Still No Period After Arm Implant Removal
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The progestogen-only contraceptive implant is the only non-biodegradable, flexible rod approved for use for up to three years.1 2 It is the best form of contraception available today3 and the most common type of recommended long-term replacement contraception on the NHS. sexual and reproductive (SRH).
Still No Period After Arm Implant Removal
When properly placed, the implant should be under the skin and significant migration is unlikely.1 5 Nexplanon’s summary of product characteristics states that there have been “occasional reports of implant migration; this usually involves little movement relative to the original site, but may result in the implant not being able to be placed in place”.2
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A PubMed literature search (2000–2018) found rare cases of etonogestrel implant migration into the vasculature6 7, but no evidence of migration after fractures or hand trauma. This phenomenon points to the possibility of secondary migration after major injuries, fractures and/or subsequent muscle atrophy.
A 26-year-old woman presented to the emergency department with pain and paralysis of her right hand after a fall on icy, hard stairs in December 2017. She had an Explanon implant in situ that had expired in her right hand. The patient did not mention the implant during the initial presentation or at any time during the orthopedic care. Her medicine was called microgynon, just a birth control pill. He has been taking it for the last year since his placement expired. The presence of her implant was not documented in her clinical notes or multiple radiology reports.
Anteroposterior (AP) radiograph showing a closed, displaced, midshaft transverse fracture of the right humerus and a dislodged Nexplanon contraceptive implant (Figure 1).
This woman was successfully treated with a Clasby brace for two months. He was discharged from the fracture clinic three months after the injury, without pain, but with a limited range of motion (forward flexion to 140°, abduction to 140°, and internal rotation to L3) and a planned physical therapy follow-up.
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Four months after the accident, the woman went to the SRH outpatient clinic and asked to have her leg removed. The installation was untouchable. The patient reported that after approximately four years of implantation from his GP, he could easily feel the device and when interviewed said that he could not feel it since the fracture and muscle wasting. He thought that might have caused him to get inside.
The patient was referred for ultrasound-guided removal using a high-frequency linear transducer to a specialist to position the removal site according to current guidelines. It was successfully performed without complications using the u technique and modified ring vasectomy forceps.
When I broke my arm and during the months of recovery, I didn’t think about my implant for a second, I just knew that when I was out, I had to be taken out. Looking back at the x-rays I took during the fracture clinic, it’s clearly visible and I’m surprised no one asked more than once what it was!
The process of pulling it out wasn’t painful, but it was hard for me to find it shifted and hard to find. Luckily I had pictures of my x-rays on my phone to use as a guide, but I only had them as I requested them at the fracture clinic appointment.
Birth Control Implants
I was implanted before this and the procedure was easy so I didn’t even think it was circulating during recovery. Unfortunately, I didn’t believe in contraception and used a different method this time. If you would like to reuse any or all of this article, please use the link below to be directed to the Copyright Center’s RightsLink service. You’ll be able to get quick pricing and quick permission to reuse your content in many different ways.
” in the July 2013 edition of the journal. In the last five months, two, maybe three cases of skin infections have occurred in our department due to the use of contraception in patients with comorbidity of atopic eczema.
The first case was a 15-year-old girl who developed an infection within 10 days of the transplant. A skin swab showed growth
Sensitive to both flucloxacillin and co-amoxiclav. The patient first received oral flucloxacillin and then a second treatment with oral co-amoxiclav. However, despite feeling alive, the wound did not heal, leading to removal of the extruded implant (Figures 1 and 2). Interestingly, the patient had a history of atopic eczema that was present in the area near the transplant site.
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The second patient was a 33-year-old woman who developed an access site infection within 1 week of implantation. Moderate to severe atopic eczema was reported and was considered poorly controlled. The infection at the implant site was treated with oral co-fluampicil and initially appeared to improve. However, after a period of antibiotics, erythema was found to follow from the precubital fossa to the implantation site. The implant again faced self-extrusion and was therefore removed.
Evidence of implant-related infection was unclear in our third patient, who also had atopic eczema. The site around the implant showed a rapid erythematous reaction within 7 days of insertion. Although antibiotics seemed to resolve the infection, the patient decided to have the implant removed despite the resolution of symptoms. Unlike the first two cases, there was no pus at the site of entry, so in retrospect it is not entirely clear whether the erythematous reaction was caused by an infection or some other form of allergy.
After reviewing these three cases, we contacted our local microbiology department to discuss ways to prevent postimplantation infections in women with atopic eczema. Patients with atopic eczema are at risk of colonization with staphylococci. If eczema is not properly controlled, the patient may shed large volumes of squamous cells.
We have taken three simple steps to reduce the risk of implant-related infection in such patients. First, after cleaning the skin with a chlorhexidine solution, we allow enough time to make sure the skin is completely dry. Second, we ensure that there is a sterile field with drapes to reduce the risk of staphylococcal colonized squamous cells falling back onto already cleaned skin. Finally, the patient’s skin condition and eczema should be evaluated so that more implants can be placed if their eczema is fully under control.
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We have been dealing with implants in this area for more than 10 years and have never had a problem with an implant infection. We would be very interested if other contraceptive services have also recorded the development of post-implantation infections in patients with atopic eczema.- Recommendations are independently selected by the editors of Reviewed. Purchases you make through our links may earn us a commission.
From birth control pills to IUDs to condoms, you have many options for safe and effective birth control methods. One you may not be familiar with: the Nexplanon birth control implant. When inserted under the skin of the upper arm, the device is on average more than 99% effective in preventing pregnancy for up to three years. But how does it work and what are its results? We’ve dug through the literature on birth control based on birth control and why you might like it.
Nexplanonis is a thin plastic stick about the size of a match that contains a synthetic version of the pregnancy hormone progesterone. When placed under the skin of the upper arm, it slowly releases a hormone that effectively prevents you from getting pregnant for years without protection.
Older brands include Implanon, Norplant, and Jadelle, but they all work in a similar way. Nexplanon replaced Implanon, which is no longer manufactured due to its propensity to move after implantation and the risk of over-implantation (ouch!). Nexplanon comes in a pre-installed applicator to reduce application errors.
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Like other birth control methods that use hormones, such as the hormonal intrauterine device (IUD) or the pill, Nexplanon releases progestin in the body to prevent pregnancy. Progestin works by thickening cervical mucus, making it harder for sperm to reach and meet the egg. Progestin can also prevent ovulation, or the release of an egg from the ovaries. You cannot get pregnant without a fertilized egg.
The implant is more than 99% effective in preventing pregnancy. Once the implant is placed in your hand, you can leave it there until it’s done, meaning it won’t be forgotten.
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