Suscripción a Biblioteca: Guest
Portal Digitalde Biblioteca Digital eLibros Revistas Referencias y Libros de Ponencias Colecciones
Journal of Long-Term Effects of Medical Implants
SJR: 0.145 SNIP: 0.491 CiteScore™: 0.89

ISSN Imprimir: 1050-6934
ISSN En Línea: 1940-4379

Journal of Long-Term Effects of Medical Implants

DOI: 10.1615/JLongTermEffMedImplants.2020034958
pages 49-55

Complications and Risk Factors Influencing Hardware Removal after Open Reduction and Internal Fixation of the Radius or Ulna: A Nationwide Study

Paul W. Perdue
Department of Orthopaedics Surgery, Virginia Commonwealth University, Richmond, Virginia
James Satalich
Department of Orthopaedics Surgery, Virginia Commonwealth University, Richmond, Virginia
Julio Jauregui
Department of Orthopaedics, University of Maryland Medical Center, Baltimore, Maryland

SINOPSIS

Indications for open reduction and internal fixation (ORIF) of forearm fractures vary, and some patients require removal of hardware (ROH) for various complications. Currently, limited data exist to evaluate the epidemiology of and risk factors for ROH of the radius/ulna. We examine associations between radius/ulna fractures and (1) characteristics of fractures requiring ORIF, (2) indications for ROH, (3) demographic risk factors for ROH, (4) length of stay, and (5) total hospital charges. We use the Nationwide Inpatient Sample (NIS) to identify patients admitted for radius/ulna ORIF and ROH between 1998 and 2010 in the United States. To identify fracture locations, comorbidities, and indications for ROH, the International Classification of Diseases (ICD)-9 codes were accessed. We identify 423,727 ORIF patients and 12,868 patients (3.0% of ORIF admissions) who underwent ROH. Logistic regression analyses and independent sample t-tests are used to assess risk factors and differences. Among fractures requiring ORIF, the most common is for distal, closed fractures of radius and ulna. The most common indications for ROH are implant infection and mechanical complication. Risk factors for ROH include male gender, Caucasian ethnic group, and Deyo comorbidity scores of 1 or greater. Length of hospital stay and total charges are significantly higher for ROH patients compared to those with ORIF only. ROH following ORIF for radius/ulnar fractures is an infrequent but serious complication that increases patient morbidity and burdens patients and providers. Patient demographics of male gender, Caucasian ethnic group, payer status, and comorbid conditions were identified as independent risk factors for ROH.

REFERENCIAS

  1. Schulte LM, Meals CG, Neviaser RJ. Management of adult diaphyseal both-bone forearm fractures. J Am Acad Ortho Surg. 2014;22:437-46. .

  2. Anderson CE. Intramedullary nailing of the ulna in fractures of both bones of the forearm in adults. West J Surg Obstet Gynecol. 1951;59:559-64. .

  3. Chapman MW, Gordon JE, Zissimos AG. Compression-plate fixation of acute fractures of the diaphyses of the radius and ulna. J Bone Joint Surg. 1989;71:159-69. .

  4. Busam ML, Esther RJ, Obremskey WT. Hardware removal: Indications and expectations. J Am Acad Ortho Surg. 2006;14:113-20. .

  5. Alosh H, Riley LH 3rd, Skolasky RL. Insurance status, geography, race, and ethnicity as predictors of anterior cervical spine surgery rates and in-hospital mortality: An examination of United States trends from 1992 to 2005. Spine. 2009;34:1956-62. .

  6. Bozic KJ, Kurtz SM, Lau E, Ong K, Vail TP, Berry DJ. The epidemiology of revision total hip arthroplasty in the United States. J Bone Joint Surg. 2009;91:128-33. .

  7. Lovald S, Mercer D, Hanson J, Cowgill I, Erdman M, Robinson P, Diamond B. Complications and hardware removal after open reduction and internal fixation of humeral fractures. J Trauma Acute Care Surg. 2011 May 1;70(5):1273-8; 7-8. .

  8. Lovald S, Mercer D, Hanson J, Cowgill I, Erdman M, Robinson P, Diamond B. Hardware removal after fracture fixation procedures in the femur. J Trauma Acute Care Surg. 2012 Jan 1;72(1):282-7. .

  9. Steiner C, Elixhauser A, Schnaier J. The healthcare cost and utilization project: An overview. Effect Clin Pract. 2002;5:143-51. .

  10. Weber SC, Martin DF, Seiler JG 3rd, Harrast JJ. Superior labrum anterior and posterior lesions of the shoulder: Incidence rates, complications, and outcomes as reported by American Board of Orthopedic Surgery. Part II: Candidates. Am J Sports Med. 2012;40:1538-43. .

  11. Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical co-morbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45:613-9. .

  12. Uhthoff HK, Finnegan M. The effects of metal plates on post-traumatic remodelling and bone mass. J Bone Joint Surg. 1983;65:66-71. .

  13. Terjesen T, Benum P. The stress-protecting effect of metal plates on the intact rabbit tibia. Acta Orthopaed Scandinavica. 1983;54:810-8. .

  14. Stromberg L, Dalen N. Atrophy of cortical bone caused by rigid internal fixation plates. An experimental study in the dog. Acta Orthopaed Scandinavica. 1978;49:448-56. .

  15. Rosson JW, Petley GW, Shearer JR. Bone structure after removal of internal fixation plates. J Bone Joint Surg. 1991;73:65-7. .

  16. Langkamer VG, Ackroyd CE. Removal of forearm plates. A review of the complications. J Bone Joint Surg. 1990;72:601-4. .

  17. Duncan R, Geissler W, Freeland AE, Savoie FH. Immediate internal fixation of open fractures of the diaphysis of the forearm. J Ortho Trauma. 1992;6:25-31. .

  18. Moed BR, Kellam JF, Foster RJ, Tile M, Hansen ST Jr. Immediate internal fixation of open fractures of the diaphysis of the forearm. J Bone Joint Surg. 1986;68:1008-17. .

  19. Beaupre GS, Csongradi JJ. Refracture risk after plate removal in the forearm. J Ortho Trauma. 1996;10:87-92. .

  20. Yao CK, Lin KC, Tarng YW, Chang WN, Renn JH. Removal of forearm plate leads to a high risk of refracture: Decision regarding implant removal after fixation of the forearm and analysis of risk factors of refracture. Arch Ortho Trauma Surg. 2014;134:1691-7. .

  21. Deluca PA, Lindsey RW, Ruwe PA. Refracture of bones of the forearm after the removal of compression plates. J Bone Joint Surg. 1988;70:1372-6. .

  22. Hidaka S, Gustilo RB. Refracture of bones of the forearm after plate removal. J Bone Joint Surg. 1984;66:1241-3. .

  23. Tarallo L, Mugnai R, Zambianchi F, Adani R, Catani F. Volar plate fixation for the treatment of distal radius fractures: Analysis of adverse events. J Ortho Trauma. 2013 Dec 1;27(12):740-5. .


Articles with similar content:

What are the Risk Factors for Hardware Removal after Tibia or Fibula Fracture?
Journal of Long-Term Effects of Medical Implants, Vol.25, 2015, issue 4
Julio J. Jauregui, Matthew R. Boylan, Paul W. Perdue, Yoseph A. Rosenbaum, Dean C. Perfetti, Bhaveen V. Kapadia, Carl B. Paulino
CANNABIS USE INCREASES RISK FOR REVISION AFTER TOTAL KNEE ARTHROPLASTY
Journal of Long-Term Effects of Medical Implants, Vol.28, 2018, issue 2
Tsun Yee Law, Zachary Hubbard, Samuel Rosas, Martin Roche, Spencer Summers, Karim Sabeh, Jennifer Kurowicki
Use of a Flexible Intramedullary Rod and its Influence on Patient Satisfaction and Femoral Size in Total Knee Arthroplasty
Journal of Long-Term Effects of Medical Implants, Vol.25, 2015, issue 3
Todd P. Pierce, Evan Leibowitz, Julio J. Jauregui, Jeffery J. Cherian, Scott Logan, Michael A. Mont, Randa K Elmallah, Kirby D. Hitt
Effects of Gender, Age, and Time on Wrist Pain up to Two Years Following Distal Radius Fracture
Critical Reviews™ in Physical and Rehabilitation Medicine, Vol.32, 2020, issue 2
Joy C. MacDermid, Christina Ziebart, Nina Suh
Outcomes of Primary Total Knee Arthroplasty in the Morbidly Obese Patients
Journal of Long-Term Effects of Medical Implants, Vol.23, 2013, issue 4
Julio J. Jauregui, Mark J. McElroy, Sina Pourtaheri, Michael A. Mont, Kimona Issa, Sujal Patel