PDF herunterladen
Vet Comp Orthop Traumatol 2021; 34(01): 059-067
DOI: 10.1055/s-0040-1714411
Clinical Communication

Plate Removal after Internal Fixation of Limb Fractures: A Retrospective Study of Indications and Complications in 48 Horses

Brice Donati
1   Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
,
Anton E. Fürst
1   Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
,
Francesca Del Chicca
2   Department of Small Animals, Section of Diagnostic Imaging, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
,
Michelle A. Jackson 
1   Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
› Institutsangaben Funding None.
› Weitere Informationen
    Lizenzen und Reprints

Abstract

Objective The aim of this study was to determine the indications for, and complications of, plate removal surgery in horses that underwent internal fixation of limb fractures.

Study Design Medical records of horses presented to our hospital between 1990 and 2015 for the removal of plates after treatment of limb fractures were reviewed. Data collected at the time of initial presentation, including signalment, history, fracture features and treatment and information about the indications, timing and complications of implant removal were reviewed.

Results The most common bones involved were the ulna (n = 19) and third metacarpal and metatarsal bones (n = 14). A total of 63 plates were removed from 48 horses during 53 separate surgeries, and the complication rate was 6/48; six horses had complications related to implant removal, which included persistent infection (n = 1) and refracture (n = 5). Complications related to implant removal were associated with comminuted fractures (p = 0.002), age > 3 years (p = 0.016) and the presence of surgical site infection (p = 0.001).

Conclusion Plate removal after fracture healing is necessary in patients with implant-associated clinical signs. There is a strong relationship between the complication rate and the degree of comminution of the original fracture, increasing age and the presence of surgical site infection. The surgeon must be aware of these risk factors when planning plate removal.

Keywords

horse - osteosynthesis - plate removal - complications - refracture

Authors’ Contributions

All authors contributed to conception of study, study design, acquisition of data and data analysis and interpretation. All authors drafted, revised and approved the submitted manuscript.


Supplementary Material



Publikationsverlauf

Eingereicht: 09. Oktober 2019

Angenommen: 12. Mai 2020

Artikel online veröffentlicht:
16. August 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Rüedi TP, Buckley RE, Moran CG. AO Philosophy and evolution. In: Rüedi TP, Buckley RE, Moran CG. eds. AO Principles of Fracture Management. 2nd Expanded ed. Stuttgart, Germany: Thieme Verlag; 2007
    Google Scholar
  • 2 Auer JA. Principles of fracture treatment. In: Auer JA, Stick JA. eds. Equine Surgery. 4th ed. Saint Louis, Missouri: Elsevier Saunders; 2012. (76): 1047-1079
    Google Scholar
  • 3 Auer JA, Grainger DW. Fracture management in horses: where have we been and where are we going?. Vet J 2015; 206 (01) 5-14
    CrossrefPubMedGoogle Scholar
  • 4 Auer JA, Stick JA. Equine Surgery. 4th ed. Saint Louis, Missouri: Elsevier Saunders; 2012
    Google Scholar
  • 5 Busam ML, Esther RJ, Obremskey WT. Hardware removal: indications and expectations. J Am Acad Orthop Surg 2006; 14 (02) 113-120
    CrossrefPubMedGoogle Scholar
  • 6 Unno Veith F, Lädermann A, Hoffmeyer P. [Is hardware removal a necessity?]. Rev Med Suisse 2009; 5 (201) 977-980
    PubMedGoogle Scholar
  • 7 Krettek C, Müller C, Meller R, Jagodzinski M, Hildebrand F, Gaulke R. Is routine implant removal after trauma surgery sensible? [article in German]. Unfallchirurg 2012; 115 (04) 315-322
    CrossrefPubMedGoogle Scholar
  • 8 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 Orthop Trauma Surg 2014; 134 (12) 1691-1697
    CrossrefPubMedGoogle Scholar
  • 9 Vos D, Hanson B, Verhofstad M. Implant removal of osteosynthesis: the Dutch practice. Results of a survey. J Trauma Manag Outcomes 2012; 6 (01) 6
    CrossrefPubMedGoogle Scholar
  • 10 Müller-Färber J. Metal removal after osteosyntheses. Indications and risks [article in German]. Orthopade 2003; 32 (11) 1039-1057, quiz 1058
    CrossrefPubMedGoogle Scholar
  • 11 Richards RH, Palmer JD, Clarke NM. Observations on removal of metal implants. Injury 1992; 23 (01) 25-28
    CrossrefPubMedGoogle Scholar
  • 12 Townend M, Parker P. Metalwork removal in potential army recruits. Evidence-based changes to entry criteria. J R Army Med Corps 2005; 151 (01) 2-4
    CrossrefPubMedGoogle Scholar
  • 13 Thompson AM, Bergh MS, Wang C, Wells K. Tibial plateau levelling osteotomy implant removal: a retrospective analysis of 129 cases. Vet Comp Orthop Traumatol 2011; 24 (06) 450-456
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 14 Ahern BJ, Richardson DW, Boston RC, Schaer TP. Orthopedic infections in equine long bone fractures and arthrodeses treated by internal fixation: 192 cases (1990-2006). Vet Surg 2010; 39 (05) 588-593
    CrossrefPubMedGoogle Scholar
  • 15 Ruggles A. . Implant Removal in Horses When and Why. AOVET Course-Advances in Equine Fracture Management. Davos, Switzerland: 2013
    Google Scholar
  • 16 Richardson DW. . Indications and Technique for Removal of Implants after Fracture Healing. AOVET Course-Advances in Equine Fracture Management. Davos, Switzerland: 2008
    Google Scholar
  • 17 Brown OL, Dirschl DR, Obremskey WT. Incidence of hardware-related pain and its effect on functional outcomes after open reduction and internal fixation of ankle fractures. J Orthop Trauma 2001; 15 (04) 271-274
    CrossrefPubMedGoogle Scholar
  • 18 Evers B, Habelt R, Gerngross H. Indication, timing and complications of plate removal after forearm fractures: results of a metanalysis including 635 cases. J Bone Joint Surg Br 2004; 86-B ( SUPP III): 289
    PubMedGoogle Scholar
  • 19 Raja S, Imbuldeniya AM, Garg S, Groom G. Difficulties encountered removing locked plates. Ann R Coll Surg Engl 2012; 94 (07) 502-505
    CrossrefPubMedGoogle Scholar
  • 20 Raney EM, Freccero DM, Dolan LA, Lighter DE, Fillman RR, Chambers HG. Evidence-based analysis of removal of orthopaedic implants in the pediatric population. J Pediatr Orthop 2008; 28 (07) 701-704
    CrossrefPubMedGoogle Scholar
  • 21 Sanderson PL, Ryan W, Turner PG. Complications of metalwork removal. Injury 1992; 23 (01) 29-30
    CrossrefPubMedGoogle Scholar
  • 22 Langkamer VG, Ackroyd CE. Removal of forearm plates. A review of the complications. J Bone Joint Surg Br 1990; 72 (04) 601-604
    CrossrefPubMedGoogle Scholar
  • 23 Reith G, Schmitz-Greven V, Hensel KO. et al. Metal implant removal: benefits and drawbacks--a patient survey. BMC Surg 2015; 15: 96
    CrossrefPubMedGoogle Scholar
  • 24 Sumner-Smith G. Bone in Clinical Orthopedics. 1st ed. Stuttgart-New York: Thieme; 2002
    Google Scholar
  • 25 Jacobsen S, Honnens de Lichtenberg M, Jensen CM, Tørholm C. Removal of internal fixation--the effect on patients' complaints: a study of 66 cases of removal of internal fixation after malleolar fractures. Foot Ankle Int 1994; 15 (04) 170-171
    CrossrefPubMedGoogle Scholar
  • 26 Minkowitz RB, Bhadsavle S, Walsh M, Egol KA. Removal of painful orthopaedic implants after fracture union. J Bone Joint Surg Am 2007; 89 (09) 1906-1912
    CrossrefPubMedGoogle Scholar
  • 27 Bischofberger AS, Fürst A, Auer J, Lischer C. Surgical management of complete diaphyseal third metacarpal and metatarsal bone fractures: clinical outcome in 10 mature horses and 11 foals. Equine Vet J 2009; 41 (05) 465-473
    CrossrefPubMedGoogle Scholar
  • 28 Stewart S, Richardson D, Boston R, Schaer TP. Risk factors associated with survival to hospital discharge of 54 horses with fractures of the radius. Vet Surg 2015; 44 (08) 1036-1041
    CrossrefPubMedGoogle Scholar
  • 29 Bramlage LR. Tibia. In: Auer J, Stick JA. eds. Equine Surgery. 4th ed. Saint Louis, Missouri: Elsevier Saunders; 2012: 1409-1419
    Google Scholar
  • 30 Price JS, Jackson B, Eastell R. et al. Age related changes in biochemical markers of bone metabolism in horses. Equine Vet J 1995; 27 (03) 201-207
    CrossrefPubMedGoogle Scholar
  • 31 Donati B, Fürst AE, Hässig M, Jackson MA. Epidemiology of fractures: the role of kick injuries in equine fractures. Equine Vet J 2018; 50 (05) 580-586
    CrossrefPubMedGoogle Scholar
  • 32 McClure SR, Watkins JP, Glickman NW, Hawkins JF, Glickman LT. Complete fractures of the third metacarpal or metatarsal bone in horses: 25 cases (1980-1996). J Am Vet Med Assoc 1998; 213 (06) 847-850
    PubMedGoogle Scholar
  • 33 Richardson DW. Third Metacarpal and Metatarsal Bones. In: Auer J, Stick JA. eds. Equine Surgery. 4th ed. Saint Louis, Missouri: Elsevier Saunders; 2012: 1325-1338
    Google Scholar
  • 34 Watkins JP. Radius and Ulna. In: Auer J, Stick JA. eds. Equine Surgery. 4th ed. Saint Louis, Missouri: Elsevier Saunders; 2012: 1363-1378
    Google Scholar
  • 35 Ketonis C, Parvizi J, Jones LC. Evolving strategies to prevent implant-associated infections. J Am Acad Orthop Surg 2012; 20 (07) 478-480
    CrossrefPubMedGoogle Scholar
  • 36 Eijer H, Hauke C, Arens S, Printzen G, Schlegel U, Perren SM. PC-Fix and local infection resistance--influence of implant design on postoperative infection development, clinical and experimental results. Injury 2001; 32 (Suppl. 02) B38-B43
    CrossrefPubMedGoogle Scholar
  • 37 Melcher GA, Hauke C, Metzdorf A. et al. Infection after intramedullary nailing: an experimental investigation on rabbits. Injury 1996; 27 (Suppl. 03) SC23-SC26
    PubMedGoogle Scholar
  • 38 Metsemakers WJ, Schmid T, Zeiter S. et al. Titanium and steel fracture fixation plates with different surface topographies: influence on infection rate in a rabbit fracture model. Injury 2016; 47 (03) 633-639
    CrossrefPubMedGoogle Scholar
  • 39 Schlegel U, Perren SM. Surgical aspects of infection involving osteosynthesis implants: implant design and resistance to local infection. Injury 2006; 37 (Suppl. 02) S67-S73
    CrossrefPubMedGoogle Scholar
  • 40 Donlan RM. Biofilms: microbial life on surfaces. Emerg Infect Dis 2002; 8 (09) 881-890
    CrossrefPubMedGoogle Scholar
  • 41 Trampuz A, Zimmerli W. Diagnosis and treatment of infections associated with fracture-fixation devices. Injury 2006; 37 (Suppl. 02) S59-S66
    CrossrefPubMedGoogle Scholar
  • 42 Trampuz A, Gilomen A, Fluckiger U, Frei R, Zimmerli W, Widmer A. . Treatment outcome of infections associated with internal fixation devices: results from a 5-year retrospective study (1999–2003). Presented at: 45th ICAAC, American Society for Microbiology; December 16–19, 2005 Washington, DC:
    PubMed
  • 43 Gaine WJ, Andrew SM, Chadwick P, Cooke E, Williamson JB. Late operative site pain with isola posterior instrumentation requiring implant removal: infection or metal reaction?. Spine 2001; 26 (05) 583-587
    CrossrefPubMedGoogle Scholar
  • 44 Hidaka S, Gustilo RB. Refracture of bones of the forearm after plate removal. J Bone Joint Surg Am 1984; 66 (08) 1241-1243
    CrossrefPubMedGoogle Scholar
  • 45 Rosson JW, Shearer JR. Refracture after the removal of plates from the forearm. An avoidable complication. J Bone Joint Surg Br 1991; 73 (03) 415-417
    CrossrefPubMedGoogle Scholar
  • 46 Rumball K, Finnegan M. Refractures after forearm plate removal. J Orthop Trauma 1990; 4 (02) 124-129
    CrossrefPubMedGoogle Scholar
  • 47 Frost HM. A 2003 update of bone physiology and Wolff's Law for clinicians. Angle Orthod 2004; 74 (01) 3-15
    PubMedGoogle Scholar