The removal of metalwork in children.

The post-operative complications in 57 children under the age of 16 years requiring removal of metalwork during a 12-month period are presented. The grade of surgeon performing the operation is also discussed. The overall complication-rate was 14 per cent. Minor complications such as transiently painful scars and superficial infection occurred in 7 per cent of cases. There was one intermediate complication following removal of Knowles pins of an unacceptable scar requiring revision by a plastic surgeon. The major complication (7 per cent of all cases) involved fracture with retention of the distal part of the screws during attempted removal of Knowles, Crawford-Adams or Moores pins used for the management of slipped upper femoral epiphysis. When considering this sub-group of patients, the actual complication rate for removal of metalwork from the hip was 27 per cent. So significant was this finding that the authors changed their practice to the use of a partially threaded single cannulated screw for the fixation of slipped upper capital epiphyses.