ArticleEuropean journal of trauma and emergency surgery : official publication of the European Trauma Society2026
Re‑fracture risk following implant removal in consolidated hip fractures: a multicenter retrospective cohort study of 575 patients.
Article in European journal of trauma and emergency surgery : official publication of the European Trauma Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeThe risk of re-fracture after implant removal in healed hip fractures remains a clinical concern. This study aimed to determine the incidence of re-fracture following implant removal after osteosynthesis of a hip fracture.
methodsWe conducted a retrospective multicenter cohort study including patients aged ≥ 50 years who underwent implant removal between 2003 and 2023 after radiologically confirmed consolidation of a hip fracture. Patients were identified using procedural codes. Baseline variables included age, sex, ASA classification, fracture type (femoral neck or trochanteric), and implant type (pins/screws, sliding hip device [SHD], or short/long cephalomedullary nail [CMN]). Patients were followed from implant removal until re-fracture, conversion to arthroplasty, death, or end of follow-up, with a minimum follow-up of 1 year. Cox proportional hazards regression was used to assess associations between implant type and re-fracture risk, adjusting for age and sex. Because the proportional hazards assumption was violated, a time-stratified Cox regression and restricted mean survival time analyses were applied.
resultsA total of 575 patients (median age 73 years, IQR 65-81) were included, with a median follow-up of 53 months (IQR 18-100). Lateral hip pain was the most common indication for implant removal (72.5%). The overall re-fracture incidence was 10.4%. Risk varied by implant type: 7.1% after pins/screws, 10.5% after SHD, 18.3% after short CMN, and 15.8% after long CMN removal. Median time to re-fracture was 1.5 months, and 52% occurred after minimal or no trauma. Most re-fractures (85%) occurred within 90 months. Removal of CMNs was associated with a higher re-fracture risk compared with pins/screws (HR 2.79; 95% CI 1.52-5.13), whereas SHD removal was not.
conclusionImplant removal after consolidated hip fractures carries a measurable risk of re-fracture, most pronounced after CMN removal. These findings highlight the importance of careful patient selection and could aid in decision-making when considering implant exchange or removal following osteosynthesis. LEVELS OF EVIDENCE: IV, retrospective observational cohort study.
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