Hardware removal after tibial fracture has healed.

BACKGROUND Tibial fractures are the most common long bone fracture. The standard of care for the treatment of diaphyseal tibial fractures is an intramedullary nail (IMN). Implant removal is one of the most common procedures in bone and joint surgery, and criteria for implant removal are typically left to the treating surgeon. Currently, no clear criteria exist to guide a surgeon's decision to remove implanted tibial IMNs after healing. METHODS We undertook a retrospective chart review of a single surgeon's practice from January 1996 to February 2005. We identified patients aged 16-70 years with a tibial fracture treated with an IMN. Patients were followed until fracture union and/or request for IMN removal. The following parameters were recorded: reason for implant removal, age, sex, mechanism of fracture, location of fracture, diameter of IMN, Workers' Compensation Board (WCB) status, activity level, litigation status, insurance involvement, height, weight and body mass index (BMI). RESULTS Factors influencing the likelihood of removal were sex and litigation. Factors not influencing the likelihood of removal were age, weight, height, BMI, diameter of IMN, patients' level of activity, insurance claim involvement and WCB involvement. Overall, 72.2% of patients had an improvement in their symptoms after IMN removal. CONCLUSION Sex and litigation are positive predictive factors for patient requests to have tibial IMNs removed after healing.