PMID- 28988807
OWN - NLM
STAT- MEDLINE
DCOM- 20180815
LR  - 20180815
IS  - 1879-0267 (Electronic)
IS  - 0020-1383 (Linking)
VI  - 48
IP  - 12
DP  - 2017 Dec
TI  - Increased risk for complications following removal of hardware in patients with
      liver disease, pilon or pelvic fractures: A regression analysis.
PG  - 2705-2708
LID - S0020-1383(17)30645-9 [pii]
LID - 10.1016/j.injury.2017.09.030 [doi]
AB  - PURPOSE: Indications for removing orthopedic hardware on an elective basis varies
      widely. Although viewed as a relatively benign procedure, there is a lack of data
      regarding overall complication rates after fracture fixation. The purpose of this
      study is to determine the overall short-term complication rate for elective
      removal of orthopedic hardware after fracture fixation and to identify associated
      risk factors. MATERIALS AND METHODS: Adult patients indicated for elective
      hardware removal after fracture fixation between July 2012 and July 2016 were
      screened for inclusion. Inclusion criteria included patients with hardware
      related pain and/or impaired cosmesis with complete medical and radiographic
      records and at least 3-month follow-up. Exclusion criteria were those patients
      indicated for hardware removal for a diagnosis of malunion, non-union, and/or
      infection. Data collected included patient age, gender, anatomic location of
      hardware removed, body mass index, ASA score, and comorbidities. Overall
      complications, as well as complications requiring revision surgery were recorded.
      Statistical analysis was performed with SPSS 20.0, and included univariate and
      multivariate regression analysis. RESULTS: 391 patients (418 procedures) were
      included for analysis. Overall complication rates were 8.4%, with a 3.6% revision
      surgery rate. Univariate regression analysis revealed that patients who had liver
      disease were at significant risk for complication (p=0.001) and revision surgery 
      (p=0.036). Multivariate regression analysis showed that: 1) patients who had
      liver disease were at significant risk of overall complication (p=0.001) and
      revision surgery (p=0.039); 2) Removal of hardware following fixation for a pilon
      had significantly increased risk for complication (p=0.012), but not revision
      surgery (p=0.43); and 3) Removal of hardware for pelvic fixation had a
      significantly increased risk for revision surgery (p=0.017). CONCLUSIONS: Removal
      of hardware following fracture fixation is not a risk-free procedure. Patients
      with liver disease are at increased risk for complications, including increased
      risk for needing revision surgery following hardware removal. Patients having
      hardware removed following fixation for pilon fractures also are at increased
      risk for complication, although they may not require a return trip to the
      operating room. Finally, removal of pelvic hardware is associated with a higher
      return to the operating room.
CI  - Copyright (c) 2017 Elsevier Ltd. All rights reserved.
FAU - Brown, Bryan D
AU  - Brown BD
AD  - Department of Orthopedics, Orlando Regional Medical Center, United States.
FAU - Steinert, Justin N
AU  - Steinert JN
AD  - Department of Orthopedics, Orlando Regional Medical Center, United States.
FAU - Stelzer, John W
AU  - Stelzer JW
AD  - Department of Orthopedics, Orlando Regional Medical Center, United States.
FAU - Yoon, Richard S
AU  - Yoon RS
AD  - Department of Orthopedics, Orlando Regional Medical Center, United States.
      Electronic address: yoonrich@gmail.com.
FAU - Langford, Joshua R
AU  - Langford JR
AD  - Department of Orthopedics, Orlando Regional Medical Center, United States.
FAU - Koval, Kenneth J
AU  - Koval KJ
AD  - Department of Orthopedics, Orlando Regional Medical Center, United States.
LA  - eng
PT  - Journal Article
DEP - 20171003
PL  - Netherlands
TA  - Injury
JT  - Injury
JID - 0226040
SB  - IM
CIN - Injury. 2018 Feb;49(2):447. PMID: 29146004
MH  - Adult
MH  - *Device Removal/methods
MH  - Female
MH  - Fracture Fixation, Internal/*adverse effects
MH  - Fracture Healing/*physiology
MH  - Fractures, Bone/*surgery
MH  - Humans
MH  - Liver Diseases/surgery
MH  - Male
MH  - Middle Aged
MH  - Pain, Postoperative/physiopathology/*surgery
MH  - Patient Education as Topic
MH  - Pelvic Bones/*surgery
MH  - Regression Analysis
MH  - Reoperation
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Tibia/*surgery
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Complication rates
OT  - Painful hardware
OT  - Removal of hardware
EDAT- 2017/10/11 06:00
MHDA- 2018/08/16 06:00
CRDT- 2017/10/10 06:00
PHST- 2017/05/30 00:00 [received]
PHST- 2017/09/05 00:00 [revised]
PHST- 2017/09/28 00:00 [accepted]
PHST- 2017/10/11 06:00 [pubmed]
PHST- 2018/08/16 06:00 [medline]
PHST- 2017/10/10 06:00 [entrez]
AID - S0020-1383(17)30645-9 [pii]
AID - 10.1016/j.injury.2017.09.030 [doi]
PST - ppublish
SO  - Injury. 2017 Dec;48(12):2705-2708. doi: 10.1016/j.injury.2017.09.030. Epub 2017
      Oct 3.