Background: The purpose of this study was to conduct an examination of internal fixation of femoral fractures in a large national database. The study aims were to determine the percentage of fixation procedures that result in hardware removal in a single year and to assess differences in the likelihood for hardware removal procedures using patient characteristics.
Methods: The 2007 Nationwide Inpatient Sample was used to quantify all patients who received an open reduction and internal fixation procedure for a fracture of the femur and all patients with a removal of implanted devices from the femur. The differences in patient characteristics between both groups were assessed using statistical methods.
Results: Internal fixation of the femur was reported in 30,943 patients. Hardware removals were reported in 4,886 patients. The removal rate for the year was estimated to be 15.8%. Treatment failure was most often because of mechanical complications (18.7%), osteoarthritis (14.3%), nonunion (13.9%), refracture (10.9%), and other implant-oriented complications (10.1%). Males and younger patients composed a significantly higher percentage of removal procedures than fixation procedures (p < 0.0001 for both). Removal rates were lower in Self-Pay and Medicare patients, while the opposite was true for Medicaid and private insurance/HMO patients (p < 0.0001).
Conclusion: The results of this study suggest that gender, age, and insurance status may influence the likelihood of an implant removal procedure. Given that removal was more likely in males and younger patients, and most often because of mechanical and implant-oriented complications, patient activity and weight bearing are likely leading factors in implant removal.