Removal of orthopedic implants in children: morbidity and postoperative radiologic changes.

One hundred twenty-one procedures for the removal of metalwork performed on 110 children aged 1-15 years is reported, with a focus on postoperative morbidity and radiographic skeletal changes. The removals were for a variety of acute and chronic pediatric orthopedic conditions. The level of postoperative morbidity was lower than in adult study groups with only one refracture (0.9%). Only four removals were considered to be difficult. All patients had a postoperative radiograph taken. The skeletal response to the fixation device was assessed by measuring the degree of cortical assimilation of the implant. Dynamic compression plating was compared with third tubular fixation. Overall cortical indentation was 7.3% in the third tubular group and 41.6% in the dynamic compression plating group; similar results were found in forearm fracture and hip osteotomy subgroups (P < 0.01, Wilcoxon unpaired test). The degree of indentation was related to the length of time for which the plate was left in situ. It is postulated that plates with high stress-rising characteristics are incorporated with growth and should both be removed early and have strictly limited indications for their use.