Pediatrik İmplant Çıkarım Komplikasyonları; Gerçekten Kolay Ameliyatlar mı?

Abstract

Amaç: Bu çalışmanın amacı, pediatrik implant çıkarma vakalarında karşılaşılan komplikasyonları ve nedenlerini ortaya koymaktır. Gereç ve Yöntem: Bu retrospektif çalışma Sancaktepe Şehit Prof. Dr. İlhan Varank Eğitim ve Araştırma Hastanesi'nde gerçekleştirilmiş ve veriler Ocak 2024 ile Ekim 2024 tarihleri arasında pediatrik implant çıkarım ameliyatı geçiren hastaların dosyalarından, ameliyathane kayıtlarından ve ameliyat notlarından elde edilmiştir. Verilerin normalliği Q-Q plot testi ile değerlendirilmiştir. Student's t-testi ile normal dağılıma sahip iki bağımsız grubu karşılaştırırken, normal dağılıma sahip olmayan veriler için Kruskal-Wallis testi kullanılmıştır. Bulgular: Kırk iki pediatrik implant çıkarım hastası çalışmaya dahil edilmiş ve ameliyat süresi ile çıkarılan implant tipi arasında anlamlı korelasyon bulunmuştur (p = 0.006). İmplantların çıkarılmasından sonra 3 hastada (%7) yüzeyel enfeksiyon, 2 hastada (%5) derin doku enfeksiyonu, 2 vakada (%5) implantın çıkarılamaması, 1 hastada (%2) refraktür ve 1 hastada (%2) ekstansör tendon yaralanması gibi komplikasyonlar gözlendi. Sonuç: İmplant çıkarılması sırasında komplikasyon riskini en aza indirmek için, doğru ve yüksek kaliteli implantın seçilmesi, uygun cerrahi tekniklerin uygulanması ve kırık fiksasyonu yapılırken çıkarma ameliyatının planlanması, tedavinin buna göre ayarlanması önerilir.

Keywords

• Pediatrik İmplant
• Komplikasyon
• İmplant Çıkarımı

Pediatric Hardware Removal Complications; Are They Really Easy Surgeries?

Abstract

Objective: The aim of this study was to investigate the complications and challenges encountered in pediatric implant removal cases. Materials and Methods: This retrospective study was conducted in Sancaktepe Şehit Prof. Dr. İlhan Varank Research and Training Hospital and data was collected from patients’ charts, operating room registrations, and operation notes, who underwent hardware removal surgery between January 2024 and October 2024. The normality of the data was assessed with the Q-Q plot test. The Student's t-test was used to compare two independent groups with normal distribution, whereas the Kruskal-Wallis test was used for non-normally distributed data. Results: Forty-two cases of pediatric implant removal patients were included in the study and significant correlation was found between the duration of surgery and the type of implant removed (p=0.006). After the removal of implants, the following complications were observed: superficial infection occurred in 3 patients (7%), deep tissue infection in 2 patients (5%), failure to remove the implant in 2 cases (5%), refracture in 1 patient (2%), and extensor tendon injury in 1 patient (2%). Conclusion: To minimize the risk of complications during implant removal, it is recommended to choose the correct and high-quality implant, apply appropriate surgical techniques, and plan the removal surgery while performing fracture fixation, adjusting the treatment accordingly.

Keywords

• Hardware Removal
• Complication
• Pediatric Implant

References

1. Boutis, K. (2020). The Emergency Evaluation and Management of Pediatric Extremity Fractures. Emergency Medicine Clinics of North America, 38(1), 31-59. doi:10.1016/j.emc.2019.09.003
2. Clement, N. D., Yousif, F., Duckworth, A. D., Teoh, K. H., & Porter, D. E. (2012). Retention of forearm plates: risks and benefits in a paediatric population. The Journal of Bone and Joint Surgery, 94(1), 134-137. doi:10.1302/0301-620X.94B1.27155
3. Dodwell, E., Wright, J., Widmann, R., Edobor-Osula, F., Pan, T. J., & Lyman, S. (2016). Socioeconomic Factors Are Associated With Trends in Treatment of Pediatric Femoral Shaft Fractures, and Subsequent Implant Removal in New York State. Journal of Pediatric Orthopaedics, 36(5), 459-464. doi:10.1097/BPO.0000000000000494
4. Doğan, N., Büyükdoğan, H., Çalışkan, G., & Ertürk, C. (2024). Is it safe and effective to leave Titanium Elastic Nail (TEN) tips outside the skin in pediatric femoral diaphyseal fractures?. Acta Medica Alanya, 8(1), 3-7.
5. Evers, B., Habelt, R., & Gerngross, H. (2004, March). O2109 indication, timing and complications of plate removal after forearm fractures: Results of a metanalysis including 635 cases. In Orthopaedic Proceedings (Vol. 86, No. SUPP_III, pp. 289-289). Bone & Joint. Gölgelioğlu, F., & Yalın, M. (2023). Pediatric forearm fractures: evaluating implant removal timing and complications with exposed titanium-elastic nail tips. Journal of Health Sciences and Medicine, 6(6), 1366-1372.
6. Jain, S., Mohanachandran, J., & Mohan, R. (2023). Outcomes and complications of Titanium elastic nailing for forearm bones fracture in children: our experience in a district general hospital in the United Kingdom. Acta Orthopaedica Belgica, 89(3), 539-546. doi:10.52628/89.3.12032
7. Kahle, W. K. (1994). The case against routine metal removal.Journal of Pediatric Orthopaedics 14(2), 229-237. doi:10.1097/01241398-199403000-00019
8. Küçük, A., Asfuroğlu, Z. M., & Köse, N. (2022). Closed reduction and titanium elastic nailing in diaphyseal femoral and tibial fractures in children. Cukurova Medical Journal, 47(2), 563-569.

9. Langkamer, V. G., & Ackroyd, C. E. (1990). Removal of forearm plates. A review of the complications. The Journal of Bone and Joint Surgery, 72(4), 601-604. doi:10.1302/0301-620X.72B4.2380210
10. Sanderson, P. L., Ryan, W., & Turner, P. G. (1992). Complications of metalwork removal. Injury, 23(1), 29-30. doi:10.1016/0020-1383(92)90121-8
11. Schalamon, J., Dampf, S., Singer, G., Ainoedhofer, H., Petnehazy, T., Hoellwarth, M. E., & Saxena, A. K. (2011). Evaluation of fractures in children and adolescents in a Level I Trauma Center in Austria. Journal of Trauma and Acute Care Surgery, 71(2), E19-25. doi:10.1097/TA.0b013e3181f8a903
12. Scheider, P., Ganger, R., & Farr, S. (2020). Complications of hardware removal in pediatric upper limb surgery: A retrospective single-center study of 317 patients. Medicine (Baltimore), 99(5), e19010. doi:10.1097/MD.0000000000019010
13. Schildhauer, T. (2021). Metallentfernungen. Trauma und Berufskrankheit(21(Suppl 1)), 28-32.
14. Schmalzried, T. P., Grogan, T. J., Neumeier, P. A., & Dorey, F. J. (1991). Metal removal in a pediatric population: benign procedure or necessary evil? Journal of Pediatric Orthopaedics, 11(1), 72-76. doi:10.1097/01241398-199101000-00014
15. Simanovsky, N., Tair, M. A., Simanovsky, N., & Porat, S. (2006). Removal of flexible titanium nails in children. Journal of Pediatric Orthopaedics, 26(2), 188-192. doi:10.1097/01.bpo.0000218534.51609.aa
16. Stanitski, C. L. (2005). Metal removal in asymptomatic children and adolescents. Journal of Pediatric Orthopaedics, 25(4), 557. doi:10.1097/01.bpo.0000166345.86879.9a
17. Wells, J. C. (2012). Obesity as malnutrition: the role of capitalism in the obesity global epidemic. American Journal of Human Biology, 24(3), 261-276.
18. Wentzensen, A., & Magin, M. (1991). Plattenosteosynthese. In Die Plattenosteosynthese und ihre Konkurrenzverfahren: Von Hansmann bis Ilisarow. Springer.