The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Surgeon Referral for Extraction of Inadvertent Deep and Nonpalpable Contraceptive Implants That Place Major Peripheral Nerves at Risk: A Systematic Review of Case Reports and Case Series

Document Type : SYSTEMATIC REVIEW

Authors
Jason Noor
Stephanie Price
David Ring
Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, TX, USA
10.22038/abjs.2025.88821.4033
Abstract
Objectives: Implantable contraceptive implants placed at the medial arm are often misapplied relatively deep, sometimes in muscle or adjacent to neurovascular structures. We reviewed the available evidence regarding non-palpable medial arm implants and factors associated with deep application to help inform specialists who may be asked to assist with removal in order protect nearby nerves.  
Methods: Following PRISMA guidelines, the authors systematically reviewed PubMed, Embase, and Cochrane Library for case series and reports of complications associated with the removal of nonpalpable contraceptive implants in September of 2025. Rates and features of routine and problematic implant removal were studied. Factors potentially related to deep placement were identified.  The NIH tool for case series (2021) was used to assess study quality.
Results: We identified 16 case series and 10 case reports related to problematic implant removal from an initial search of 219 publications. In a series of routine insertions and removals, nonpalpable surgical implant removal was uncommon. Compared to routine removal, problematic removal was associated with subfascial implants, intramuscular implants, and previous attempts. A subset of implants was removed in the operating room. Transient paresthesia of the ulnar, median, and medial antebrachial cutaneous nerves was common after surgical removal of deep nonpalpable implants. Factors potentially associated with non-palpable implants included provider training, time since insertion, greater BMI, and weight gain during implant use.  Among the 10 case reports, 6 orthopedic surgeons and one plastic surgeon performed removal.
Conclusion: Hand surgeons may receive requests for assistance removing deep, nonpalpable contraceptive implants in order to limit the potential for neurovascular damage given that the medial arm insertion site is associate with the possibility of injury to adjacent to major nerves. 
        Level of evidence: IV
Keywords
Errant implant insertion
Nonpalpable contraceptive implants
Peripheral nerves
Risks of extraction
Subjects
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The Archives of Bone and Joint Surgery
Volume 14, Issue 2
February 2026
Pages 90-97

  • Receive Date 27 June 2025
  • Revise Date 19 November 2025
  • Accept Date 18 October 2025