Elective removal vs. retaining of hardware after osteosynthesis in asymptomatic patients-a scoping review.
Extremity fractures
Hardware
Internal fixations
Osteosynthetic material
Remove
Retain
Journal
Systematic reviews
ISSN: 2046-4053
Titre abrégé: Syst Rev
Pays: England
ID NLM: 101580575
Informations de publication
Date de publication:
02 10 2020
02 10 2020
Historique:
received:
07
05
2020
accepted:
18
09
2020
entrez:
3
10
2020
pubmed:
4
10
2020
medline:
25
6
2021
Statut:
epublish
Résumé
Osteosynthesis is the internal fixation of fractures or osteotomy by mechanical devices (also called hardware). After bone healing, there are two options: one is to remove the hardware, the other is to leave it in place. The removal of the hardware in patients without medical indication (elective) is controversially discussed. We performed a scoping review to identify evidence on the elective removal of hardware in asymptomatic patients compared to retaining of the hardware to check feasibility of performing a health technology assessment. In addition, we wanted to find out which type of evidence is available. A systematic literature search was performed in PubMed, Embase, EconLit, and CINAHL (November 2019). We included studies comparing asymptomatic patients with an internal fixation in the lower or upper extremities whose internal fixation was electively (without medical indication) removed or retained. We did not restrict inclusion to any effectiveness/safety outcome and considered any comparative study design as eligible. Study selection and data extraction was performed by two reviewers. We identified 13476 titles/abstracts. Of these, we obtained 115 full-text publications which were assessed in detail against the inclusion criteria. We included 13 studies (1 RCT, 4 cohort studies, 8 before-after studies) and identified two ongoing RCTs. Nine assessed the removal of the internal fixation in the lower extremities (six of these syndesmotic screws in ankle fractures only) and two in the upper extremities. One study analysed the effectiveness of hardware removal in children in all types of extremity fractures. Outcomes reported included various scales measuring functionality, pain and clinical assessments (e.g. range of motion) and health-related quality of life. We identified 13 studies that evaluated the effectiveness/safety of hardware removal in the extremities. The follow up times were short, the patient groups small and the ways of measurement differed. In general, clinical heterogeneity was high. Evidence on selected topics, e.g. syndesmotic screw removal is available nevertheless not sufficient to allow a meaningful assessment of effectiveness.
Sections du résumé
BACKGROUND
Osteosynthesis is the internal fixation of fractures or osteotomy by mechanical devices (also called hardware). After bone healing, there are two options: one is to remove the hardware, the other is to leave it in place. The removal of the hardware in patients without medical indication (elective) is controversially discussed. We performed a scoping review to identify evidence on the elective removal of hardware in asymptomatic patients compared to retaining of the hardware to check feasibility of performing a health technology assessment. In addition, we wanted to find out which type of evidence is available.
METHODS
A systematic literature search was performed in PubMed, Embase, EconLit, and CINAHL (November 2019). We included studies comparing asymptomatic patients with an internal fixation in the lower or upper extremities whose internal fixation was electively (without medical indication) removed or retained. We did not restrict inclusion to any effectiveness/safety outcome and considered any comparative study design as eligible. Study selection and data extraction was performed by two reviewers.
RESULTS
We identified 13476 titles/abstracts. Of these, we obtained 115 full-text publications which were assessed in detail against the inclusion criteria. We included 13 studies (1 RCT, 4 cohort studies, 8 before-after studies) and identified two ongoing RCTs. Nine assessed the removal of the internal fixation in the lower extremities (six of these syndesmotic screws in ankle fractures only) and two in the upper extremities. One study analysed the effectiveness of hardware removal in children in all types of extremity fractures. Outcomes reported included various scales measuring functionality, pain and clinical assessments (e.g. range of motion) and health-related quality of life.
CONCLUSIONS
We identified 13 studies that evaluated the effectiveness/safety of hardware removal in the extremities. The follow up times were short, the patient groups small and the ways of measurement differed. In general, clinical heterogeneity was high. Evidence on selected topics, e.g. syndesmotic screw removal is available nevertheless not sufficient to allow a meaningful assessment of effectiveness.
Identifiants
pubmed: 33008477
doi: 10.1186/s13643-020-01488-2
pii: 10.1186/s13643-020-01488-2
pmc: PMC7532570
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
225Références
Eur J Trauma Emerg Surg. 2013 Aug;39(4):327-37
pubmed: 26815392
Orthopade. 2003 Nov;32(11):1039-57; quiz 1058
pubmed: 15088628
Bone Joint J. 2014 Dec;96-B(12):1699-705
pubmed: 25452376
J Foot Ankle Surg. 2013 Jul-Aug;52(4):491-4
pubmed: 23628194
Rev Med Suisse. 2009 Apr 29;5(201):977-80
pubmed: 19476061
Knee Surg Sports Traumatol Arthrosc. 2020 Jun;28(6):1827-1834
pubmed: 31273409
J Bone Joint Surg Br. 2009 Aug;91(8):1069-73
pubmed: 19651836
BMC Musculoskelet Disord. 2016 Mar 10;17:119
pubmed: 26964742
Arch Orthop Trauma Surg. 2015 Nov;135(11):1491-6
pubmed: 26264713
Clin Orthop Relat Res. 2004 Jun;(423):222-6
pubmed: 15232453
BMC Musculoskelet Disord. 2018 Jan 31;19(1):35
pubmed: 29386053
Foot Ankle Int. 2019 May;40(5):499-505
pubmed: 30654661
J Pediatr Orthop B. 2009 Nov;18(6):381-7
pubmed: 19623086
J Bone Joint Surg Am. 1984 Oct;66(8):1241-3
pubmed: 6490698
Int J Technol Assess Health Care. 2012 Apr;28(2):180-6
pubmed: 22559762
Injury. 1992;23(1):29-30
pubmed: 1541495
J Am Acad Orthop Surg. 2006 Feb;14(2):113-20
pubmed: 16467186
Injury. 2008 Mar;39(3):362-7
pubmed: 18242607
J R Coll Surg Edinb. 1993 Apr;38(2):96-100
pubmed: 8478843
BMC Surg. 2015 Aug 07;15:96
pubmed: 26250649
J Orthop Trauma. 2010 Jan;24(1):2-6
pubmed: 20035170
Injury. 2006 Sep;37(9):891-8
pubmed: 16630621
J Orthop. 2019 Jun 05;17:106-109
pubmed: 31879485
BMC Med Res Methodol. 2016 Feb 09;16:15
pubmed: 26857112
Injury. 2013 Dec;44(12):1880-4
pubmed: 24021584
J Trauma. 1996 Nov;41(5):846-9
pubmed: 8913214
Chirurg. 2005 Aug;76(8):789-94
pubmed: 15843909
J Bone Joint Surg Am. 2007 Sep;89(9):1906-12
pubmed: 17768185
Injury. 1992;23(1):25-8
pubmed: 1541494
J Orthop Trauma. 2010 Jan;24(1):12-6
pubmed: 20035172
J Orthop Res. 2018 Mar;36(3):1035-1039
pubmed: 28862357