The burden of hardware removal in ankle fractures: How common is it, why do we do it and what is the cost? A ten-year review

Abstract

Background: Ankle fractures account for 9% of all fractures and 40% require surgical management. The ankle is the most common site of hardware removal. The purpose of our study was to investigate the incidence, indication and economic cost associated with removal of hardware from the ankle.

Methods: We conducted a ten-year retrospective review of 1482 patients treated by open reduction internal fixation for an unstable ankle fracture. Skeletally immature patients were excluded. Data collected was cross referenced from patient medical records, the radiological and electronic patient database. The casemix and hospital inpatient enquiry system (HIPE) were used to calculate costs.

Results: The mean age was 39.9 years with 53.6% male. 185 patients (12.5%) underwent hardware removal with unplanned removal performed in 6% of cases. The average cost of removal was €1113.

Conclusion: Removal of hardware continues to be a common operation with significant costs to all involved. More than one in 10 patients underwent future removal of hardware.

Level of evidence: Level 3.

Keywords: Ankle fracture; Cost; Hardware removal; Implant; Indication; Symptomatic; Unplanned.