RESUMO
Introduction: Elective implant removal following healed extremity fractures remains controversial. This study aimed to evaluate the reasons and outcomes of implant removal after uneventful healing of limb fractures. Materials and methods: This is a prospective single-centre observational cohort study. Patients who sustained upper or lower extremity fractures that were fixed and healed uneventfully were included in the study when they elected to remove the implants. Patients were followed for six months post-operatively. Outcomes were assessed with patient satisfaction, symptoms resolution, and complications. Results: A total of 43 patients were recruited from October 2016 to March 2019. Thirty-six patients (37 implants) were symptomatic. Pain and prominence were the most common complaints, present in 59.5% and 33.3% of patients, respectively. Cold weather pain was also not uncommon (19.0%). Pain improved in 91.3% of the patients who complained of pain. The 94.6% symptomatic patients had at least partial resolution of pre-operative symptoms. All the patients who completed follow-up were satisfied with the procedure. In two patients, there were broken and retained screws intra-operatively. Post-operative complication rate was 23.8%, although no major complications occurred. Conclusions: Implant removal after uneventful healing of extremity fractures is a safe procedure that conferred a predictable relief of symptoms and satisfactory outcomes in most.
RESUMO
@#Introduction: Elective implant removal following healed extremity fractures remains controversial. This study aimed to evaluate the reasons and outcomes of implant removal after uneventful healing of limb fractures. Materials and methods: This is a prospective single-centre observational cohort study. Patients who sustained upper or lower extremity fractures that were fixed and healed uneventfully were included in the study when they elected to remove the implants. Patients were followed for six months post-operatively. Outcomes were assessed with patient satisfaction, symptoms resolution, and complications. Results: A total of 43 patients were recruited from October 2016 to March 2019. Thirty-six patients (37 implants) were symptomatic. Pain and prominence were the most common complaints, present in 59.5% and 33.3% of patients, respectively. Cold weather pain was also not uncommon (19.0%). Pain improved in 91.3% of the patients who complained of pain. The 94.6% symptomatic patients had at least partial resolution of pre-operative symptoms. All the patients who completed follow-up were satisfied with the procedure. In two patients, there were broken and retained screws intra-operatively. Post-operative complication rate was 23.8%, although no major complications occurred. Conclusions: Implant removal after uneventful healing of extremity fractures is a safe procedure that conferred a predictable relief of symptoms and satisfactory outcomes in most.
RESUMO
Atypical femoral fractures (AFF) have low union rates. The use of teriparatide has been advocated for the post-operative healing of AFF, but the evidence is limited to case reports and some series due to its low incidence. We present a case series of four female patients to support the use of teriparatide after the surgical fixation of their AFF. Three of the patients had a complete AFF and one had an incomplete fracture. Their mean age was 70 (52 - 87) years, mean body mass index 24.6 (18.3 - 29.3), mean bone mineral density T-score of -2.3 (-4.8/-1.0), with a prior history of anti-resorptive therapy with bisphosphonates and denosumab. Teriparatide was started at an average of 8 (2-18) days post-fixation, with 20mcg daily for six months. Immediate full weight-bearing was permitted in three patients, while one was non-weight bearing for two months. The mean time to union was 12 (10 - 14) weeks. No side effects were observed over a mean follow-up of 58 (50 - 72) weeks. The use of teriparatide facilitated the quick union of AFF after surgical fixation. It appeared to be safe and promoted fracture healing in AFF.
