Internal fixation removal is more common in orthopedics, but the need for its removal is still controversial and has been elaborated upon. The procedure of internal fixation removal is more common in clinical practice, but at this stage there is no evidence that internal fixation routinely needs to be removed. Removal of internal fixation raises more economic issues, such as the cost of surgery and the delay in work due to postoperative rehabilitation. There is no clear clinical definition of the surgical indication for internal fixation removal, and only a small part of the literature has reported on the need for removal of internal fixation. When patients request removal of internal fixation because of pain at the surgical site, the clinical outcome, i.e., pain relief, is often unpredictable and depends mainly on the type of internal fixation and the location of the internal fixation. Indications for removal of internal fixation such as allergy prevention, tumor induction, and metal are not supported by available literature studies. Surgeons and patients should be aware of the indications for internal fixation removal and be well informed about the possible risks and benefits of internal fixation removal intraoperatively and postoperatively so that patients have reasonable expectations for its removal. Removal of internal fixation is more common in patients with symptomatic internal fixation. In addition, patient concerns about the potential for systemic or local side effects induced by the retention of metal internal fixation are also a common clinical reason for removal of internal fixation. Although most clinicians use internal fixation removal as a routine management procedure after internal fixation treatment, there are times when internal fixation removal can have more serious consequences than the initial surgery. Available evidence supports the removal of internal fixation in patients with failed internal fixation, infection, nonhealing fractures, and soft tissue irritation; however, there is a lack of consensus on the need for removal in patients with normal healing clinical fractures. In addition, there is no unanimous opinion on how long it takes for a patient to return to full normal activity after internal fixation removal. The clinical decision to remove internal fixation should take into account the potential complications and economic loss associated with the removal of internal fixation. To ensure that the decision to remove internal fixation is the most appropriate one, clinicians should have an understanding of the potential complications that may occur when internal fixation is removed, the patient’s sensitivity to the metal, and the effect on the tumor.