There are absolute and relative indications for the removal of metal structures. Absolute indications include cases of late postoperative complications. For example, when osteosynthesis was performed after an open fracture, but an infection occurred during an injury or in the early postoperative period. It was gradually leveled under the action of an antibiotic, but the body failed to completely get rid of it. Skin healed, the patient was discharged. And after about six months or a year, the wound suppurates. The fact is that the microorganism that is located on the border between the implant and body tissues, as a rule, is Staphylococcus aureus, has sufficient resistance to antibiotics and the ability to form colonies on the surface of implants, protected by glycokalium, specially synthesized as a barrier that prevents penetration to him body cells and medicines. Without removing the implant, this problem cannot be solved. You can temporarily prescribe antibiotics, reduce inflammation, but in this case, the infection becomes chronic.
Metal structures, if they do not cause a local tissue reaction, can remain in the body for a long time. However, the presence of metal in the body often contributes to the development inflammatory process in the implant area after suffering colds. Usually, in a "planned" manner, the implants are removed after reliable fusion of fragments and restructuring of the callus. In elderly patients, the issue of removing a metal structure is decided individually.
Indications for premature removal of the implant are:
1) pronounced phenomena of corrosion of the metal fixator (pain, fistulas, pathological reaction of bone tissue, etc.);
2) penetration of the fixator into the joint, accompanied by dysfunction and pain syndrome;
3) fixator fracture;
4) suppurative process;
5) atrophy of bone tissue, the threat of a pathological fracture;
6) discomfort in the operated limb.
When removing a metal retainer, there are often great difficulties, so you need to carefully prepare for such an operative intervention. To remove the retainer, you must have the following tools: extractors with a supply of hooks, tongs with a screw clamp, a set of screwdrivers of various sizes, including those with a screw head lock. It is useful to have a small vise, hammers, chisels, and a circular bur for drilling screws. The operation is usually performed under general anesthesia, so that the surgeon is not limited in time.
Fixer removal technique.
Intramedullary fixators are usually removed using distractors, fixing them at the holes present at the end of the pin. However, it is often impossible to remove the pin with this technique. In these cases, resort to electrocoagulation. The electrode is placed for a short time on the protruding end of the fixator, the tissue surrounding the structure is burned, which often facilitates the removal of the nail. If this procedure is ineffective, especially when removing a nail from the femur, a surgical external approach is made to the middle third of the thigh (the narrowest part of the medullary cavity) and a longitudinal groove is made for 12-15 cm with a circular saw, penetrating into the medullary cavity. After that, the nail is easily removed.
Difficulties are also observed when removing screws, as well as plates fixed with screws. Often the screws and plates are “bricked up” with newly formed bone tissue. In these cases, in order not to cause additional trauma, it is necessary to accurately establish the location of the fixing structure radiologically. Then the chisel is removed bone tissue covering the structure.
Removing screws is often difficult, especially when the screw slot is broken. If the screws fix the plate, then their heads are knocked down with a chisel, the plate is removed, and the remains of the screws are drilled with a bur. Individual screws are unscrewed with a screwdriver.
If difficulties are encountered, the surrounding bone tissue is removed with a chisel around the screw head so that a screwdriver with a screw lock can be fixed behind the screw head; if this does not work, the screw is drilled out with a drill having an internal channel for the screw.