O2109 INDICATION, TIMING AND COMPLICATIONS OF PLATE REMOVAL AFTER FOREARM FRACTURES: RESULTS OF A METANALYSIS INCLUDING 635 CASES

Abstract

Aims: Removal of metal implants after complete fracture healing is controversial. Potential negative aspects of indwelling implants such as stress shielding, metal release, allergies, limitations for later surgical procedures contrast with high cost. Furthermore, knowledge about indication, timing and complications remains very limited. Purpose of this study was to analyse published reports on indication, timing and complications of forearm plate removal. Methods: 14 studies (1984 to 2002), including 635 cases of forearm plate removal, were analysed for indication, timing and complications. Results: While 69.1% of the patients were asymptomatic, 30.9% complained of tenderness, barometric pain, implant prominence and bone infections. The average total frequency of complications was 24.0 (11.8–40)%: Iatrogenic nerve injuries occurred in 11.5 (2.0Ð29.1)%, followed by refractures in 7.7 (2.0–26.1)%, wound infections in 6.8 (4.8–11.5)% and hypertrophic scars in up to 9.1%. However, e.g. the increased forearm refracture rate turned out to be clearly associated with the use of 4.5mm DC plates, plate removal after less than 12 months, poor anatomic reduction and open fractures. Conclusions: Considering the identiþed risk factors, forearm plate removal can be performed with a low complication rate. Since the present analysis is based on a few heterogeneous retrospective studies, major prospective clinical studies are required to acquire representative data to þnally answer the question whether to remove the implant or not. However, leaving metal implants in young patients is necessarily associated with disadvantageous biomechanical properties, inevitable metal release and may interfere with later bone surgical procedures.