Onche I I, Osagie O E, INuhu S
Department of Orthopaedics / Trauma and Anaesthesia Jos University Teaching Hospital, PMB 2076, Jos, Plateau State, Nigeria.
J West Afr Coll Surg. 2011 Jan;1(1):101-12.
The removal of implants after fracture healing has always been a topical and controversial issue. Undisputed however, is the removal of implants which are associated with complications. In this paper, we evaluated the indications, the outcome and economic cost to the patient and the health system of routine removal of implants after union.
This is a two-year comparative, prospective study carried out in three hospitals in North Central Nigeria. All patients who presented for implant removal and consented to the study were recruited. Fracture union was confirmed both clinically and radiological. Direct costs of treatment paid for by the patients and number of absences from work and school were used as economic indices.
Forty-seven patients comprising 20(42.6%) males and 27(57,4%) females, mean age of 31.6 (±13.4) years were analysed. Forty-two (89.4%) had fixation with plates and screws, three (6.4%) had screws with cerclage wire and two(4.2%) had tension band wiring. Patient request was the main indication for removal in 34(72.3%), surgeon's request without symptoms in 7(14.9%),six(10.7%) were symptomatic comprising four(8.5%) due to postoperative chronic osteomyelitis and intractable pain in two(4.3%). Total cost of implant removal was $33,293.59 ($ 708.37 ±22.10; range $366.97-1,100.92). Total cost of removal in patients with symptomatic implants-in-situ was $3,678,90( $ 613.15±14.50) One patient had a refracture. Mean duration away from work or school was 16 days.
Routine removal of implants after fracture union constituted great waste of highly needed cash in both direct cost and loss of man-hour especially in a dwindling economy in an era of evidence based Medicare and best practice. It is recommended that each hospital adopts strict criteria for implant removal.
骨折愈合后取出内固定物一直是一个热门且有争议的问题。然而，对于那些引发并发症的内固定物，取出则毫无争议。在本文中，我们评估了骨折愈合后常规取出内固定物的指征、结果以及对患者和卫生系统的经济成本。
这是一项在尼日利亚中北部三家医院进行的为期两年的比较性前瞻性研究。所有前来取出内固定物并同意参与研究的患者均被纳入。通过临床和影像学检查确认骨折已愈合。将患者支付的直接治疗费用以及误工和缺课天数作为经济指标。
共分析了47例患者，其中男性20例（42.6%），女性27例（57.4%），平均年龄31.6（±13.4）岁。42例（89.4%）采用钢板螺钉固定，3例（6.4%）采用螺钉加环扎钢丝固定，2例（4.2%）采用张力带钢丝固定。34例（72.3%）取出内固定物的主要指征是患者要求，7例（14.9%）是医生在无症状情况下的要求，6例（10.7%）有症状，其中4例（8.5%）是由于术后慢性骨髓炎，2例（4.3%）是顽固性疼痛。取出内固定物的总费用为33,293.59美元（708.37±22.10美元；范围366.97 - 1,100.92美元）。有症状的原位内固定物患者取出的总费用为3,678.90美元（613.15±14.50美元）。1例患者发生再骨折。平均误工或缺课天数为16天。
在循证医疗和最佳实践的时代，尤其是在经济萎缩的情况下，骨折愈合后常规取出内固定物在直接成本和工时损失方面都造成了对急需资金的巨大浪费。建议每家医院采用严格的内固定物取出标准。
