Hardware Removal 20680

 

Xtract-All

Synthes Screw Removal Set

Winquist Nail Removal Set 

White Broken Screw Removal

White Hardware Removal Sets 

White Univeral Hip Screw Removal 
ICD-9 Classification / Treatment
Etiology  / Natural History Associated Injuries / Differential Diagnosis
Anatomy Complications
Clinical Evaluation Follow-up Care
Xray / Diagnositc Tests Review References

synonyms:

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

Antibiotic Beads

  • 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

  • Nonunion
  • Malunion
  • Infection
  • Hematoma
  • Nerve injury

Hardware Removal Complications

  • Refracture
  • 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. 

Review References

  • 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