title: Detection of orthopaedic foot and ankle implants by security screening devices.
abstract: BACKGROUND
  A common question asked by patients contemplating foot and ankle surgery is whether the implants used will set off security screening devices in airports and elsewhere. Detectability of specific implants may require the orthopaedic surgeon to provide attestation regarding their presence in patients undergoing implantation of these devices. Only two studies have been published since security measures became more stringent in the post-9/11 era. None of these studies specifically focused on the large numbers of orthopaedic foot and ankle implants in use today. This study establishes empiric data on the detectability by security screening devices of some currently used foot and ankle implants.
  
  
  METHODS
  A list of foot and ankle procedures was compiled, including procedures frequently used by general orthopaedists as well as those usually performed only by foot and ankle specialists. Implants tested included those used for open reduction and internal fixation, joint fusion, joint arthroplasty, osteotomies, arthroreisis, and internal bone stimulation. A test subject walked through a gate-type security device and was subsequently screened using a wand-type detection device while wearing each construct grouping. The screening was repeated with the implants placed within uncooked steak to simulate subcutaneous and submuscular implantation.
  
  
  RESULTS
  None of the implants were detected by the gate-type security device. Specific implants that triggered the wand-type detection device regardless of coverage with the meat were total ankle prostheses, implantable bone stimulators, large metatarsophalangeal hemiarthroplasty, large arthroreisis plugs, medial distal tibial locking construct, supramalleolar osteotomy fixation, stainless steel bimalleolar ankle fracture fixation, calcaneal fracture plate and screw constructs, large fragment blade plate constructs, intramedullary tibiotalocalcaneal fusion constructs, and screw fixation for calcaneal osteotomies, ankle arthrodeses, triple arthrodeses, and stainless steel first metatarsophalangeal joint arthrodeses. The placement of implants in meat prevented the detectability of only the stainless steel Jones fracture implant (stainless steel 6.5-mm cannulated screw) and the stainless steel midfoot fusion construct (four stainless steel 4.0-mm cannulated screws).
  
  
  CONCLUSIONS
  These data may help the orthopaedic surgeon in counseling patients as to the detectability of some orthopaedic foot and ankle implants in use today. Specific constructs for which documentation may need to be provided to the patient are identified. As security standards evolve and the environments in which they are practiced change, empiric testing of many of these devices may need to be repeated.
authors.affiliation: Orthopaedic Surgery, Madigan Army Medical Center, 9040 A. Fitzsimmons Drive, Tacoma, WA 98431, USA. emb43@cornell.edu
authors.forename: Eric M
authors.initials: EM
authors.lastname: Bluman
authors.forename: Cedric
authors.initials: C
authors.lastname: Tankson
authors.forename: Mark S
authors.initials: MS
authors.lastname: Myerson
authors.forename: Clifford L
authors.initials: CL
authors.lastname: Jeng
mesh_terms: D000842:Ankle; D001359:Aviation; D005528:Foot; D006801:Humans; D019736:Prostheses and Implants; D012637:Security Measures; D013193:Stainless Steel; D014025:Titanium
chemical_list: D013193:Stainless Steel; D014025:Titanium