Villatte G, Haverlan A, Le Baron M, Mulliez A, Boisgard S, Descamps S, Erivan R. Epidemiology of complications after non-compulsory planned hardware-removal after limbs fracture.
Orthop Traumatol Surg Res 2024:104028. [PMID:
39433175 DOI:
10.1016/j.otsr.2024.104028]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 08/27/2024] [Accepted: 09/18/2024] [Indexed: 10/23/2024]
Abstract
INTRODUCTION
Removal of hardware (HR) following a fracture is a frequent question from patients. The incidence of this kind of intervention remains very variable depending on the healthcare systems and its interest is debated in view of the benefits and associated risks that remain poorly defined. Mandatory preoperative information cannot be given optimally in this context.
OBJECTIVE
To determine the rate of complications (major and minor) after non-compulsory planned hardware-removal following a limb fracture.
HYPOTHESIS
The rate of major complications was greater than 1%.
METHODS
A 10-year retrospective single-center study included 1990 patients who had undergone routine HR. Analysis of medical records, with a minimum of one year of follow-up, allowed us to collect: patient data, the type and anatomical location of the osteosynthesis material, as well as the occurrence of a postoperative complication, categorized as a major complication (resulting in either a new surgical procedure, re-hospitalization, or lasting functional impairment) or a minor complication.
RESULTS
Overall, 4.1% (79/1990) of patients experienced postoperative complications, including 1.56% (31/1990) major complications and 21 surgical revisions (1.06%). The time to onset of complications was 9.1 +/- 8.4 days. The most common complications were deep infections and impaired skin healing with superficial infection (55/79, 69.6%). Locations "around the knee" and "around the ankle" were at higher risk of complications (p < 0.01). Smoking was identified as a significant risk factor for complications, particularly deep infection (p = 0.004, OR = 8.7 [1.98; 38.11]).
DISCUSSION
Non-mandatory routine RH has a significant complication rate even in a healthy population. Preoperative information of the patient and the assessment of the benefit/risk balance are essential in this indication. This study also raises the question of mandatory smoking cessation preoperatively.
LEVEL OF EVIDENCE
IV; retrospective study.
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