Gallery of Orthopedic Medical Devices - Complications
By Tim B. Hunter, MD and Mihra S. Taljanovic, MD, PhD
Complications of Orthopedic Apparatus
Medical apparatus is sometimes life-saving and usually adds significant improvement to patient lives with reduction in mortality and morbidity. Nevertheless, all medical devices no matter the type or intended use - intravenous lines, prosthetic heart valves, cerebrospinal fluid shunts, pacemakers, fracture fixation plates, and joint arthroplasties - are always subject to one or more possible complications. These fortunately are rare and usually recognized appropriately. However, one should always be aware of medical apparatus complications and carefully examine every imaging study for possible complications so they can 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, vascular injury, nervous system injury, localized infection with cellulitis or abscess formation, and generalized sepsis.
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.
A fixation plate or rod may be malpositioned or break, becoming displaced. It may become infected and have to be removed. More rarely, there can be bone osteolysis, osteomyelitis, or a nearby stress fracture. 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 chemical reaction (particle disease).
The present Gallery provides an overview of many of the complications that can be associated with orthopedic apparatus. The examples shown are typical with some quite dramatic and others more subtle. This is not an all inclusive demonstration of a every possible complication, but it is a good overview. In all cases, every 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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