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Research
Barbara Prediger
Universitat Witten/Herdecke
Corresponding Author
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Background
Osteosynthesis is the internal fixation of fractures or osteotomy by mechanical devices (also called hardware). After bone healing, there are two options: One is to remove the hardware, the other is to leave it in place. The removal of the hardware in patients without medical indication (elective) is controversially discussed. We performed a scoping review to identify evidence on the elective removal of hardware in asymptomatic patients compared to retaining of the hardware to check feasibility of performing a health technology assessment. In addition, we wanted to find out which type of evidence is available.
Methods
A systematic literature search was performed in Pubmed, Embase, EconLit and Cinahl (11/2019). We included studies comparing asymptomatic patients with an internal fixation in the lower or upper extremities whose internal fixation was electively (without medical indication) removed or retained. We did not restrict inclusion to any effectiveness/safety outcome and considered any comparative study design as eligible. Study selection and data extraction was performed by two reviewers.
Results
We identified 13476 titles/abstracts. Of these we obtained 115 full-text publications which were assessed in detail against the inclusion criteria. We included 13 studies (1 RCT, 4 cohort studies, 8 before-after studies) and identified two ongoing RCTs. Nine assessed the removal of the internal fixation in the lower extremities (six of these syndesmotic screws in ankle fractures only) and two in the upper extremities. One study analysed the effectiveness of hardware removal in children in all types of extremity fractures. Outcomes reported included various scales measuring functionality, pain and clinical assessments (e.g. range of motion) and health-related quality of life.
Conclusions
We identified 13 studies that evaluated the effectiveness/safety of hardware removal in the extremities. The follow up times were short, the patient groups small and the ways of measurement differed. In general clinical heterogeneity was high. Evidence on selected topics e.g. syndesmotic screw removal is available nevertheless not sufficient to allow a meaningful assessment of effectiveness.
Keywords
Extremity fractures, osteosynthetic material, internal fixations, hardware, remove, retain
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Peer Review Timeline
CURRENT STATUS: Published
View the published article at Systematic Reviews.
Version 2
Posted 20 Aug, 2020
No community comments so far
Editorial decision: Accept
On 17 Sep, 2020
Review #1 received
Received 08 Sep, 2020
Reviewer #1 agreed
On 23 Aug, 2020
Reviewers invited
Invitations sent on 20 Aug, 2020
Editor assigned
On 18 Aug, 2020
Submission checks complete
On 17 Aug, 2020
Editor invited
On 17 Aug, 2020
No comments provided
Editorial decision: Major revision
On 02 Jul, 2020
Review #2 received
Received 28 Jun, 2020
Review #1 received
Received 17 Jun, 2020
Reviewer #2 agreed
On 11 Jun, 2020
Reviewer #1 agreed
On 25 May, 2020
Reviewers invited
Invitations sent on 23 May, 2020
Editor assigned
On 22 May, 2020
Editor invited
On 21 May, 2020
Submission checks complete
On 08 May, 2020
First submitted
On 07 May, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
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A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
See the published version of this preprint at Systematic Reviews.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Barbara Prediger
Universitat Witten/Herdecke
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at Systematic Reviews.
Version 2
Posted 20 Aug, 2020
No community comments so far
Editorial decision: Accept
On 17 Sep, 2020
Review #1 received
Received 08 Sep, 2020
Reviewer #1 agreed
On 23 Aug, 2020
Reviewers invited
Invitations sent on 20 Aug, 2020
Editor assigned
On 18 Aug, 2020
Submission checks complete
On 17 Aug, 2020
Editor invited
On 17 Aug, 2020
No comments provided
Editorial decision: Major revision
On 02 Jul, 2020
Review #2 received
Received 28 Jun, 2020
Review #1 received
Received 17 Jun, 2020
Reviewer #2 agreed
On 11 Jun, 2020
Reviewer #1 agreed
On 25 May, 2020
Reviewers invited
Invitations sent on 23 May, 2020
Editor assigned
On 22 May, 2020
Editor invited
On 21 May, 2020
Submission checks complete
On 08 May, 2020
First submitted
On 07 May, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at Systematic Reviews.
Background
Osteosynthesis is the internal fixation of fractures or osteotomy by mechanical devices (also called hardware). After bone healing, there are two options: One is to remove the hardware, the other is to leave it in place. The removal of the hardware in patients without medical indication (elective) is controversially discussed. We performed a scoping review to identify evidence on the elective removal of hardware in asymptomatic patients compared to retaining of the hardware to check feasibility of performing a health technology assessment. In addition, we wanted to find out which type of evidence is available.
Methods
A systematic literature search was performed in Pubmed, Embase, EconLit and Cinahl (11/2019). We included studies comparing asymptomatic patients with an internal fixation in the lower or upper extremities whose internal fixation was electively (without medical indication) removed or retained. We did not restrict inclusion to any effectiveness/safety outcome and considered any comparative study design as eligible. Study selection and data extraction was performed by two reviewers.
Results
We identified 13476 titles/abstracts. Of these we obtained 115 full-text publications which were assessed in detail against the inclusion criteria. We included 13 studies (1 RCT, 4 cohort studies, 8 before-after studies) and identified two ongoing RCTs. Nine assessed the removal of the internal fixation in the lower extremities (six of these syndesmotic screws in ankle fractures only) and two in the upper extremities. One study analysed the effectiveness of hardware removal in children in all types of extremity fractures. Outcomes reported included various scales measuring functionality, pain and clinical assessments (e.g. range of motion) and health-related quality of life.
Conclusions
We identified 13 studies that evaluated the effectiveness/safety of hardware removal in the extremities. The follow up times were short, the patient groups small and the ways of measurement differed. In general clinical heterogeneity was high. Evidence on selected topics e.g. syndesmotic screw removal is available nevertheless not sufficient to allow a meaningful assessment of effectiveness.
Figure 1
Figure 2
This is a list of supplementary files associated with this preprint. Click to download.
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