Traditionally, internal fixations are usually removed. Since the 1990s, there has been much discussion about whether internal fixation should be removed. Internal fixation removal has certain risks, including local hematoma, infection, re-fracture, nerve injury, and failure to remove internal fixation residue, etc. The complication rate ranges from 3% to 20%, of which the overall rate of serious complications with significant impact on the human body should be within 5%, including nerve injury, deep infection, and re-fracture. However, the risk of re-fracture after plate removal for forearm and lower middle femur fractures is relatively high, and the re-fracture rate can be as high as 10% or more, which should be given sufficient attention. It is a general consensus among clinicians that internal fixation removal is a simple and safe procedure. However, it is precisely this perception that leads to a certain degree of neglect of the potential risks of internal fixation removal. The potential risks may be magnified, especially if the procedure is performed by under-qualified or junior surgeons. It has been reported that severe nerve injuries are most often caused by less experienced surgeons. Internal fixation removal requires a certain level of skill and experience, and adequate preoperative risk judgment should be made, such as a higher incidence of re-fracture of the forearm and lower femoral segment with plate removal, and a higher risk of nerve injury with plate removal of the humerus and proximal radius. Relative re-fracture after internal fixation removal is one of the most compelling issues. The common risk factors include 3 main aspects, one is anatomical factors, the risk of re-fracture after taking internal fixation for lower femur and forearm fractures is relatively high, the former is because the cortical bone in this area is thin and does not easily form a stable contact. The latter is because the contact section of the bone is relatively small and is often subjected to rotational shear stress. Secondly, the fixation material and method factor, re-fracture is most commonly seen after plate removal, also after external fixation frame, and rarely after intramedullary nailing. This is because the plate fixation has the strongest stress masking effect. The type of steel plate is also an important factor affecting re-fracture. Heavy steel plates, especially L-shaped condylar support plates with significant stress masking effect, have now been replaced by condylar anatomic plates. Thirdly, the degree of fracture comminution and the technique of repositioning and fixation. The serious degree of comminution and the large fracture gap caused by insufficient pressure are important reasons for re-fracture after taking the plate. Most of the complications of internal fixation removal surgery can be prevented by developing appropriate procedures. The first step is to take a careful history, which turns out to be an open fracture or an infected process after surgery, and to adequately plan for the possibility of infection after internal fixation removal. The second is to fully analyze the current as well as the original radiographic data; previous comminuted fractures, excessive gaps, or delayed fracture healing should be given high priority. Extrapolation based on current radiographic data and time of fixation alone is sometimes unreliable, although there may be hints of unreliable healing on the radiographs of patients with re-fractures when internal fixation is taken, such as local texture disturbances and local translucency, but these signs are easily overlooked. At present, there are many kinds of internal fixation materials and the standard of equipment is not completely unified, so if there are no special instruments, it may cause difficulties in removing the internal fixation and should be well prepared. Finally, routine protection should be provided to the sites at risk of re-fracture, for example, patients with plate removal for femoral stem and forearm stem fractures should be protected by bracing for 3 months and avoid movement for 6 months, based on the fact that the majority of re-fractures occur within 3 months after surgery, and only one group reported 7 re-fractures after forearm plate removal occurring at an average of 6 months after surgery. Bracing cushions against harmful shear stresses and is a good fracture treatment in its own right. So, should the metal internal fixation be removed? In terms of the nature of the metal material, the commonly used medical stainless steel as well as titanium materials have excellent safety properties, and titanium has better biocompatibility. It is worth noting that MRI technology will gradually become popular in the near future as CT examinations are today, and stainless steel internal fixation has a tendency to be gradually eliminated because it hinders MRI examinations. Non-magnetic and better biological properties of titanium materials may become the mainstream of future internal fixation materials. At present, clinical observation of titanium materials in vivo has been accumulated for more than ten years or even twenty years, and most patients with retained internal fixation have no significant adverse effects. Therefore, many articles believe that it is not necessary to remove the internal fixation for asymptomatic patients. However, in the complex human environment, these metals have the potential to corrode and some people may be allergic to titanium metal. The risk of long-term retention of metallic internal fixation has not been fully evaluated so far. From a biomechanical perspective, the retention of internal fixation materials in the body can alter the stress state of the bone, resulting in both stress masking and stress concentration. Stress masking may delay fracture healing and produce osteoporosis at the fixation site. Concentration of stress occurs at the transition between the fixation material and the normal bone, increasing the stress on that area, such as at the ends of the plate, the distal end of the hip prosthesis or the gamma nail, resulting in a fatigue stress fracture. Of all the bones, the femur is subjected to the greatest shear forces, and the risk of long-term retention of the femoral plate or gamma nail is greatest. The author has repeatedly seen fractures around the femoral plate, and therefore recommends that the plate or short-segment intramedullary nail of the femur should be removed, with the exception of the long-segment intramedullary nail. Although plate fixation of other long bones is subject to similar risks, the risks are relatively much less. There is also the question of whether the internal fixation material should be removed from children’s bones. Analysis of the data from the experiment shows that the internal fixation material does not affect skeletal development in the short term for at least 1 to 2 years and has little to no effect on the growth of the bones in terms of thickness and length. However, as the bone grows, there is a tendency for the internal fixation material to be embedded in the bone, or buried in the bone, due to the enlargement of the medullary cavity resorption that occurs as the bone grows thicker, while the outer layer is new bone buried in old bone. It is difficult to evaluate how the plate being buried into the bone will affect the bone. Although there is disagreement as to whether the internal fixation should be removed from the bone in children, if the decision is made to remove it, it should be done early and at the right time; removing it too late can make surgery very difficult. In summary, the indications for internal fixation removal include: 1. The fracture is healed, but there are clinical signs of discomfort, such as pain, infection, and functional limitation. The case of unhealed fracture is not discussed in this paper. 2.Plate fixation of the femur or intramedullary nail fixation of the short segment of the femur. 3.Plate screws for fixation of the lower tibiofibular joint. 4.Erosional bone resorption or signs of loosening or fracture around the internal fixation, such as loosening of the crestal internal fixation. 5, specific occupations, such as athletes, acrobatic dancers and other internal fixation materials should be considered for removal if they are at risk of causing stress fractures. 6.Patients or parents of pediatric patients who do not want to face the uncertainty of long-term retention of internal fixation materials and actively request to remove them. In conclusion, the patient needs to have the right to be fully informed about whether the internal fixation should be removed, which is the basic purpose of this paper. The following factors can also be considered: 1, the internal fixation of micro-movement joint parts: such as hook and plate fixation of acromioclavicular joint, inferior tibiofibular joint screw fixation, pubic joint plate, etc.; 2, the internal fixation of crestal fracture if no bone graft fusion is performed, the removal of internal fixation will free the original fixed vertebral body to see the intervertebral disc, increase the mobility of crestal column, and avoid the failure of internal fixation and degeneration of adjacent vertebral body; 3, the internal fixation that mainly plays the role of tension reduction If the tendon suture of the reduction steel wire, the reduction steel cable fixation of the infrapatellar avulsion fracture, etc.; 4, the internal fixation loosening, withdrawal, fracture caused local discomfort, and even nails in the subcutaneous tendency to penetrate the skin; 5, the patient has serious psychological barriers to the existence of internal fixation, and firmly request to remove; 6, a very small number of patients have metal allergy, should also be considered to remove.