This phase is more critical to patients who have been treated with external fixator (Ex-fix) systems. Premature removal of the ex-fix in these cases may result in complications and, at the same time, these patients are understandably eager to have their Ex-fix removed as soon as possible after the consolidation has been completed.
Patients with Ex-fix Systems:
The clearance for the removal of the external fixator is given by Dr Giotikas after careful evaluation of the x-rays. When specific radiographic findings have appeared on your x-rays and well-defined criteria have been fulfilled, a CT scan will be done to confirm the consolidation of the regenerate. CT scan gives better information than x-ray about the progression of the bone union (consolidation) and is always requested by Dr Giotikas before the ex-fix removal.
Fig 1
This assessment requires experience in understanding the subtle differences of the healing patterns and the limitations of imaging studies (x-rays, CT scan). Now is the time when mistakes from lack of and experience, or even from giving in on patient’s extreme pressure, may lead to re-fractures and other disastrous adverse events which jeopardize all previous efforts and may even result in permanent disability.
Before its definitive removal, the frame is “dynamized” (partially released) and any pain or other sign of instability during walking is monitored for 2-3 weeks. If everything is as expected, the definitive removal of ex-fix is cleared. With this combination of findings from x-ray, CT scan and clinical response on dynamization, the risks are kept to a minimum.
The external fixator can be removed at Athens BJR or in your place of residence, by an appropriately trained orthopaedic surgeon. It is a minor procedure so you will be able to leave the hospital on the same day. It is performed with light, short-acting sedation or anaesthetic. There is a very small risk of introducing an infection when a contaminated transfixion wire is withdrawn through the bone, so it is advised that transfixion wires are cleaned thoroughly with Chlorexidin alcoholic solution and cut flush-with-the-skin before they are pulled out form their other end. After the removal of the frame you will be wearing a hard boot for 4 weeks when you walk around (Fig.1)
Patients with Precise-2 Nail
Although the timing of nail removal is not critical, it is recommended to be done between 1 and 2 years after insertion. This is because nails:
- have moving parts which produce titanium metal ions over the course of many years. Although these ions are inert the recommendation is to remove them
- have a rare-earth magnet. Although it is sealed inside a waterproof chamber, it is possible that after years this seal could leak and the rare-earth magnet be exposed to body fluids.
In Athens BJR we remove the nail in 18-24 months since their implantation. It is a relatively minor procedure so usually the patients return to their accommodation on the same day. The cost for removal of two nails is 3400 euros and it is not included in the initial package price.