Utility of Pathologic Evaluation Following Removal of Explanted Orthopaedic Internal Fixation Hardware‪.‬

Currently, removal of internal fixation hardware following orthopaedic surgery is a common procedure. In 2004, there were 4,040,000 musculoskeletal system operations, with the number of open reduction and internal fixation procedures performed being 441,000. (1) In the same year, removal of internal fixation hardware represented 4.9% (197,960) of all orthopaedic operations. There are concerns, however, about the usefulness and cost-effectiveness of these hardware removal procedures. (2) While the indications for hardware removal following successful fracture union remain constant, (3-5) the utility of their pathologic evaluation following explantation remains unclear. Many hospitals currently require surgeons to submit explanted orthopaedic hardware for pathologic analysis. The Joint Commission on Accreditation of Healthcare Organizations' (JCAHO) regulation states that exceptions to mandatory submission of surgical specimens may be made by the clinical staff, in consultation with the pathologist, when three conditions are met: 1. the quality of care has not been compromised by the exception, 2. another suitable means of verification of the removal has been routinely used, and 3. there is an authenticated operative or other official report that documents the removal. (6)