• Catherine Hui, Ian Jorgensen, Richard Buckley, and Gordon Fick.
• Division of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
• Can J Surg. 2007 Feb 1;50(1):13-8.

IntroductionThere are limited data on hardware removal after femoral fracture healing. We determined the incidence of intramedullary nail (IMN) removal after midshaft femoral fractures. We also studied demographic factors influencing IMN removal.MethodsThe senior author reviewed all adult femoral fractures with IMN placement in the trauma practice between July 1990 and November 2003. There were a total of 74 IMNs in 68 subjects with midshaft fractures. The incidence of hardware removal was the primary outcome measure. We also analyzed age, sex, body mass index (BMI), mechanism of injury, IMN dimensions, occupation, and Workers' Compensation Board (WCB) insurance and litigation involvement.ResultsOverall incidence of IMN removal was 20% (15 of 74 fractures). No significant difference was found with age (p=0.965), sex (p=0.086), BMI (p=0.423), occupation (p=0.341), insurance involvement (p=0.229), WCB involvement (p=0.663) or IMN dimensions (width, p=0.752; length, p=0.312). Litigants had the highest incidence of IMN removal (p=0.004).DiscussionAll hardware was removed for pain or irritation. These results suggest that litigants require hardware removal more often than nonlitigants. A larger study is needed to identify specific criteria for hardware removal and to determine whether secondary gains affect the incidence of femoral removal.

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