Metal implant removal after consolidation of the malleolar fractures, I s worth it?

Abstract

Ankle fractures are a frequent injury, the treatment of which is most often open reduction and internal fixation. The removal of the material after consolidation is a common procedure but is not risk free and entails a significant associated cost. Although routinely performed in some hospitals, the indications for removal as well as the clinical benefit of this gesture are also still uncertain. Indeed, in this location the presence of material can lead to specific problems given the mechanical characteristics of the ankle and lack of surrounding tissue, however, local sensitivity and pain may also be caused by post-traumatic ankle changes. This study was designed to analyse the clinical benefits after removal of osteosynthesis material and expectations of symptomatic patients. Thirty patients with surgically treated malleolus fractures and with complaints related to the presence of metal implants were reviewed and the AOFAS and FAOS questionnaires were applied preoperatively and 3 months after the material extraction. Statistical analysis was performed using the Wilcoxon test and the results considered statistically significant if p<0,05. Most patients (67%) improved significantly after material extraction. There seems to be a clinical benefit in the extraction of the internal fixation material after consolidation, however, the patient must be correctly informed about the risks and expectations of this second operation.