Metal removal
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EDITORIAL
Metal removal N. Schwarz
Received: 27 February 2013 / Accepted: 11 March 2013 / Published online: 26 April 2013 Ó Springer-Verlag Berlin Heidelberg 2013
Osteosynthetic implants lose their purpose once fracture healing has taken place. They are foreign bodies deprived of their function. Plates and nails can potentially remain in place without any negative impact. Occasionally, however, implants may cause pain, discomfort, or meteosensitivity, limit joint mobility, or irritate skin, tendons, or nerves. In some patients, the implant can cause psychic alterations simply by its presence, which only can be reversed by removal. Metallic implants are not chemically inert. They may undergo chemical changes, provoking an overload of the body with metal ions and even causing toxic or allergic reactions. Metal uptake is increased in stainless steel implants as compared to titanium [1]. Infection is a complication that can occur many years after implantation. Such an event may be quite problematic if osseous integration of the implant demands the removal of newly formed bone, weakening the bone itself. In children, the integration of a metallic implant is even more pronounced, especially with titanium devices. In the case of a child, retaining a lifelong implant carries an additional set of issues to that of an adult patient. In this journal, Schmittenbecher deals with the specific problems of implant removal in children. Secondary surgery, like the implantation of artificial joints or osteosynthesis of acute fractures, close to old implants may be complicated if metal removal has to precede the procedure itself. The presence of metallic implants can be problematic both for the patient and for the surgeon. Therefore, the N. Schwarz (&) Trauma Hospital of Klagenfurt, Waidmannsdorferstr. 35, 9021 Klagenfurt, Austria e-mail: [email protected]
question of implant removal after fracture healing is relevant. The indications for implant removal lack proper guidelines. The decision for or against implant removal still depends on individual factors, and the surgeons’ attitudes toward the problem are strongly based on beliefs and not on evidence [2]. Wide variations even within a relatively small country like the Netherlands have been recently demonstrated by Vos et al. [3]. In this journal, Dagmar Vos discusses the indications for metal removal. No operation is without risks, but the complications of implant removal have only been partially evaluated. Postoperative infection, lesion of a nerve, scarring, or refracture are common complications of such procedures. After removal, some patients experience pain that they did not feel before. In modern osteosynthetic devices, hardware removal can be more challenging and more invasive than the implantation itself. Locking compression plates with locking-head screws made of titanium may resist all attempts at removal due to a tight integration of either the shaft into the surrounding bone or the screw into the screw hole of the plate, or both. Incorrect implantation technique
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