Orthopaedic implant removal in children

When to consider removing wires, plates or screws in children: preparation, risks and recovery instructions after the procedure.

In my paediatric orthopaedic practice, I recommend implant removal in the large majority of cases after the fracture has healed. I prefer to assess and plan it with the family, choosing the timing according to the implant, its location and bone healing. The decision remains individual: retaining an implant can also be appropriate.

This page mainly concerns implants used for fractures. Removing a guided-growth plate follows the correction achieved and the monitoring plan for that treatment.

Informational hub for parents (when to worry, what to bring) →

Whether and when to remove an implant

Infection, exposure, migration or irritation of nearby tissues may require removal or other specific treatment. In other cases, the benefits and risks of retention and surgery are weighed together. Removal does not guarantee that all pain will disappear.

For internal implants, I often consider removal at around 6, 12 or 14 months after the original operation, depending on the device and healing. This reflects my clinical approach, not an automatic deadline: X-rays and individual assessment may indicate that a longer wait is appropriate. Wires that protrude through the skin follow a different, generally much shorter, timetable.

Why I consider planned removal

An implant may cause discomfort beneath the skin or irritate nearby tissues. When the implant is responsible for the symptoms, removal may help; however, not all pain comes from the implant or disappears after removal.

In uncomplicated cases, a planned procedure allows the timing to be chosen after the fracture has united. As the child grows, some implants can become harder to extract because bone grows over them. This is another consideration, not a reason to remove an implant before it is safe to do so.

I also consider a possible new injury: removal may avoid difficulties related to the old implant during any future treatment. This is a surgical planning consideration; it does not mean that removal prevents fractures or always makes treatment easier. The bone does not immediately return to its original condition: screw holes and bone remodelling require a period of protection.

Preparing for the procedure

Bring recent X-rays, the operation report and implant information, if available. These help the team plan the approach and equipment. Anaesthesia, admission and the removal method are agreed with the team; not all implants can be removed in an outpatient clinic.

Risks include infection, injury to nearby tissues, difficulty removing the entire implant and another fracture. Removal should therefore not be regarded as risk-free.

After removal

Before discharge, the instructions for wound care, movement, weight-bearing, school and follow-up should be clear. Absence of pain alone does not authorise running, jumping or contact sports: the bone may still need protection after the wound has healed.

Contact the treating team promptly for increasing pain or pain not controlled by the prescribed treatment, fever, increasing redness, wound discharge or persistent bleeding. Pale or cold fingers or toes, or new loss of sensation or numbness lasting beyond the expected anaesthetic effect, require urgent assessment.

The article on timing and refracture risk provides further background for discussion with the surgeon. The written discharge plan remains the reference for the individual child.

Sources

Montgomery BK et al. Indications for and Risks Associated With Implant Removal After Pediatric Trauma. JAAOS Global Research & Reviews, 2022;6(4):e22.00050. Testo integrale. DOI: 10.5435/JAAOSGlobal-D-22-00050.
Padgett AM et al. Pediatric fractures following implant removal: A systematic review. Journal of Children's Orthopaedics, 2022;16(6):488–497. PubMed, PMID 36483642. DOI: 10.1177/18632521221138376.
Texas Children's Hospital. What to Expect from Hardware Removal Surgery, 2023. Indicazioni del singolo centro da contestualizzare per impianto e sede.
Royal Children's Hospital Melbourne. Removal of metalware, per cura della ferita e segni che richiedono assistenza.
Royal Children's Hospital Melbourne. Hand or limb surgery, per segni neurovascolari e distinzione dall'effetto atteso del blocco anestetico. Non trasferire tempi di ripresa o schemi analgesici del foglio a ogni rimozione.
Rakow A, Lebek S, Renz N, Funk J. Sonication findings do not support routine removal of paediatric orthopaedic implants. Journal of Children's Orthopaedics, 2026;20(1):23–29; online 8 dicembre 2025. Articolo. PMID 41376863.
Tirta M et al. Should we remove flexible intramedullary nails after diaphyseal forearm pediatric fracture? A cohort study of 288 patients. Acta Orthopaedica, 2026;97:665–671. Abstract PubMed. DOI: 10.2340/17453674.2026.46804.
Pediatric forearm fractures with in situ intramedullary implants, 2016. Studio. Serie retrospettiva sui problemi di un nuovo trauma con mezzi ancora presenti; non confronto tra rimozione e mantenimento.

For parents

Paediatric injuries and fractures: the guide for families

Causes, diagnosis, conservative options and when surgery is considered.

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