The selection of the timing for removing the bone plate after fixation

The timing of removing the bone plate after fixation needs to be comprehensively judged in combination with the fracture healing condition, the patient’s age, the fracture site, the overall condition and the characteristics of the internal fixator. Generally, it is more appropriate to remove it 1 to 2 years after the operation, but the specific time needs to be evaluated on an individual basis. The following are the influences of different factors on the timing of extraction and the precautions:

First, the healing condition of fractures

Imaging assessment: Before removal, X-ray or CT examinations should be conducted to confirm that the fracture line has disappeared, the callus has formed well, and the fracture end has reached the clinical healing standard. If the fracture heals slowly or nonunion occurs, the fixation time needs to be prolonged.

Healing time: Generally, it takes 6 months to 1 year for limb fractures to heal, but it takes 1 to 2 years to fully restore bone strength. Premature removal may lead to re-displacement of the fracture, while too late removal may increase the difficulty of fracture or removal of the internal fixator.

Second, the patient’s age

Children and adolescents: The bone growth and metabolism are vigorous, and the healing speed is fast. Usually, removal can be considered 6 months to 1 year after the operation.

Adults: The healing speed is moderate, and it is generally removed 1 to 2 years after the operation.

Elderly people: Due to osteoporosis or decreased healing ability, the removal time may be delayed to more than two years, and in some cases, it is even recommended to keep it permanently.

Third, the fracture site

Non-weight-bearing parts of the upper limb, such as the clavicle and radius, can be removed relatively early, usually one to one and a half years after the operation.

The weight-bearing parts of the lower limbs, such as the femur and tibia, due to bearing greater stress, require a longer time to ensure fracture healing. They are usually removed one and a half to two years after the operation.

Near the joint: To avoid affecting the range of motion of the joint, it is recommended to remove it as soon as possible after the fracture has completely healed, but it is necessary to ensure that the bone strength is sufficient.

Fourth, general condition

Underlying diseases such as diabetes and malnutrition may affect fracture healing. It is necessary to control the condition first. Only after the fracture has healed to the standard can removal be considered.

Osteoporosis: For the elderly or patients with osteoporosis, after the removal of the internal fixator, the risk of refracture should be evaluated. If necessary, the fixation time should be extended or preventive measures should be taken.

Fifth, characteristics of the internal fixator

Material and type: Titanium alloy bone plates have good biocompatibility and can be retained in the body for a long time. If stainless steel bone plates remain in the body for too long, there may be risks such as loosening and breaking, and they need to be removed according to the regular time assessment.

The condition of the internal fixation device: If any discomfort, pain, infection, breakage or displacement caused by the internal fixation device occurs, it should be removed as soon as possible.

Sixth, Special circumstances

Infection or complications: If there is a concurrent infection at the surgical site, non-union of the fracture, or failure of the internal fixation device, the internal fixation device should be removed immediately and the complications should be managed.

Patient’s requirement: If the internal fixation device causes significant discomfort or affects daily life, it can be removed in advance after a doctor’s assessment.

Seventh, precautions after removal

Rehabilitation training: After the internal fixation device is removed, the patient still needs to undergo a period of rehabilitation training to restore the function of the injured area.

Avoid strenuous exercise: In the initial stage after removal, avoid strenuous exercise and excessive weight-bearing to prevent recurrence of fractures.

Regular follow-up: After removal, regular follow-up is required to monitor bone healing and functional recovery.