{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T15:19:09Z","timestamp":1783351149546,"version":"3.54.6"},"reference-count":26,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T00:00:00Z","timestamp":1783296000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T00:00:00Z","timestamp":1783296000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Umea University"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Trauma Emerg Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>The risk of re-fracture after implant removal in healed hip fractures remains a clinical concern. This study aimed to determine the incidence of re-fracture following implant removal after osteosynthesis of a hip fracture.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective multicenter cohort study including patients aged\u2009\u2265\u200950 years who underwent implant removal between 2003 and 2023 after radiologically confirmed consolidation of a hip fracture. Patients were identified using procedural codes. Baseline variables included age, sex, ASA classification, fracture type (femoral neck or trochanteric), and implant type (pins\/screws, sliding hip device [SHD], or short\/long cephalomedullary nail [CMN]). Patients were followed from implant removal until re-fracture, conversion to arthroplasty, death, or end of follow-up, with a minimum follow-up of 1 year. Cox proportional hazards regression was used to assess associations between implant type and re-fracture risk, adjusting for age and sex. Because the proportional hazards assumption was violated, a time-stratified Cox regression and restricted mean survival time analyses were applied.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 575 patients (median age 73 years, IQR 65\u201381) were included, with a median follow-up of 53 months (IQR 18\u2013100). Lateral hip pain was the most common indication for implant removal (72.5%). The overall re-fracture incidence was 10.4%. Risk varied by implant type: 7.1% after pins\/screws, 10.5% after SHD, 18.3% after short CMN, and 15.8% after long CMN removal. Median time to re-fracture was 1.5 months, and 52% occurred after minimal or no trauma. Most re-fractures (85%) occurred within 90 months. Removal of CMNs was associated with a higher re-fracture risk compared with pins\/screws (HR 2.79; 95% CI 1.52\u20135.13), whereas SHD removal was not.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Implant removal after consolidated hip fractures carries a measurable risk of re-fracture, most pronounced after CMN removal. These findings highlight the importance of careful patient selection and could aid in decision-making when considering implant exchange or removal following osteosynthesis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Levels of evidence<\/jats:title>\n                    <jats:p>IV, retrospective observational cohort study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00068-026-03258-6","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T15:01:38Z","timestamp":1783350098000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Re\u2011fracture risk following implant removal in consolidated hip fractures: a multicenter retrospective cohort study of 575 patients"],"prefix":"10.1007","volume":"52","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-4398-0376","authenticated-orcid":false,"given":"Jabbar","family":"Mohammed","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viktor","family":"Mili-Schmidt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mats","family":"Wadsten","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans","family":"Juto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olof","family":"Wolf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sead","family":"Crnalic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olof","family":"Sk\u00f6ldenberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Mukka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Per","family":"Fischer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,6]]},"reference":[{"issue":"1","key":"3258_CR1","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1186\/s12891-018-2276-3","volume":"19","author":"L Mattisson","year":"2018","unstructured":"Mattisson L, Bojan A, Enocson A. 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Individual patient consent was waived due to the observational cohort design.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"The authors declare no competing interests related to this study. OW serves as director and SM as board member of the Swedish Fracture Register.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"215"}}