gms | German Medical Science

Objectives/Interrogation: Previous studies indicated that hardware removal may lead to increased morbidity and therefore, at least in adults, remains questionable for certain indications. However, risks such as corrosion or local reactions may be less likely in younger patients with current, improved hardware materials. We sought to determine complication rates of hardware removal in pediatric upper limb surgery, and establish potential risk factors for increased morbidity.

Methods: All children and adolescents who underwent hardware removal under sedo-analgesia or general anaesthesia after previous upper limb surgery (2006-2016) were retrospectively evaluated. Cases with ambulatory hardware removal were not included. We performed a chart review and extracted the following details at latest follow-up available: patient demographics, diagnosis, implant location (e.g. humerus, radius/ulna, phalanges), hardware material, duration of surgery, duration of hardware-in-place, complication grades according to Goslings et al. (grade 0-5) and Sink et al. (grade 1-5), respectively. Correlations were calculated to establish potential relationships between specific outcome parameters (BMI, duration of surgery, hardware-in-place) and complication grades.

Results and Conclusions: A total of 2.090 children were evaluated of whom 450 (222 males, 228 females; mean age 9.5 years) fulfilled the inclusion criteria for this study. Overall, K-wires (46%), plates (22%), external fixators (23%), intramedullary hardware (7%), screws (1%), cerclages (1%) and pins (0.2%) were removed; most common locations were the forearm (34%), humerus (24%), metacarpalia (9%), phalanges (8%) and carpalia (2%). The mean duration of surgery was 40 minutes (range, 2-620), mean time-in-place was 194 days (range, 2-4018). Complication rates were low overall, with most being grade 0 (n=373; 83%) or 1 (n=60; 13%) acc. to Goslings et al. and grade 1 (n=387; 86%) and 2 (n=43; 9%) acc. to Sink et al. No severe complications acc. to Goslings (grades 4,5) and Sink (grade 5) were observed. Five cases required postoperative ICU admission which thus classified them as Sink grade 4 (1.1%). We found no correlation between BMI, duration of surgery or hardware-in-place duration with classification grades.

To summarize, hardware removal under sedo-analgesia or general anaesthesia in the pediatric upper extremity is a safe procedure. However, despite this large group of patients analyzed, we were unable to find any particular determinants for possible complications.