Complication profile and risk patterns following elective implant removal in pediatric fractures: a 10-year retrospective analysis.

Abstract

Background: There is no clear consensus regarding the optimal timing and necessity of implant removal (IR) following fracture healing in children. Although generally recommended between 1 and 12 months after osteosynthesis, IR carries risks such as refracture, infection, and neurovascular injury. This study aimed to evaluate the indications for IR, the timing of removal, and the complications observed during and after implant extraction in pediatric patients.

Methods: This retrospective study included 115 pediatric patients (mean age: 10.8 years, range: 2-17) who underwent IR following fracture treatment. Data on implant retention duration, type of implant, indication for removal, and post-removal complications were recorded and analyzed.

Results: IR was most commonly performed in asymptomatic cases upon parental request (90.4%), particularly for forearm fractures. Titanium elastic nails and plate-screw systems were the most frequently removed implants. Post-removal complications included refracture (4.3%), infection (1.7%), incomplete removal (1.7%), radial nerve neuropraxia (0.9%), and wound problems (0.9%). Refractures occurred within 5 to 18 days postoperatively, with the forearm being the most frequently affected region (7.5% of forearm IR cases). No statistically significant association was found between implant type, retention duration, and the occurrence of refracture (p > 0.05). These findings underscore the importance of patient-specific planning and postoperative protective strategies, especially for forearm IR.

Conclusion: Implant removal in pediatric patients is generally safe; however, the risk of early refracture, especially in the forearm, highlights the need for short-term activity restrictions and splint immobilization post-removal. Surgeons should clearly communicate the risks and timing of IR with families during the decision-making process.