Journal of Pediatric Orthopaedics - 2026-06-08 - Journal Article
Complications of Implant Removal of Pediatric Femoral Shaft Fractures.
Aslanturk O, Roberts C, Siddique R, Rowland J, Sheffer B, Kelly DM
Topics
Key Takeaway
Plate removal for pediatric femoral shaft fractures required the longest OR time (63 min) and greatest EBL, while rigid nail removal had significantly more bony overgrowth and 19 total intraoperative/postoperative complications versus zero for plate removal.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This study examined complications, EBL, OR time, and admission rates for implant removal after surgically treated pediatric diaphyseal femur fractures across three fixation types at a Level I trauma center over 15 years. Plate removal averaged 63 minutes OR time versus 58 minutes for rigid nails and 36 minutes for flexible nails, with greater EBL for plates than all nail types. Rigid nail removal produced significantly more bony overgrowth than flexible nails and accounted for 11 intraoperative and 8 postoperative complications, while plate removal had zero documented complications.
Key Limitation
The total cohort size is unreported, making it impossible to determine whether the zero-complication rate in the plate group reflects a true safety advantage or simply an underpowered comparison.
Original Abstract
INTRODUCTION
Pediatric femur fractures are treated with rigid intramedullary nails, flexible intramedullary nails, and plates, which are usually removed after fracture union. This study aimed to analyze complications, estimated blood loss (EBL), length of stay, and operative times for implant removal after successful surgical management of pediatric diaphyseal femur fractures.
METHODS
After IRB approval was received, data were collected from pediatric patients at a major level I trauma center from 2008 to 2023. Fixation types were separated based on flexible nail, rigid nail, and plating. Postoperative complications included wound dehiscence, wound abscess, infection, and hematoma.
RESULTS
Admission rates were higher for the rigid nail group than for the flexible nail group. No difference was found for admission rates between the plate and nail groups. In terms of OR time, plates were the longest at 63 minutes on average, rigid nails at 58 minutes, and flexible nails at 36 minutes. EBL was greater for plate removal than for all nail removal, and greater for rigid nail removal than for flexible nail removal. Bony overgrowth was on the implant in 17 nail and 8 plate patients. It was statistically higher in the rigid nail group compared with the flexible nail group. Time between fixation and removal was greater for the nail group than the plate group. When comparing flex nails to rigid nails regarding time to removal, this remained significant (9.4 and 12.4 mo, respectively; P<0.0001). There was one incidence of refracture, which occurred in the flexible nail group.
CONCLUSION
Operative time and EBL were higher for plate-removal patients. Bony overgrowth and time between fixation and removal were significantly higher for the nail group. Eleven intraoperative complications and 8 postoperative complications were documented for the nail-removal patients; none were documented intraoperatively or postoperatively for the plate-removal patients. Refracture in the short-term follow-up period was very low.
SIGNIFICANCE
Implant removal following pediatric femur fractures has a low complication rate, with greater operative time and EBL for plates.
LEVEL OF EVIDENCE
Level III.