Incidence of intramedullary nail removal after femoral shaft fracture healing.
BACKGROUND
There are limited data on hardware removal after femoral fracture healing. We determined the incidence of intramedullary nail (IMN) removal after midshaft femoral fractures. We also studied demographic factors influencing IMN removal.


METHODS
The senior author reviewed all adult femoral fractures with IMN placement in the trauma practice between July 1990 and November 2003. There were a total of 74 IMNs in 68 subjects with midshaft fractures. The incidence of hardware removal was the primary outcome measure. We also analyzed age, sex, body mass index (BMI), mechanism of injury, IMN dimensions, occupation, and Workers' Compensation Board (WCB) insurance and litigation involvement.


RESULTS
Overall incidence of IMN removal was 20% (15 of 74 fractures). No significant difference was found with age (p=0.965), sex (p=0.086), BMI (p=0.423), occupation (p=0.341), insurance involvement (p=0.229), WCB involvement (p=0.663) or IMN dimensions (width, p=0.752; length, p=0.312). Litigants had the highest incidence of IMN removal (p=0.004).


CONCLUSIONS
All hardware was removed for pain or irritation. These results suggest that litigants require hardware removal more often than nonlitigants. A larger study is needed to identify specific criteria for hardware removal and to determine whether secondary gains affect the incidence of femoral removal.
Hui
Catherine
C
Division of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
Jorgensen
Ian
I
Buckley
Richard
R
Fick
Gordon
G
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D001858:Bone Nails; D020878:Device Removal; D004867:Equipment Design; D005260:Female; D005264:Femoral Fractures / Q000209:etiology / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation*; D017102:Fracture Healing; D006801:Humans; D007341:Insurance; D007603:Jurisprudence; D008297:Male; D008875:Middle Aged; D009790:Occupations; D010149:Postoperative Pain / Q000209:etiology; D011183:Postoperative Complications; D012189:Retrospective Studies; D012737:Sex Factors; D016896:Treatment Outcome; D014942:Workers' Compensation