Elective plate removal after fracture union in adults requires symptom-driven and risk-stratified decision-making

Elective plate removal after fracture union is common in adult orthopaedic trauma but remains poorly standardized. Expected benefit varies according to symptom specificity, anatomical site, patient risk factors, timing after union, and technical complexity. This narrative review synthesizes clinically relevant evidence on elective plate removal after fracture healing in adults, focusing on indication strength, site-specific risk, complications, patient satisfaction, shared decision-making, and clinically applicable counseling considerations. A structured but non-systematic search was conducted in PubMed/MEDLINE, Scopus, and Web of Science from database inception to April 2026, supplemented by hand-searching of key reviews and reference lists. The available literature, which is largely observational, heterogeneous, and site-specific, generally favors a selective rather than routine approach. Plate removal appears more justifiable when symptoms are specific, reproducible, and plausibly attributable to the implant, such as painful prominence, tendon irritation, motion restriction, or mechanical impingement. In contrast, removal for vague discomfort, retained-metal anxiety, or asymptomatic preference has less predictable benefit and should be interpreted cautiously in light of the risks of a second operation. We introduce the SSRT framework (Symptom, Site, Risk, and Timing) as an evidence-informed conceptual framework for organizing clinical reasoning before elective plate removal. Rather than proposing a validated prediction rule or a formal guideline, SSRT is intended to synthesize established but often separately considered factors into a structured approach to patient selection and counseling. By organizing heterogeneous evidence into a practical clinical reasoning structure, this review aims to support safer patient selection and more transparent counseling.