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Complications Associated With Retained Implants After Plate Fixation of the Pediatric Forearm

Objective: Our present study examines the complications of pediatric patients treated with plate fixation for forearm fractures. Design: Case series of pediatric patients after their forearm fracture was fixed using a plate, with the majority of patients retaining their implants. Setting: Level 1 Trauma Center. Methods: From 1999 to 2009, 58 patients between the ages of 6 and 15 years had fixation of their forearm fracture with plates. Thirty-three of these patients were available for a long-term follow-up with an average of 6.4 years. The patients were interviewed over the phone, and a physician filled out a questionnaire with regard to their clinical course. Records and x-ray data were reviewed for each patient. Factors such as implant complications, functional activity level, pain score, and clinical symptoms were studied. Results: Fractures occurred in 7.1% (2/28) of the patients who chose to retain their implants. Of the 28 patients who initially chose to leave the implants in place, 17.9% (5/28) had a partial or complete removal of the implants because of irritation. These patients reported the following symptoms: mild pain 42.3% (11/26), clicking 34.6% (9/26), ability to feel the plates 73.1% (19/26), and mild weakness 26.9% (7/26). The number of patients who reported return to the preinjury level of activity was 88.5% (23/26), and 96.2% (25/26) reported being satisfied with their clinical outcome when implants were retained. Females had a significantly greater subjective weakness of 60.0% (6/10) compared with that of males, which was 14.3% (3/21; P = 0.009) after a forearm fracture. The inability to return to the preinjury level of activity was significantly greater for females, which was 30.0% (3/10) versus 0.0% (0/21) for males (P = 0.008). Conclusions: We concluded that retaining the plates in pediatric forearm fractures does not increase the refracture rate compared with the removal from the historical rates in the literature. Patients should be warned of possible symptoms and complications that may be present with retained plates. Also, a more aggressive physical therapy may be considered for females because they were observed to have more subjective weakness and dysfunction at long-term follow-up. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.