Fate of rigid fixation in pediatric craniofacial surgery

The advantages of rigid fixation in adult craniofacial surgery are well doc umented, and implanted hardware is not routinely removed unless specificall y indicated. There is a tendency, however, to remove hardware in children b ecause of concerns with growth restriction, plate migration, and the lack o f information on the fate of miniplates when used in pediatric craniofacial surgery. It has been our practice during the past decade not to remove har dware in children unless specifically indicated. Our study included a total of 121 procedures in 96 children, with an average age of 3.9 years and an average follow-up of 5 years. We placed 375 titanium plates and 1944 screws from 3 manufacturers. Complications encountered in children with titanium plates were as follows: 5 cases of delayed growth and 1 instance of restric ted growth, 4 screw migrations (none intracranial), 9 palpable plates causi ng pain, 3 fluid accumulations over plates, 2 cases of meningitis, and 8 in stances of plate and screw removal from the above complications. Twenty-two of 96 patients (23%) had a total of 27 complications from 121 procedures ( 22%). There were 6 cases in which pain precipitated removal of hardware, 1 case of an excessively mobile plate, and 1 case of documented growth restri ction requiring removal; therefore our overall reoperation rate for plate r emoval was 8%, with no intracranial plate or screw migration.