Sahin E, Calbiyik M. Comparison of novel intramedullary nailing with mini-invasive plating in surgical fixation of displaced midshaft clavicle fractures. Arch Orthop Trauma Surg. 2015;135:339–344. doi: 10.1007/s00402-014-2142-1.
    1. Beirer M, Banke IJ, Harrasser N, Cronlein M, Pforringer D, Huber-Wagner S, et al. Mid-term outcome following revision surgery of clavicular non- and malunion using anatomic locking compression plate and iliac crest bone graft. BMC Musculoskelet Disord. 2017;18:129. doi: 10.1186/s12891-017-1488-2.
    1. Beirer M, Siebenlist S, Crönlein M, Postl L, Huber-Wagner S, Biberthaler B, et al. Clinical and radiological outcome following treatment of displaced lateral clavicle fractures using a locking compression plate with lateral extension. BMC Musculoskelet Disord. 2014;15:380. doi: 10.1186/1471-2474-15-380.
    1. Naveen BM, Joshi GR, Harikrishnan B. Management of mid-shaft clavicular fractures: comparison between non-operative treatment and plate fixation in 60 patients. Strategies Trauma Limb Reconstr. 2017;12:11–18. doi: 10.1007/s11751-016-0272-4.
    1. Dhakad R, Panwar M, Gupta S. Plating versus conservative treatment in mid shaft fractures of clavicle: a comparative study. J Clinic Orthop Trauma. 2016;7:166–170. doi: 10.1016/j.jcot.2015.11.002.
    1. Hulsmans MH, van Heijl M, Houwert RM, Hammacher ER, Meylaerts SA, Verhofstad MH, et al. High irritation and removal rates after plate or nail fixation in patients with displaced midshaft clavicle fractures. Clin Orthop Relat Res. 2017;475:532–539. doi: 10.1007/s11999-016-5113-8.
    1. Acklin YP, Michelitsch C, Sommer C. Elective implant removal in symptomatic patients after internal fixation of proximal humerus fractures improves clinical outcome. BMC Musculoskelet Disord. 2016;17:119. doi: 10.1186/s12891-016-0977-z.
    1. Krettek C, Muller C, Meller R, Jagodzinski M, Hildebrand F, Gaulke R. Is routine implant removal after trauma surgery sensible? Unfallchirurg. 2012;115:315–322. doi: 10.1007/s00113-012-2159-2.
    1. Muller-Farber J. Removal of metal in traumatology. Unfallchirurg. 2003;106:653–668. doi: 10.1007/s00113-003-0637-2.
    1. Liska F, Neu J. Consequences of uncritical indication assessment for hardware removal. Unfallchirurg. 2014;117:658–661. doi: 10.1007/s00113-014-2583-6.
    1. Vos D, Hanson B, Verhofstad M. Implant removal of osteosynthesis the Dutch practice. Results of a survey. J Trauma Manag Outcomes. 2012;6(1):6. doi: 10.1186/1752-2897-6-6.
    1. Böstman O, Pihlajamäki H. Routine implant removal after fracture surgery: a potentially reducible consumer of hospital resources in trauma units. J Trauma. 1996;41:846–849. doi: 10.1097/00005373-199611000-00013.
    1. Sehmisch S, Müller-Färber J (2018) Implantatentfernung nach Osteosynthese. AWMF Online Nr: 012–004
    1. Schmidutz F, Beirer M, Braunstein V, Bogner V, Wiedemann E, Biberthaler B. The Munich Shoulder Questionnaire (MSQ)-development and validation of an effective patient-reported tool for outcome measurement and patient safety in shoulder surgery. Patient Saf Surg. 2012;6(1):9. doi: 10.1186/1754-9493-6-9.
    1. Crönlein M, Zyskowski M, Beirer M, Imhoff FB, Pforringer D, Sandmann GH, et al. Using an anatomically preshaped low-profile locking plate system leads to reliable results in comminuted radial head fractures. Arch Orthop Trauma Surg. 2017;137:789–795. doi: 10.1007/s00402-017-2693-z.
    1. Minkowitz RB, Bhadsavle S, Walsh M, Egol KA. Removal of painful orthopaedic implants after fracture union. J Bone Joint Surg Am. 2007;89:1906–1912. doi: 10.2106/00004623-200709000-00003.
    1. Williams BR, McCreary DL, Chau M, Cunningham BP, Pena F, Swiontkowski MF. Functional outcomes of symptomatic implant removal following ankle fracture open reduction and internal fixation. Foot Ankle Int. 2018;39:674–680. doi: 10.1177/1071100718757719.
    1. Backes M, Schep NW, Luitse JS, Goslings JC, Schepers T. Indications for implant removal following intra-articular calcaneal fractures and subsequent complications. Foot Ankle Int. 2013;34:1521–1525. doi: 10.1177/1071100713502466.
    1. Snoddy MC, An TJ, Hooe BS, Kay HF, Lee DH, Pappas ND. Incidence and reasons for hardware removal following operative fixation of distal radius fractures. J Hand Surg Am. 2015;40:505–507. doi: 10.1016/j.jhsa.2014.11.022.
    1. Hulsmans MH, van Heijl M, Houwert RM, Timmers TK, van Olden G, Verleisdonk EJ. Anteroinferior versus superior plating of clavicular fractures. J Shoulder Elbow Surg. 2016;25:448–454. doi: 10.1016/j.jse.2015.09.005.
    1. Wang J, Chidambaram R, Mok D. Is removal of clavicle plate after fracture union necessary? Int J Shoulder Surg. 2011;5:85–89. doi: 10.4103/0973-6042.90998.
    1. Schwarz N, Euler S, Schlittler M, Ulbing T, Wilhelm P, Fronhofer G, et al. Technical complications during removal of locking screws from locking compression plates: a prospective multicenter study. Eur J Trauma Emerg Surg. 2013;39:339–344. doi: 10.1007/s00068-013-0301-7.

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner