Does Implant Removal of Superior Clavicle Plate Osteosynthesis Affect the Functional Outcome: a Prospective Trial

Overview

Journal Arch Orthop Trauma Surg

Specialties Emergency Medicine
General Surgery
Orthopedics

Date 2020 Nov 1

PMID 33130933

Citations 7

Authors

Markus Wurm

Marc Beirer

Michael Zyskowski

Christopher Volk

Arthur Schwarz

Peter Biberthaler

Chlodwig Kirchhoff

Moritz Cronlein

Affiliations

Soon will be listed here.

Abstract

Background: Elective implant removal (IR) accounts for up to 30% of all orthopaedic surgeries. While there is general acceptance about the need of implant removal for obvious reasons, such as infections or implant failure, little is known about the beneficial aspects in cases of minor reasons such as patients' wish for IR. Therefore, we initiated this study to define patients' benefit of elective implant removal following plate osteosynthesis of displaced clavicle fractures.

Patients And Methods: Prospective evaluation of patients was conducted before implant removal and 6 weeks postoperative. Subjective and objective criteria included pain rating on a visual analogue scale (VAS) and active range of motion (ROM) pre- and 6 weeks postoperative. Functional scoring included Constant-Murley Score, DASH (Disabilities of Arm, Shoulder and Hand Score), MSQ (Munich Shoulder Questionnaire) and SPADI (Shoulder Pain and Disability Index).

Results: 37 patients were prospectively enrolled in this study and implant removal was performed after 16 ± 6.1 months. No re-fractures nor other complications were detected during routine follow up. Functional outcome increased through all scores (Constant score 73.3 ± 14.6 preoperative to 87.4 ± 12.0 postoperative (p = 0.000), MSQ 85.0 ± 7.3 preoperative to 91.8 ± 9.0 postoperative (p = 0.005), DASH Score 7.4 ± 8.2 preoperative to 5.7 ± 9.5 postoperative (p = 0.414), SPADI 93.4 ± 6.6 preoperative to 94.0 ± 10.1 postoperative (p = 0.734).

Conclusions: Discomfort during daily activities or performing sports as well as limited range of motion were the main reasons for patients' wish for implant removal. We found increased functional outcome parameters and decreased irritation after implant removal. Therefore we suggest implant removal in case of patients' wish and completed fracture consolidation.

Trial Registration: Trial registration no: NCT04343118, Retrospective registered: www.clinicaltrials.gov .

Citing Articles

Clavicle Shaft Non-Unions-Do We Even Need Bone Grafts?.

Muhlenfeld N, Wagner F, Hupperich A, Heykendorf L, Frodl A, Obid P J Clin Med. 2024; 13(16).

PMID: 39200992 PMC: 11355853. DOI: 10.3390/jcm13164850.

Patient satisfaction after elective implant removal of the lower extremity - a retrospective cohort study.

Hambrecht J, Canal C, Klingebiel F, Kohli P, Neuhaus V, Pape H Eur J Trauma Emerg Surg. 2024; 50(3):1165-1172.

PMID: 38319352 PMC: 11249532. DOI: 10.1007/s00068-024-02462-6.

Elective implant removal in the upper extremity: only symptomatic patients benefit.

Hambrecht J, Canal C, Klingebiel F, Pfammatter C, Teuben M, Neuhaus V Eur J Orthop Surg Traumatol. 2023; 34(2):1153-1161.

PMID: 37982914 PMC: 10858111. DOI: 10.1007/s00590-023-03777-7.

Excellent clinical and radiological outcome following locking compression plate fixation of displaced medial clavicle fractures.

Wurm M, Siebenlist S, Zyskowski M, Pfluger P, Biberthaler P, Beirer M BMC Musculoskelet Disord. 2021; 22(1):905.

PMID: 34706701 PMC: 8555070. DOI: 10.1186/s12891-021-04775-8.

Good to Excellent Functional Outcome and High Return to Sports Rate after Operative Treatment of Unstable Lateral Clavicle Fractures: Comparison of Two Coracoclavicular Button Fixation Techniques.

Wurm M, Zyskowski M, Pesch S, Biberthaler P, Kirchhoff C, Beirer M J Clin Med. 2021; 10(20).

PMID: 34682807 PMC: 8538234. DOI: 10.3390/jcm10204685.

References

Schmidutz F, Beirer M, Braunstein V, Bogner V, Wiedemann E, Biberthaler P . The Munich Shoulder Questionnaire (MSQ): development and validation of an effective patient-reported tool for outcome measurement and patient safety in shoulder surgery. Patient Saf Surg. 2012; 6(1):9. PMC: 3502470. DOI: 10.1186/1754-9493-6-9. View

Snoddy M, An T, Hooe B, Kay H, Lee D, Pappas N . Incidence and reasons for hardware removal following operative fixation of distal radius fractures. J Hand Surg Am. 2015; 40(3):505-7. DOI: 10.1016/j.jhsa.2014.11.022. View

Dhakad R, Panwar M, Gupta S . Plating versus conservative treatment in mid shaft fractures of clavicle: A comparative study. J Clin Orthop Trauma. 2017; 7(Suppl 2):166-170. PMC: 5197043. DOI: 10.1016/j.jcot.2015.11.002. View

Beirer M, Banke I, Harrasser N, Cronlein M, Pforringer D, Huber-Wagner S . Mid-term outcome following revision surgery of clavicular non- and malunion using anatomic locking compression plate and iliac crest bone graft. BMC Musculoskelet Disord. 2017; 18(1):129. PMC: 5371239. DOI: 10.1186/s12891-017-1488-2. View

Muller-Farber J . [Removal of metal in traumatology]. Unfallchirurg. 2003; 106(8):653-68. DOI: 10.1007/s00113-003-0637-2. View

Zehir S, Zehir R, Sahin E, Calbiyik M . Comparison of novel intramedullary nailing with mini-invasive plating in surgical fixation of displaced midshaft clavicle fractures. Arch Orthop Trauma Surg. 2015; 135(3):339-44. DOI: 10.1007/s00402-014-2142-1. View

Williams B, Mccreary D, Chau M, Cunningham B, Pena F, Swiontkowski M . Functional Outcomes of Symptomatic Implant Removal Following Ankle Fracture Open Reduction and Internal Fixation. Foot Ankle Int. 2018; 39(6):674-680. DOI: 10.1177/1071100718757719. View

Hulsmans M, van Heijl M, Houwert R, Timmers T, van Olden G, Verleisdonk E . Anteroinferior versus superior plating of clavicular fractures. J Shoulder Elbow Surg. 2015; 25(3):448-54. DOI: 10.1016/j.jse.2015.09.005. View

Backes M, Schep N, Luitse J, Goslings J, Schepers T . Indications for implant removal following intra-articular calcaneal fractures and subsequent complications. Foot Ankle Int. 2013; 34(11):1521-5. DOI: 10.1177/1071100713502466. View

10.

Minkowitz R, Bhadsavle S, Walsh M, Egol K . Removal of painful orthopaedic implants after fracture union. J Bone Joint Surg Am. 2007; 89(9):1906-12. DOI: 10.2106/JBJS.F.01536. View

11.

Hulsmans M, van Heijl M, Houwert R, Hammacher E, Meylaerts S, Verhofstad M . High Irritation and Removal Rates After Plate or Nail Fixation in Patients With Displaced Midshaft Clavicle Fractures. Clin Orthop Relat Res. 2016; 475(2):532-539. PMC: 5213945. DOI: 10.1007/s11999-016-5113-8. View

12.

Schwarz N, Euler S, Schlittler M, Ulbing T, Wilhelm P, Fronhofer G . Technical complications during removal of locking screws from locking compression plates: a prospective multicenter study. Eur J Trauma Emerg Surg. 2016; 39(4):339-44. DOI: 10.1007/s00068-013-0301-7. View

13.

Acklin Y, Michelitsch C, Sommer C . Elective implant removal in symptomatic patients after internal fixation of proximal humerus fractures improves clinical outcome. BMC Musculoskelet Disord. 2016; 17:119. PMC: 4785746. DOI: 10.1186/s12891-016-0977-z. View

14.

Beirer M, Siebenlist S, Cronlein M, Postl L, Huber-Wagner S, Biberthaler P . Clinical and radiological outcome following treatment of displaced lateral clavicle fractures using a locking compression plate with lateral extension: a prospective study. BMC Musculoskelet Disord. 2014; 15:380. PMC: 4247764. DOI: 10.1186/1471-2474-15-380. View

15.

Vos D, Hanson B, Verhofstad M . Implant removal of osteosynthesis: the Dutch practice. Results of a survey. J Trauma Manag Outcomes. 2012; 6(1):6. PMC: 3485133. DOI: 10.1186/1752-2897-6-6. View

16.

Fuglesang H, Flugsrud G, Randsborg P, Oord P, Benth J, Utvag S . Plate fixation intramedullary nailing of completely displaced midshaft fractures of the clavicle: a prospective randomised controlled trial. Bone Joint J. 2017; 99-B(8):1095-1101. DOI: 10.1302/0301-620X.99B8.BJJ-2016-1318.R1. View

17.

Cronlein M, Zyskowski M, Beirer M, Imhoff F, Pforringer D, Sandmann G . Using an anatomically preshaped low-profile locking plate system leads to reliable results in comminuted radial head fractures. Arch Orthop Trauma Surg. 2017; 137(6):789-795. DOI: 10.1007/s00402-017-2693-z. View

18.

Huttunen T, Launonen A, Berg H, Lepola V, Fellander-Tsai L, Mattila V . Trends in the Incidence of Clavicle Fractures and Surgical Repair in Sweden: 2001-2012. J Bone Joint Surg Am. 2016; 98(21):1837-1842. DOI: 10.2106/JBJS.15.01284. View

19.

Naveen B, Joshi G, Harikrishnan B . Management of mid-shaft clavicular fractures: comparison between non-operative treatment and plate fixation in 60 patients. Strategies Trauma Limb Reconstr. 2017; 12(1):11-18. PMC: 5360671. DOI: 10.1007/s11751-016-0272-4. View

20.

Liska F, Neu J . [Consequences of uncritical indication assessment for hardware removal]. Unfallchirurg. 2014; 117(7):658-61. DOI: 10.1007/s00113-014-2583-6. View