Complications of Implant Removal of Pediatric Femoral Shaft Fractures

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.