title: Removal of forearm plate leads to a high risk of refracture: decision regarding implant removal after fixation of the forearm and analysis of risk factors of refracture.
abstract: BACKGROUND
  Plate fixation is the gold standard for the treatment of forearm fractures at present, and whether or not to remove the implant after bone union remains controversial. This study demonstrated some cases of refracture in adult forearm fractures after bone union and discussed the risk factors for decision-making regarding implant removal.
  
  
  METHODS
  We reviewed patients with forearm diaphyseal fractures (including the radius, ulna, or both bones) who received open reduction and internal fixation (ORIF) from January 2008 to May 2011 in our institute. Fracture type was classified according to the AO/OTA system. All patients were fixed with a 3.5-mm dynamic compression plate. The patients were divided into two main groups: group A received implant removal after bone union, and group B retained the implant.
  
  
  RESULTS
  There were 122 patients (170 bones) included in this study (40 females and 82 males). In group A, 7/51 patients (8/62 bones; 12.9 %) had refracture. As classified by the AO/OTA classification, one patient was classified as type A1, one patient as type A2, two patients as type A3, and three patients as type B3. All patients suffered refracture without high-energy trauma. In group B, the refracture rate was 2.77 %, and all were caused by high-energy trauma. Patients with refracture had a shorter time interval between ORIF and implant removal. The possible risk factors of refracture in this study included a wedge bone defect on plain film, implant removal performed after less than 18 months, and AO/OTA type B fracture.
  
  
  CONCLUSIONS
  The incidence of refracture was significantly lower in the group that retained the implant. Routine implant removal after bone union in adult forearm fractures is not recommended due to the higher refracture rate.
authors.affiliation: Department of Orthopaedic Surgery, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung, 813, Taiwan.
authors.forename: Chi-Kuo
authors.initials: CK
authors.lastname: Yao
authors.forename: Kai-Cheng
authors.initials: KC
authors.lastname: Lin
authors.forename: Yih-Wen
authors.initials: YW
authors.lastname: Tarng
authors.forename: Wei-Ning
authors.initials: WN
authors.lastname: Chang
authors.forename: Jenn-Hui
authors.initials: JH
authors.lastname: Renn
mesh_terms: D000328:Adult; D000368:Aged; D001860:Bone Plates; D020878:Device Removal; D005260:Female; D005543:Forearm Injuries / Q000000981:diagnostic imaging / Q000601:surgery; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011859:Radiography; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D014458:Ulna Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D055815:Young Adult