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The implantation of osteosynthesis material is a surgical procedure used to stabilise and fix fractured bones. It is commonly used in orthopaedic and traumatological surgery1.
It consists of surgically accessing the fracture, and then reducing it by placing the bone fragments in their anatomical position, by means of two options: open (open reduction) or closed (closed reduction). The next stage is to fix the fragments with what is called osteosynthesis material, which may involve the use of the following elements depending on the trauma:
Plates and screws: metal plaques are fixed to the bone with screws.
Intramedullary screws: a long screw is inserted within the medullary cavity of the bone.
External fixings: external elements that hold the bones in the correct positions with pins inserted into the bone.
An increasing number of persons enter prison with osteosynthesis materials caused by injuries.
When the materials are placed openly, they can lead to a range of problems, such as infections, rejection, breakage or displacement of the material, pain, stiffness, hypertrophic scars and keloids, etc. In such cases the material may need to be removed2.
Case description
Background. Female patient of 44 years of age:
No known allergies.
Surgical history: fracture of femur and knee cap. Pseudoartrosis.
Chronic treatment: Clorazepate, Aceclofenac, Methadone. Currently treated for hepatitis C virus with RVs. Rest of serology negative.
Current anterior opening of knee, with fistulectomy of proximal region, where 2 screws are exposed (Figure 1) which cause the patient problems in daily life due to pain, discomfort, snagging and the need to have the screws covered on a daily basis.
Patient referred to traumatology service where exeresis of the proximal pole of the patella was carried out, along with the 2 screws. Extraction of osteosynthesis material (plaque on patella). Debridement and abundant washing. Chronic breakage of ap. Extensor was observed, due to pseudoartrosis of upper part of knee cap, with a GAP of 4 cm, which could not be directly repaired. Drainage and closure. Scarring was adequate (Figure 2).
No post-operative incidents. Articulated knee brace required for blocking in full extension. Item requested from orthopaedics during patient's hospitalisation, but was not possible as assessment was required by social worker to subsidise payment. Cruropedic splint was used instead, until the articulated brace prescribed and managed by the social workers at the centre could be put in place (Figure 3).
Final comment: one very striking feature of this process was that the prison had to take charge of managing the hospital prescription of the articulated brace.
