Abstract
Introduction
Tibial plateau fractures are common injuries often treated with open reduction and internal fixation. We have noted improved patient satisfaction following implant removal for these patients. The purpose of this study was to assess the effect of removal of surgical implants after union on patient reported outcomes.
Materials and methods
All patients at our Level 1 Trauma Center undergoing open reduction an internal fixation by the senior surgeon are offered enrollment into a prospective registry and have clinical outcomes recorded at follow-up [Knee Outcomes Survey (KOS), Lower Extremity Functional Scale (LEFS), Short Form-36 Physical and Mental Component Summary (SF-36 PCS, SF-36 MCS), and Visual analog pain scale (VAS)]. Routinely, removal of surgical implants is offered after fracture union resulting in two cohorts: those who had undergone elective removal of surgical implants and those who had not. Outcome scores were compared before and after implant removal as well as between the two study populations at final follow-up.
Results
Seventy-five patients were identified as having 12 month outcome scores: 36 (48 %) had retained implants; 39 (52 %) had implants removed. KOS and LEFS outcomes improved significantly after implant removal (p < 0.05). Clinical outcomes (KOS, SF-36 PCS) were also significantly better in patients who had implants removed compared to those that did not at final follow-up (p < 0.05). There was no statistical difference seen in VAS pain scores.
Conclusions
The results of this study indicate that patients who have elective removal of their surgical implants after open reduction and internal fixation of a tibial plateau fracture have improved clinical outcomes after removal and also demonstrate significantly better outcomes than those who have retained implants at final follow-up. Patients who are unhappy with their clinical result should be counseled that removal of the implant may improve function, but may not improve pain.
Similar content being viewed by others
References
Rockwood CA, Green DP, Bucholz RW (2010) Rockwood & Green’s fractures in adults. 1 Online resource (2 v. xvii, 2174, 39)
Court-Brown CM, Caesar B (2006) Epidemiology of adult fractures: a review. Injury 37(8):691–697
Browner BD (2009) MD Consult LLC. Skeletal trauma
Barei DP, Nork SE, Mills WJ, Coles CP, Henley MB, Benirschke SK (2006) Functional outcomes of severe bicondylar tibial plateau fractures treated with dual incisions and medial and lateral plates. J Bone Joint Surg Am 88(8):1713–1721
Honkonen SE (1995) Degenerative arthritis after tibial plateau fractures. J Orthop Trauma 9(4):273–277
Rademakers MV, Kerkhoffs GM, Sierevelt IN, Raaymakers EL, Marti RK (2007) Operative treatment of 109 tibial plateau fractures: 5- to 27-year follow-up results. J Orthop Trauma 21(1):5–10
Schatzker J, McBroom R, Bruce D (1979) The tibial plateau fracture. The Toronto experience 1968–1975. Clin Orthop Relat Res 138:94–104
Parkkinen M, Madanat R, Mustonen A, Koskinen SK, Paavola M, Lindahl J (2014) Factors predicting the development of early osteoarthritis following lateral tibial plateau fractures Mid-term clinical and radiographic outcomes of 73 operatively treated patients. Scand J Surg
Biyani A, Reddy NS, Chaudhury J, Simison AJ, Klenerman L (1995) The results of surgical management of displaced tibial plateau fractures in the elderly. Injury 26(5):291–297
Gerich T, Blauth M, Witte F, Krettek C (2001) Osteosynthesis of fractures of the head of the tibia in advanced age. A matched-pair analysis. Unfallchirurg 104(1):50–56
Hsu CJ, Chang WN, Wong CY (2001) Surgical treatment of tibial plateau fracture in elderly patients. Arch Orthop Trauma Surg 121(1–2):67–70
Keating JF (1999) Tibial plateau fractures in the older patient. Bull Hosp Jt Dis 58(1):19–23
Levy O, Salai M, Ganel A, Mazor J, Oran A, Horoszowski H (1993) The operative results of tibial plateau fractures in older patients: a long-term follow-up and review. Bull Hosp Jt Dis 53(1):15–6
Stevens DG, Beharry R, McKee MD, Waddell JP, Schemitsch EH (2001) The long-term functional outcome of operatively treated tibial plateau fractures. J Orthop Trauma 15(5):312–320
Houben PF, van der Linden ES, van den Wildenberg FA, Stapert JW (1997) Functional and radiological outcome after intra-articular tibial plateau fractures. Injury. 28(7):459–462
Ahearn N, Oppy A, Halliday R, Rowett-Harris J, Morris SA, Chesser TJ et al (2014) The outcome following fixation of bicondylar tibial plateau fractures. Bone Joint J 96-B(7):956–962
Berkes MB, Little MT, Schottel PC, Pardee NC, Zuiderbaan A, Lazaro LE et al (2014) Outcomes of Schatzker II tibial plateau fracture open reduction internal fixation using structural bone allograft. J Orthop Trauma 28(2):97–102
Tucker A, Street J, Kealey D, McDonald S, Stevenson M (2013) Functional outcomes following syndesmotic fixation: a comparison of screws retained in situ versus routine removal—is it really necessary? Injury 44(12):1880–1884
Ogundele OJ, Ifesanya AO, Adesanya AA, Alonge TO (2013) Removal of orthopaedic implants from patients at the University College Hospital, Ibadan. Afr J Med Med Sci 42(2):151–155
Kumar G, Mereddy PK, Hakkalamani S, Donnachie NJ (2010) Implant removal following surgical stabilization of patella fracture. Orthopedics. doi:10.3928/01477447-20100329-14
Miller AN, Paul O, Boraiah S, Parker RJ, Helfet DL, Lorich DG (2010) Functional outcomes after syndesmotic screw fixation and removal. J Orthop Trauma 24(1):12–16
Kim HN, Park YJ, Kim GL, Park YW (2013) Arthroscopy combined with hardware removal for chronic pain after ankle fracture. Knee Surg Sports Traumatol Arthrosc 21(6):1427–1433
Brown OL, Dirschl DR, Obremskey WT (2001) Incidence of hardware-related pain and its effect on functional outcomes after open reduction and internal fixation of ankle fractures. J Orthop Trauma 15(4):271–274
Vos D, Hanson B, Verhofstad M (2012) Implant removal of osteosynthesis: the Dutch practice. Results of a survey. J Trauma Manag Outcomes 6(1):6 (2897-6-6)
Hanson B, van der Werken C, Stengel D (2008) Surgeons’ beliefs and perceptions about removal of orthopaedic implants. BMC Musculoskelet Disord 9:73 (2474-9-73)
Bostman O, Pihlajamaki H (1996) Routine implant removal after fracture surgery: a potentially reducible consumer of hospital resources in trauma units. J Trauma 41(5):846–849
Minkowitz RB, Bhadsavle S, Walsh M, Egol KA (2007) Removal of painful orthopaedic implants after fracture union. J Bone Joint Surg Am 89(9):1906–1912
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
None.
Rights and permissions
About this article
Cite this article
Garner, M.R., Thacher, R.R., Ni, A. et al. Elective removal of implants after open reduction and internal fixation of Tibial Plateau fractures improves clinical outcomes. Arch Orthop Trauma Surg 135, 1491–1496 (2015). https://doi.org/10.1007/s00402-015-2299-2
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00402-015-2299-2