Synthes Screw Removal Set
Winquist Nail Removal Set
White Broken Screw Removal
White Hardware Removal Sets
White Univeral Hip Screw Removal
||Classification / Treatment
|Etiology / Natural History
||Associated Injuries / Differential Diagnosis
|Xray / Diagnositc Tests
Painful Hardware ICD-9
- 996.67 Complication due to internal orthopedic device
- 996.4 (mechanical complication of internal orthopedic device, implant, and graft.
- 996.78(other complications of internal orthopedic device / implant), 996.77(other complication of internal implant/device due to internal joint prosthesis)
Hardware Removal CPT
- 11981 Insertion, non-biodegradable drug delivery implant
- 11982 Removal, non biodegradable drug delivery implant
- 11983 Removal with reinsertion, non-biodegradable drug delivery implant
Hardware Removal Etiology / Epidemiology / Natural History
- Accounts for @ 5% of orthopaedic procedures
Hardware Removal Anatomy
- Direct fracture healing: no fracture callus; new osseous channels form across the fracture site; rigid fixation; can occur with compression plating.
- Indirect fracture healing: with callus formation; less rigid fixation; intramedullary or external fixation.
Hardware Removal Clinical Evaluation
Hardware Removal Xray / Diagnositc Tests
- Evaluate xryas for radiographic evidence of circumferential bridging external callus,
Hardware Removal Classification / Treatment
- Retain implants for at least 12 months postoperatively to allow for bone remodeling before hardware removal. (Brumback RJ, J Bone Joint Surg Am 1992; 74: 106-112.)
- Achieving complete union and remodeling before implant removal decreases the risk of refracture.
- Avoiding unnecessary disruption of the vascular supply to the bone decreases osteopenia. Furthermore, allowing sufficient time for the vascular supply to recover may correct the initial osteopenia.
- Screw holes may remain as stress risers for as long as 4 months.
- Ankle Fracture: 75% improvement after hardware removal (Jacobsen S, Foot Ankle 1994; 15: 170-171).
- Femoral IM nail: 65% Pain relief following femoral intramedullary nail removal (Dodenhoff RM, J Bone Joint Surg Br 1997; 79: 738-741).
- Tibial IM nail hardware removal: 45% rate of complete relief of knee pain after tibial nail removal; 35% of patients experienced partial relief and 20%, no relief. (Keating JF, J Orthop Trauma 1997; 11: 10-13)
- No patient should be guaranteed complete pain relief.
Hardware Removal Associated Injuries / Differential Diagnosis
- Nerve injury
Hardware Removal Complications
- Continued pain
Hardware Removal Follow-up Care
- There is no consensus concerning the necessary amount of protection, weight-bearing limits, or activity modification after implant removal.
- Screw holes present a stess riser for up to 4 months after screw removal (Rosson J, Injury 1991; 22: 383-384).
- Consider limiting impact and torsional loading for up to 4 months after hardware removal.
- Jones DB Jr, Kakar S. Adult diaphyseal forearm fractures: intramedullary nail versus plate fixation. J Hand Surg Am. 2011 Jul;36(7):1216-9. Epub 2011 May 14.
- Rosson JW, Shearer JR. Refracture after the removal of plates from the forearm. An avoidable complication. J Bone Joint Surg Br. 1991 May;73(3):415-7.
- Deluca PA, Lindsey RW, Ruwe PA. Refracture of bones of the forearm after the removal of compression plates. J Bone Joint Surg Am. 1988 Oct;70(9):1372-6.
- Busam ML, JAAOS 2006;14:113