SLR - April 2018 - Anson Chu

Functional Outcomes of Symptomatic Implant Removal Following Ankle Fracture Open Reduction and Internal Fixation

Reference: Williams BR, McCreary DL, Chau M, Cunningham BP, Pena F, Swiontkowski MF. Functional Outcomes of Symptomatic Implant Removal Following Fracture Open Reduction and Internal Fixation. Foot Ankle Int. 2018 Feb 1:1071100718757719. doi: 10.1177/1071100718757719.
Scientific Literature Review

Reviewed By: Anson Chu, DPM
Residency Program: Grant Medical Center, Columbus, OH

Podiatric Relevance: Foot and ankle surgeons commonly encounter patients with unexplained pain following open reduction internal fixation. Hardware removal is often utilized to relieve this pain, but little is known about the functional outcomes following removal. It is often a dilemma on whether removal of hardware is worth the risk, especially when the pain is not localized. In the present study, the authors hypothesize that implant removal following open reduction internal fixation of the ankle would result in improved patient function and limited complications.

Methods: The study was a retrospective review of prospectively collected information consisting of patients with open reduction internal fixation for ankle fractures who underwent subsequent hardware removal. The included patients completed a Short Musculoskeletal Function Assessment (SMFA) prior to surgery and six months following hardware removal. Demographic and health history data was collected on all patients in the study. The purpose was to evaluate patient function and to identify possible complications following hardware removal. The primary outcome measure was the change in SMFA dysfunction index score preoperatively to six-month follow-up.

Results: Of the 121 patients who met the inclusion and exclusion criteria, 43 returned for follow-up. The mean time for follow-up SMFA questionnaires to be filled out was 5.7 months. The authors found that in the study cohort (43 patients), the SMFA dysfunction index scores decreased from baseline to follow-up, which indicated increased functional outcomes. The SMFA Bother Score and Daily Activities Domain also significantly decreased. There was a 2.5 percent complication rate in the 121 patients who met the inclusion and exclusion criteria.

Conclusion: The authors of this study concluded that removal of hardware following ankle fractures improved level of function in patients. Due to the decrease in SMFA dysfunction index scores following implant removal, the improvement in patient function is apparent. The authors speculated that improvement in function may be due to removing retained hardware that is altering the biomechanical properties of the ankle. It may also simply be due to relief of soft-tissue irritation. Further research would be valuable in determining specific variables of patients who would benefit the most from hardware removal.  

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