Complications and Risk Factors Influencing Hardware Removal after Open Reduction and Internal Fixation of the Radius or Ulna: A Nationwide Study

Abstract

Indications for open reduction and internal fixation (ORIF) of forearm fractures vary, and some patients require removal of hardware (ROH) for various complications. Currently, limited data exist to evaluate the epidemiology of and risk factors for ROH of the radius/ulna. We examine associations between radius/ulna fractures and (1) characteristics of fractures requiring ORIF, (2) indications for ROH, (3) demographic risk factors for ROH, (4) length of stay, and (5) total hospital charges. We use the Nationwide Inpatient Sample (NIS) to identify patients admitted for radius/ulna ORIF and ROH between 1998 and 2010 in the United States. To identify fracture locations, comorbidities, and indications for ROH, the International Classification of Diseases (ICD)-9 codes were accessed. We identify 423,727 ORIF patients and 12,868 patients (3.0% of ORIF admissions) who underwent ROH. Logistic regression analyses and independent sample t-tests are used to assess risk factors and differences. Among fractures requiring ORIF, the most common is for distal, closed fractures of radius and ulna. The most common indications for ROH are implant infection and mechanical complication. Risk factors for ROH include male gender, Caucasian ethnic group, and Deyo comorbidity scores of 1 or greater. Length of hospital stay and total charges are significantly higher for ROH patients compared to those with ORIF only. ROH following ORIF for radius/ulnar fractures is an infrequent but serious complication that increases patient morbidity and burdens patients and providers. Patient demographics of male gender, Caucasian ethnic group, payer status, and comorbid conditions were identified as independent risk factors for ROH.