Sat., 10/6/12 Pediatric Fractures, PAPER #109, 3:23 pm OTA-2012
Complications of Retained Hardware After Plate Fixation of the Pediatric Forearm
Bryan G. Vopat, MD; Peter G. Fitzgibbons, MD; Patrick M. Kane, MD;
Christopher J. Got, MD; Julia A. Katarincic, MD;
Rhode Island Hospital, Providence, Rhode Island, USA
Purpose: The removal of plates and screws placed during fracture fixation for pediatric forearm fractures is an historically common but currently controversial procedure. In a recent survey, 40% of pediatric orthopaedic surgeons recommended routine hardware removal, despite evidence that it exposes children to risks such as refracture though empty screw holes. Our hypothesis is that retained hardware after plate fixation results in equal or less morbidity than surgical removal of implants in pediatric forearm fractures.
Methods: Billing records and operative reports were used to identify all children between the ages of 6 and 15 years who underwent plate fixation of a single or both-bone forearm fracture from 1999 and 2009 at a single institution. Patients were interviewed over the phone and a physician filled out a questionnaire with regard to their clinical course. Factors such as hardware complications, functional activity level, pain score, and clinical symptoms were analyzed. These data were used to establish rates of complication between patients who had hardware retained and patients who had their hardware removed.
Results: Between 1999 and 2009, 58 patients (59 forearms) between the ages of 6 and 15 years who were treated with plate fixation for a forearm fracture were identified. Long-term follow-up was acquired for 33 of these patients. Average length of follow-up was 6.4 years (range, 1.5-10.1 years). Of the 33 patients, 6 had the plates electively removed while 27 patients initially elected to retain their hardware. Fractures occurred in 3 of 6 (50%) of the patients who chose to have their hardware electively removed versus 2 of 27 (7.4%) of the patients who chose to retain their hardware. Of the 27 patients who initially chose to leave the hardware in place, 3 of 27 (11.1%) had partial or complete removal of the hardware due to irritation. Additionally, patients with retained hardware reported the following symptoms: mild pain (10 of 27; 37.0%), clicking (10 of 27; 37.0%), ability to feel the plates (21 of 27; 77.8%), and mild weakness (9 of 27; 33.3%). However, significant functional improvement from injury was observed in this group, as 24 of 27 (88.9%) returned to preinjury level of activity and 26 of 27 (96.3%) reported being satisfied with their clinical outcome.
Conclusion: There is a decreased rate of refracture and, overall, a high level of satisfaction in those patients whose plates are left in place. Leaving forearm plates in place is a reasonable option in pediatric patients with forearm fractures.
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