Implant removal following open reduction and internal fixation for distal radius fracture: A study based on the Diagnosis Procedure Combination database in Japan

The rate of implant removal and the factors influencing its indication in patients with distal radius fracture (DRF) in Japan are unclear.We retrospectively evaluated the incidence rate of implant removal in a large cohort of DRF patients obtained from the Diagnosis Procedure Combination database in Japan between April 2014 and March 2019. Patient- and hospital-related factors possibly affecting removal rate, including age, sex, annual number of open reduction and internal fixation (ORIF) for DRF procedures per hospital, number of hospital beds, advanced or general care hospital, and hospital location were analyzed as well. Hospital location was classified into three types based on population and population density as 1) large city, 2) local city, and 3) sparse area.Implant removal was performed in 3242 (26.3%) of 12,328 DRF patients receiving ORIF. According to multivariate analysis, the significant factors related to a decreased probability of removal were older patients, male, large annual number of ORIF for DRF procedures per hospital, large number of hospital beds, advanced care hospital, and hospital in large city.This study clarified the current implant removal rate and trends following ORIF for DRF in Japan. Both patient- and hospital-related factors significantly impacted the decision for implant removal.