Locking Compression Plates are more difficult to remove than conventional non-locking plates

Musters, G. D.; Hensbroek, Pieter Boele van; Ponsen, Kees-Jan; Luitse, Jan S. K.; Goslings, J. Carel

doi:10.1007/s00068-012-0245-3

Cited by 4 publications

(6 citation statements)

References 9 publications

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“…It is widely used for various fractures, such as comminuted tibia fractures, or even in joint sparing salvage surgery after articular oncological resections [3][4][5][6][7]25 . However, there are reports of difficulties in removing 3.5-mm titanium locking screws due to stripping of hexagonal sockets 3,5,10,16 . This may be because titanium is more malleable than stainless steel, and the difference in the mechanical resistance between the stainless-steel screwdriver and the titanium screw may lead to stripping of the titanium screw.…”

Section: Discussionmentioning

confidence: 99%

“…However, titanium is prone to crossthreading or cold welding under strong metal-to-metal contact 7-9 . There have been several reports about the difficulties in removing 3.5-mm titanium locking screws from the locking plates after healing of the fractured bone 3,5,[10][11][12][13][14][15][16] . Removal is challenging when the hexagonal socket of the screw is stripped, rendering the drivers useless.…”

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confidence: 99%

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Screw stripping and its prevention in the hexagonal socket of 3.5-mm titanium locking screws

Lee

Park

Kim

et al. 2021

Sci Rep

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There have been several reports about the difficulties in removing 3.5-mm titanium locking screws from plates due to the stripping or rounding of the hexagonal screw socket. We investigated whether stripping the locking screw sockets can be prevented by using different screwdrivers or interposing materials into the socket during removal. We overtightened 120 3.5-mm titanium locking screws (Depuy Synthes, Paoli, PA) equally into locking plates on sawbone tibia models, applying a uniform torque of 4.5 Nm, exceeding the recommended torque of 1.5 Nm. Twenty screws each were removed using a straight-handle 2.5-mm screwdriver, T-handle screwdriver, hex key wrench, and straight-handle screwdriver with a non-dominant hand. In addition, 20 screws were removed using foil from a suture packet inserted into the screw socket or using parts of a latex glove inserted into the screw socket. The incidence rates of screw stripping using the straight-handle screwdriver, T-handle screwdriver, hex key wrench, non-dominant hand, foil interposition, and latex glove interposition were 75%, 40%, 35%, 90%, 60%, and 70%, respectively. When a T-handle screwdriver or hex key wrench was used, the probability of screw stripping was 4.50 times (odds ratio = 4.50, 95% confidence interval = 1.17 to 17.37, p = 0.03) and 5.57 times (odds ratio = 5.57, 95% confidence interval = 1.42 to 21.56, p = 0.01) lower than that with the straight-handle screwdriver, respectively. Foil or latex glove interpositions did not prevent screw stripping. Thus, in the current experimental study, T-handle screwdriver or hex key wrench usage decreased the incidence rate of screw stripping during removal compared to straight-handle screwdriver use.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Screw stripping and its prevention in the hexagonal socket of 3.5-mm titanium locking screws

Lee

Park

Kim

et al. 2021

Sci Rep

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“…Latrogenic factors. The irregular operation of the surgeon is an important reason leading to slide wire screw, including：①The drill bit didn't match the screw; ②The sight was not used when drilling the screw was not placed in the direction of the screw path, and no torque limiting screwdriver was used; ③The screwdriver was not in the same direction as the screw, resulting in wear at the tail of the screw; ④The soft tissue or hyperplastic bone in the groove was not cleaned when the nail was removed (13,14); ⑤When the combination of the screw and the plate is over tightened, the surgeon tried to use a power tool to remove the screw instead of the T-handle screwdriver (15).…”

Section: Discussionmentioning

confidence: 99%

Study on the Effect of Removing the Slide Wire Screw on Locking Plate by Nail Groove Reconstruction Method

Zheng

2021

Preprint

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Background: This paper is to describe and evaluate the nail groove reconstruction method in removing slide wire screw on locking plate. Then compare the method with tungsten steel drilling nail method, to explore a new method of removing slide wire screw on locking plate.Method: A total of 1254 patients with removal fracture internal fixation devices were collected from the Affiliated Hospital of Hangzhou Normal University from July 2015 to September 2021, of which 62 cases met the inclusion and exclusion criteria. All patients were randomly divided into the experimental group and the control group. 31 people per group. There were 19 males and 12 females in the experimental group, the age of patients was 35.68±11.70years; while 18 males and 13 females in the control group, the age of patients was 36.27±10.37years. Nail groove reconstruction method was used in the experimental group, and the tungsten steel drilling nail method was used in the control group. Collect and count surgical-related indicators, the data of two groups were compared and analyzed from four aspects: intraoperative blood loss, operation time, incision healing time and limb function recovery time.Result: All slide wire screws were removed successfully, and all patients had no serious postoperative complications such as internal fixation retention and neurovascular injury. The experimental group was better than the control group in the following three aspects: the amount of intraoperative blood loss, the operative time, the recovery time of limb function, and the differences were statistically significant(p < 0.05). There was no significant difference in incision healing time between the two groups.Conclusion: The nail groove reconstruction method has less damage to the bone and soft tissue, less intraoperative blood loss, shorter operation time, and faster postoperative recovery of limb function. The nail groove reconstruction method is a simple and effective method, it has obvious advantages compared with the traditional method.

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“…These surgeries are also cost-intensive, which constitutes an economic burden on both patients and public health care systems [9]. Importantly, revisions may not always be feasible due to clinical constraints and/or health conditions, which results in permanent disability, where the retained implants may cause pain, infection, soft tissue irritation, and/or allergic/autoimmune reactions [10].…”

Section: Introductionmentioning

confidence: 99%

“…On the other hand, there is ample evidence in the literature that under-torquing can lead to screw loosening and unstable fixation [12], while over-torquing may cause thread stripping, cam-out failure or cold welding [7,15]; both under-and over-torquing can potentially result in an increased risk of implant failure and/or delayed bone healing. Furthermore, forcefully removing screws significantly increases the chance of stripping and causing severe damage at the socket and screwdriver interface, leading to additional clinical complications [10]. Difficult screw extractions also give rise to various challenges, such as prolonged operations, bleeding, infection, and potential neurovascular injuries [10].…”

Section: Introductionmentioning

confidence: 99%

Biomechanical Investigation of Bone Screw Head Design for Extracting Stripped Screw Heads: Integration of Mechanical Tests and Finite Element Analyses

et al. 2023

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Enhancing the design of bone screw head sockets to prevent stripping and improve the torque required for smooth unscrewing is a significant challenge in orthopedic applications. This research aims to establish a quantitative methodology by integrating mechanical testing with finite element (FE) simulations to determine a safe limitation depth for the screwdriver when engaging with the hexagonal socket, thus avoiding stripped screw heads. A FE model was developed to investigate the biomechanical responses of the screw head design. Five custom-made hexagonal sockets were manufactured, and single load torsional tests were conducted to assess the mechanical performance of the screws and drivers. The results from the mechanical tests were compared with the FE simulations, demonstrating a close agreement and confirming the model’s validity. Furthermore, additional FE models were created to study the impact of manufacturing tolerances on the socket width and screwdriver width. The findings revealed that the maximum torque to failure for the four designs was lower than the margins specified in ISO 6475. Additionally, increasing the depth of the screwdriver led to higher maximum torque values. This research suggests that the technique of screw insertion, specifically the depth of the driver tool within the screw socket, holds greater importance in preventing stripped screw heads than the design and manufacturing width of the bone screw’s hexagonal socket and screwdriver. This confirms the importance of screwdriver engagement inside the bone screw socket to prevent stripped screw heads and sheds light on the added value of maximum torque prediction for future design modifications.

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Locking Compression Plates are more difficult to remove than conventional non-locking plates

Abstract: LCP removal is associated with significantly more complications than conventional non-locking plate removal. The indication for removal of locking compression should be made cautiously, and surgical instruments for LCP removal should be optimized.

Cited by 4 publications

References 9 publications

Screw stripping and its prevention in the hexagonal socket of 3.5-mm titanium locking screws

Screw stripping and its prevention in the hexagonal socket of 3.5-mm titanium locking screws

Study on the Effect of Removing the Slide Wire Screw on Locking Plate by Nail Groove Reconstruction Method

Biomechanical Investigation of Bone Screw Head Design for Extracting Stripped Screw Heads: Integration of Mechanical Tests and Finite Element Analyses

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