J Korean Orthop Assoc.  2023 Dec;58(6):514-523. 10.4055/jkoa.2023.58.6.514 .

Timing and Reason for Implant Removal after Ankle Fracture Surgery

• Kim J
• Kim GL
• Jeon YH
• Lee DW

• KMID: 2549826
• DOI: http://doi.org/10.4055/jkoa.2023.58.6.514

Abstract

Purpose
Ankle fractures are one of the common fractures occurring in adults and often require internal fixation devices to be inserted to aid in the healing process. Typically, surgery is performed one year after the initial fracture surgery to remove the device. However, the timing and factors for hardware removal surgery vary depending on the patient’s specific medical circumstances and various other factors. There is a lack of domestic research on the appropriate timing and reasons for hardware removal surgery after fracture surgery. Therefore, the authors conducted a study to examine the timing and factors for the removal of the internal fixation devices.
Materials and Methods
Our study consisted of a retrospective review of 502 patients who underwent open reduction and internal fixation for ankle fractures over a period of four years from 2017 to 2021. We checked the time to hardware removal surgery for each patient. For those who underwent hardware removal surgery, the timing of metal removal surgery for each patient was determined, and the presenting symptoms at the time of the surgery, the occurrence of surgical complications related to metal removal, and the improvement of symptoms after the procedure were assessed.
Results
Among the 502 cases reviewed, hardware removal surgery was performed in 347 cases (69.1%). The average time elapsed until hardware removal surgery was 9.3 months. Age, initial fracture pattern, or surgical technique did not show significant variations with respect to the timing of hardware removal surgery. A significant number of cases in the patient group that underwent hardware removal surgery at a later stage (476–1,117 days) after the initial surgery and in the group that had a syndesmotic fixation with implants, showed restricted joint mobility.
Conclusion
In the group of patients who had a syndesmotic fixation with implants, the removal of metal allowed for an improvement in joint mobility. Hardware removal surgery has a relatively low frequency of associated surgical complications. Hence, performing early hardware removal surgery after confirming bone union can be beneficial in preventing joint stiffness as long as the patient’s condition permits it.

Keyword

ankle fractures; internal fixators; pain; range of motion