Complications of Orthopedic Apparatus - Introduction
by Jason R Wild, MD
The use of orthopedic devices can sometimes be life-saving. More often, they significantly reduce pain and discomfort while restoring mobility and improving one's sense of well being. Nevertheless, all medical devices no matter the type or intended use - intravenous lines, prosthetic heart valves, cerebrospinal fluid shunts, pacemakers, fracture fixation plates, joint arthroplasties - are subject to malfunction and complications. These fortunately are rare and usually recognized appropriately. However, one should always carefully examine every imaging study for possible device complications so they may be addressed in a timely fashion.
There are generic complications that can be found with almost any piece of medical equipment placed on or inside the body for patient monitoring or treatment. These include incorrect device location, device malfunction, device breakage with displacement into adjacent tissues, device breakage with embolization to distant sites as well as device caused vascular and nervous system injury or device induced localized infection with cellulitis, abscess formation, or generalized sepsis (Hunter, 1994).
Orthopedic apparatus also may be subject to particular complications that are derived from the location or the intended application of a specific device. These complications vary considerable from increased spinal degenerative disease above the level of spinal fixation apparatus to particle wear disease in a joint arthroplasty.
Fracture fixation apparatus - wires, rods, nails, plates, and screws - are a major part of everyday orthopedic practice, and their complications are frequently evident on radiographs. Many of these " complications" are minor and of no consequence. The most common example is the fracturing of fixation screws. These are frequently incidental findings, but their significance obviously depends on their location and intended use (Benjamin, 1994).
These plates, rods, or screws may be malpositioned iatrogenically, or they can bend, break, or migrate, becoming displaced. The bone around these implants can fail with a fracture, potentially related to stress from the implant. All implants have the risk of becoming infected, which may necessitate implant removal and treatment of the infection. While complications associated with fracture fixation are uncommon on a percentage basis, they are frequent in a busy practice situation, because fracture fixation is so common.
Joint arthroplasty complications are somewhat less common as joint arthroplasty is not as frequently performed as fracture fixation. However, hip, knee, and shoulder joint replacement is very common, and practices with large number of patients with joint prostheses can expect to see displaced, broken, or dislocated prostheses from time to time. Joint prostheses can become infected which may be difficult to diagnose by imaging, and their joint liners can have excessive or uneven wear producing improper joint functioning or a severe granulomatous reaction (particle disease).
The present discussion provides an overview of those complications, common and uncommon, associated with orthopedic devices of the extremities, joints, and pelvis. The discussion is extensive but by no means exhaustive, and one is encouraged to also review the attached references. In addition, a pictorial Gallery of Complications provides a quick reference for reviewing many of the complications that can be associated with orthopedic apparatus. In all cases, every patient radiograph, cross-sectional image, or nuclear medicine image should be examined carefully for the presence of medical apparatus. Ideally, the type of apparatus, its proper placement and function, and any complication should be noted. The presence of any significant complications should be rapidly conveyed to the patient's physicians.
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