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Hardware: femur re-fracture after hardware removal?
You would think that there would be a lot of information about re-fracture of the femur for two reasons. The first is that fracture of the hip and subsequent treatment with a plate on the femur is very common in the elderly. And the second is that you would expect the elderly population to have a high incidence of repeat falls and therefore a risk of re-injury. But my personal experience has been that re-fracture of the hip is very rare. I must do about 50 hip fracture operations a year and after 20 years I cannot remember seeing a re-fracture. This is born out by searching the literature. A search for "refracture and femur" and "refracture and hip" yielded the following papers.
It is even more difficult to compare the risk of refracture with the plate removed to the risk of refracture with the plate retained. However, it is probablbly true to say the both these risks are about the same and are low - about 1:50 or less. This is the same size of risk as the risk of a fracture on the other side. My own approach to this situation is to go by the patient's symptoms; if there are very few symptoms I advise against plate removal. If the pain is disabling I believe the risk of trouble of some sort (ulcers, overdosing from medications, falling, depression etc) to be greater if the plate is left in.
Recuperation involves recovery from the operation (usually one or two days in hospital for pain relief); healing of the skin and msucle where the operation took place (4 weeks); and recovery of full strength of the bone by filling in of the screw holes and restoration of normal bone anatomy (3 months. During this time there is probably an increased risk of refracture. In one of the papers cited they note that all "refractures" occured within 90 days of removal of the plate.
Myles CloughMD OS Jan 15 2002
What are the chances of refracturing the femur after the hardware is removed? Would this be easily re-fractured?
is the possibility of femur fracture after removing an im nail higher if you have poor bone regeneration?
my femur broke again after 15 years.it had fractured before now and just had to go onto crutches for a few weeks.but 13th march this year it broke and it had to be fixed again with a rod and three screws.I had the old rod removed after two years
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|14 February 2016
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