Elective removal of implants after open reduction and internal fixation of Tibial Plateau fractures improves clinical outcomes.
BACKGROUND
Tibial plateau fractures are common injuries often treated with open reduction and internal fixation. We have noted improved patient satisfaction following implant removal for these patients. The purpose of this study was to assess the effect of removal of surgical implants after union on patient reported outcomes.


METHODS
All patients at our Level 1 Trauma Center undergoing open reduction an internal fixation by the senior surgeon are offered enrollment into a prospective registry and have clinical outcomes recorded at follow-up [Knee Outcomes Survey (KOS), Lower Extremity Functional Scale (LEFS), Short Form-36 Physical and Mental Component Summary (SF-36 PCS, SF-36 MCS), and Visual analog pain scale (VAS)]. Routinely, removal of surgical implants is offered after fracture union resulting in two cohorts: those who had undergone elective removal of surgical implants and those who had not. Outcome scores were compared before and after implant removal as well as between the two study populations at final follow-up.


RESULTS
Seventy-five patients were identified as having 12 month outcome scores: 36 (48%) had retained implants; 39 (52%) had implants removed. KOS and LEFS outcomes improved significantly after implant removal (p < 0.05). Clinical outcomes (KOS, SF-36 PCS) were also significantly better in patients who had implants removed compared to those that did not at final follow-up (p < 0.05). There was no statistical difference seen in VAS pain scores.


CONCLUSIONS
The results of this study indicate that patients who have elective removal of their surgical implants after open reduction and internal fixation of a tibial plateau fracture have improved clinical outcomes after removal and also demonstrate significantly better outcomes than those who have retained implants at final follow-up. Patients who are unhappy with their clinical result should be counseled that removal of the implant may improve function, but may not improve pain.
Hospital for Special Surgery, Weill Cornell Medical College, 35 East 70th Street, New York, NY, 10021, USA. garnermr@gmail.com.
Matthew R
MR
Garner
Hospital for Special Surgery, Weill Cornell Medical College, 35 East 70th Street, New York, NY, 10021, USA.
Ryan R
RR
Thacher
Hospital for Special Surgery, Weill Cornell Medical College, 35 East 70th Street, New York, NY, 10021, USA.
Amelia
A
Ni
Landstuhl Regional Medical Center, Landstuhl, Germany.
Marschall B
MB
Berkes
Hospital for Special Surgery, Weill Cornell Medical College, 35 East 70th Street, New York, NY, 10021, USA.
Dean G
DG
Lorich
D000328:Adult; D000368:Aged; D020878:Device Removal; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D007720:Knee Prosthesis; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013978:Tibial Fractures / Q000601:surgery*
Clinical outcomes; Implant removal; Removal of hardware; Tibial plateau fracture