про удаление металлических имплантов

[Adonin]

В нашей ветке форума регулярно поднимается один и тот же вопрос - надо ли удалять их бессимптомные погружные фиксаторы. Единого мнения пока нет, отвечать на этот вопрос приходится несколько раз в неделю, потому предлагаю вынести обсуждение в отдельную ветку, а потом, при необходимости, давать больным ссылку на нее.

Мой скромный первый вклад Campbell's operative orthopaedics, 11 ed

After adequate bone regeneration has occurred, implant removal may be indicated because of patient preference or to restore skeletal strength. The risk of refracture after plate removal can be minimized by evaluating multiple radiographic views of the fracture. Restoration of the medullary canal and obliteration of all fracture lines suggest adequate healing, although refracture through screw holes still may occur. The AO-ASIF has published general guidelines for implant removal that may be helpful (Table 50-10).

Table 50-10 -- Timing of Metal Removal
Bone Fracture Time after Implantation (mo)
Malleolar fractures 8–12
Tibial pilon 12–18
Tibial shaft
Plate  12–18
Intramedullary nail  18–24
Tibial head 12–18
Patella, tension band 8–12
Femoral condyles 12–24
Femoral shaft
Single plate  24–36
Double plates  From mo 18, in two steps (interval, 6 mo)
Intramedullary nail  24–36
Peritrochanteric and femoral neck fractures 12–18
Pelvis (only in case of complaints) From mo 10
Upper extremity (optional) 12–18
These data essentially relate to recent fractures with uncomplicated healing processes and do not apply to osteosyntheses in pseudarthroses, major fragments, or after infections, which must be considered on an individual basis.