Complications during removal of conventional versus locked compression plates: is there a difference?

Neumann, H.; Stadler, Anne; Heuer, Hinrich J.D.; Auerswald, M.; Gille, Justus; Schulz, Arndt P.; Kienast, B.

doi:10.1007/s00264-016-3352-7

Cited by 5 publications

(3 citation statements)

References 23 publications

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“…The LCP (Depuy Synthes) has been introduced as a new standard of AO plating osteosynthesis. 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 .…”

Section: Discussionmentioning

confidence: 99%

“…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%

Section: Discussionmentioning

confidence: 99%

mentioning

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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Citations, non-citations and visibility of International Orthopaedics in 2017

Mavrogenis

Quaile

Pećina

et al. 2018

International Orthopaedics (SICOT)

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Hardware considerations in infection and nonunion management

Hoit

Bonyun

Nauth

2020

OTA International: The Open Access Journal of Orthopaedic Trauma

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The occurrence of both nonunion and fracture-related infection provides challenges for both the patient and the treating orthopaedic surgeon, with the potential need for complex reconstructive procedures to achieve union and/or eradicate infection. In addition to addressing the multiple different factors that often contribute to nonunion, surgeons are often forced to deal with difficult hardware issues at the time of revision surgery including infected hardware, loose or failing hardware, malaligned hardware, or inappropriate hardware constructs. This article reviews common causes of nonunions with emphasis on infection management and provides indications and techniques for hardware removal in the context of an algorithmic approach to nonunion management with illustrative case examples.

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Complications during removal of conventional versus locked compression plates: is there a difference?

Abstract: Hardware removal can be a complication-afflicted operation, especially cases involving locked-plate removal should only be performed if a strong indication is evident. Possible benefits of the procedure should be considered carefully, taking the cost-benefit ratio into account.

Cited by 5 publications

References 23 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

Citations, non-citations and visibility of International Orthopaedics in 2017

Hardware considerations in infection and nonunion management

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