[Practical guidelines for difficult and complex hardware removal in orthopedic surgery].

چکیده اصلی

OBJECTIVE: Safe and complete removal of osteosynthesis materials while preserving the surrounding soft tissues. INDICATIONS: Indications include implant-related pain, soft-tissue irritation, infection, implant failure, pseudarthrosis, and risk to adjacent tendons, nerves, or vessels as well as implants in children. CONTRAINDICATIONS: Disproportionate procedural risk in patients with poor bone quality, extensive scarring, or high surgical morbidity. SURGICAL TECHNIQUE: Thorough preoperative planning, precise identification of the implant type and manufacturer, and the availability of the manufacturer's original extraction tools as well as alternative extraction instruments-such as special extractors, carbide drills, and hollow reamers-are essential. In this article, stepwise removal techniques are detailed for screws, plates, intramedullary nails, and spinal or pelvic implants, including strategies for managing stripped, cold-welded, or fractured implants. POSTOPERATIVE MANAGEMENT: Early functional rehabilitation is encouraged. Following removal of load-bearing implants, temporary activity restrictions and postoperative X‑rays to detect iatrogenic fractures are recommended. CLINICAL RELEVANCE: Implant removal is a frequent yet technically demanding procedure. Careful preparation, appropriate instrumentation, and meticulous technique reduce complications and enhance patient safety.

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