In terms of trauma surgery, fracture caused by trauma mostly requires internal fixations such as steel plate, titanium plate, steel wire, and intramedullary nail fixation, and internal fixations need to remain in the body for more than two years until the fracture is healed. Does the internal fixation need to be removed after fracture healing?
First, we need to know about the material of the internal fixator and its degradation characteristics. At present, most fracture plants are inert metals such as nickel, titanium, and steel, which are not easy to degrade, oxidize and react with tissues in the body. Generally speaking, they are safe in the body. However, the degradation or non-degradation of substances is relative, not absolute. Therefore, with the extension of time, the inert metal in the body will gradually decompose due to prolonged immersion by body fluids, oxidation by oxygen ions, stress shielding, and fatigue, and adverse reactions caused by inflammatory media. Some researchers have studied that endogenous plants will degrade within 20 to 30 years.
Once we understand the nature of the inner plant itself, let’s talk about the clinical aspect. After the fracture is healed, the internal fixation ends its fracture fixation and becomes an unnecessary decoration. In addition, some internal plants also have the effect of stress shielding after fracture healing, resulting in osteoporosis and loss of calcium ions at the place where the steel plate is applied, which may lead to the occurrence of re-fracture in severe cases. There are also follow-up examination problems, for example, MRI (magnetic resonance imaging) currently used in clinical practice is limited to metal objects such as internal fixations. Some elderly patients who need an MRI may wish they had taken out their internal fixations earlier.
It can be seen from the characteristics of the endoplant that the removal of the internal fixator should be a correct choice. However, the clinical treatment should also be based on the patient’s age, time of internal fixations, position (cervical vertebra, pelvis, displaced joint, heart stent, etc.), materials (absorbable) and other factors. The author thinks that the internal fixation of the limb fracture should be removed under the guidance of the physician after the fracture is healed.