title: Fracture incidence following plate removal in Legg-Calvé-Perthes disease: a 32-year study.
abstract: OBJECTIVE
  The decision of whether or not to remove pediatric metallic implants remains a controversial issue. Many factors have been cited both in favor and against routine removal of metallic implants. The purpose of this study was to determine the fracture rate following the routine removal of hardware from patients with Legg-Calvé-Perthes (LCP) disease treated by proximal femoral varus osteotomy (PFVO) and to determine if there is an optimal time to remove hardware in this population.
  
  
  METHODS
  We performed a retrospective chart review of children who had PFVO with subsequent hardware removal from March 1973 to May 2005 performed by a single surgeon. A total of 196 hips in 184 patients were included. Data was analyzed using logistic regression. Inverse prediction was also used to obtain estimates of the time needed to produce probabilities of no fracture.
  
  
  RESULTS
  Ten out of the 196 hips included (5.1%) sustained a fracture after plate removal. The time from osteotomy to plate removal averaged 10.4 months in the nonfracture group and 4.8 months in the fracture group. This was statistically significant (P < 0.0001). Using the logistic regression model, the predicted time to plate removal corresponding to a 95% probability of no fracture was between 5.1 and 8.4 months.
  
  
  CONCLUSIONS
  Plate removal remains a reasonable choice but questions remain as to the timing of removal. These data suggest that patients may benefit from extending the time to hardware removal beyond radiographic union to at least six months or more after the osteotomy.
authors.affiliation: Department of Orthopaedic Surgery, Summa Health System and Akron Children's Hospital, Akron, OH, 44309, USA.
authors.forename: Adam C
authors.initials: AC
authors.lastname: Schaaf
authors.forename: Dennis S
authors.initials: DS
authors.lastname: Weiner
authors.forename: Richard P
authors.initials: RP
authors.lastname: Steiner
authors.forename: Melanie A
authors.initials: MA
authors.lastname: Morscher
authors.forename: Martin S
authors.initials: MS
authors.lastname: Dicintio