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Montgomery BK, Gamble JG, Kha ST, Hecht GG, Vorhies JS, Lucas JF. Indications for and Risks Associated With Implant Removal After Pediatric Trauma. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202204000-00016. [PMID: 35427259 PMCID: PMC10566936 DOI: 10.5435/jaaosglobal-d-22-00050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 02/14/2022] [Indexed: 06/14/2023]
Abstract
A wide range of implants are used in the treatment of pediatric fractures, including wires, plates, screws, flexible rods, rigid rods, and external fixation devices. Pediatric bones differ from adult bones both mechanically and biologically, including the potential for remodeling. Implants used in pediatric trauma patients present a unique set of circumstances regarding indications, risks, timing of implant removal, weight-bearing restrictions, and long-term sequelae. Indications for implant removal include wire/pin fixation, when substantial growth remains, and infection. When considering implant removal, the risks and benefits must be assessed. The primary risk of implant removal is refracture. The timing of implant removal varies widely from several weeks to a year or more with the option of retention depending on the fracture, type of implant, and skeletal maturity of the patient.
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Affiliation(s)
- Blake K. Montgomery
- From the Department of Orthopaedic Surgery, Santa Clara Valley Medical Center, San Jose, CA (Dr. Lucas and Dr. Hecht); Stanford Orthopaedics, San Jose, CA (Dr. Lucas and Dr. Hecht); and the Department of Orthopaedic Surgery, Stanford University, Redwood City, CA (Dr. Montgomery, Dr. Gamble, Dr. Kha, and Dr. Vorhies)
| | - James G. Gamble
- From the Department of Orthopaedic Surgery, Santa Clara Valley Medical Center, San Jose, CA (Dr. Lucas and Dr. Hecht); Stanford Orthopaedics, San Jose, CA (Dr. Lucas and Dr. Hecht); and the Department of Orthopaedic Surgery, Stanford University, Redwood City, CA (Dr. Montgomery, Dr. Gamble, Dr. Kha, and Dr. Vorhies)
| | - Stephanie T. Kha
- From the Department of Orthopaedic Surgery, Santa Clara Valley Medical Center, San Jose, CA (Dr. Lucas and Dr. Hecht); Stanford Orthopaedics, San Jose, CA (Dr. Lucas and Dr. Hecht); and the Department of Orthopaedic Surgery, Stanford University, Redwood City, CA (Dr. Montgomery, Dr. Gamble, Dr. Kha, and Dr. Vorhies)
| | - Garin G. Hecht
- From the Department of Orthopaedic Surgery, Santa Clara Valley Medical Center, San Jose, CA (Dr. Lucas and Dr. Hecht); Stanford Orthopaedics, San Jose, CA (Dr. Lucas and Dr. Hecht); and the Department of Orthopaedic Surgery, Stanford University, Redwood City, CA (Dr. Montgomery, Dr. Gamble, Dr. Kha, and Dr. Vorhies)
| | - John S. Vorhies
- From the Department of Orthopaedic Surgery, Santa Clara Valley Medical Center, San Jose, CA (Dr. Lucas and Dr. Hecht); Stanford Orthopaedics, San Jose, CA (Dr. Lucas and Dr. Hecht); and the Department of Orthopaedic Surgery, Stanford University, Redwood City, CA (Dr. Montgomery, Dr. Gamble, Dr. Kha, and Dr. Vorhies)
| | - Justin F. Lucas
- From the Department of Orthopaedic Surgery, Santa Clara Valley Medical Center, San Jose, CA (Dr. Lucas and Dr. Hecht); Stanford Orthopaedics, San Jose, CA (Dr. Lucas and Dr. Hecht); and the Department of Orthopaedic Surgery, Stanford University, Redwood City, CA (Dr. Montgomery, Dr. Gamble, Dr. Kha, and Dr. Vorhies)
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