Cohort study reveals comparable refracture risk between nail retention and removal in pediatric forearm fractures, suggesting routine hardware extraction is often unnecessary.
Key Points
To evaluate refracture risk, complication rates, and healthcare resource utilization associated with retaining versus routinely removing elastic stable intramedullary nails (ESIN) in pediatric diaphyseal forearm fractures.
Retrospective single-center cohort study evaluating 288 pediatric patients treated with ESIN for diaphyseal forearm fractures after an institutional transition from routine implant removal to selective retention.
Patients were categorized into an implant removal cohort (n=136) and an implant retention cohort (n=152).
Primary outcomes included overall refracture analyzed via Cox regression and early refracture (<12 months) analyzed via logistic regression, alongside secondary endpoints of surgical complications and outpatient healthcare visits.
Refracture occurred in 13/136 (9.6%) patients following implant removal versus 8/152 (5.3%) after implant retention (absolute risk difference 4.3 percentage points, 95% CI -1.8 to 10.4; HR 1.4, 95% CI 0.5–3.4).
Early refracture (<12 months) occurred in 8/136 (5.9%) patients with implant removal compared to 5/152 (3.3%) with retention (absolute risk difference 2.6 percentage points, 95% CI -2.3 to 7.5; OR 1.8, 95% CI 0.6–6.2).
Routine implant removal resulted in complications in 11/136 (8.1%) patients, including infections in 5/136 (3.7%), whereas only 9/152 (5.9%) retained implants ultimately required secondary removal due to local irritation.