PROGRESS OF DIFFICULTY IN REMOVING OF LOCKING PLATE AND SCREW_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 YINQudong , GUSanjun , SUNZhenzhong

Department of Orthopaedics, Wuxi No.9 People's Hospital, Wuxi Jiangsu, 214062, P. R. China;

Corresponding author：

YINQudong, Email: yinqudong@sina.com

Keywords：

Removing of internal fixation; Complication; Stripping; Cross-threading; Cold-welding

DOI：

10.7507/1002-1892.20150081

Video：

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Objective To summarize the research progress of difficulty in removing of locking plate and screw. Methods The domestic and foreign related literature about difficulty in removing of locking plate and screw was reviewed. The incidence, the reason, preventive measure, removing method, and its advantages and disadvantages were summarized and analyzed. Results With the popularization of locking plate application, cases with difficulty in removing locking screw have significantly increased compared with non-locking plate, so it has become a new clinical problem. The main reasons are stripping, cross-threading, and cold-welding. In recent years, for the difficulty in removing of locking plate and screw, some special extraction tools and new extraction methods have developed, but each has its defects and indications. Conclusion Sufficient preoperative preparation, being familiar with its advantage and disadvantage as well as its indications are necessary. The specific situations of patient, including the reason, the screw, the plate, the incision, the bone quantity, and existing equipment, should be comprehensively considered to select appropriate methods.

Citation： YINQudong, GUSanjun, SUNZhenzhong. PROGRESS OF DIFFICULTY IN REMOVING OF LOCKING PLATE AND SCREW. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(3): 386-389. doi: 10.7507/1002-1892.20150081 Copy

1.	Sanderson PL, Ryan W, Turner PG. Complications of metalwork removal. Injury, 1992, 23(1):29-30.
2.	Georgiadis GM, Gove NK, Smith AD, et al. Removal of the less invasive stabilization system. J Orthop Trauma, 2004, 18(8):562-564.
3.	Cole PA, Zlowodzki M, Kregor PJ. Treatment of proximal tibia fractures using the less invasive stabilization system:surgical experience and early clinical results in 77 fractures. J Orthop Trauma, 2004, 18(8):528-535.
4.	Bae JH, Oh JK, Oh CW, et al. Technical difficulties of removal of locking screw after locking compression plating. Arch Orthop Trauma Surg, 2009, 129(1):91-95.
5.	Hamilton P, Doig S, Williamson O. Technical difficulty of metal removal after LISS plating. Injury, 2004, 35(6):626-628.
6.	Ehlinger M, Adam P, Simon P, et al. Technical difficulties in hardware removal in titanium compression plates with locking screws. Orthop Traumatol Surg Res, 2009, 95(5):373-376.
7.	Hak DJ, McElvany M. Removal of broken hardware. J Am Acad Orthop Surg, 2008, 16(2):113-120.
8.	Tan SL, Balogh ZJ. Indications and limitations of locked plating. Injury, 2009, 40(7):683-691.
9.	Raja S, Imbuldeniya AM, Garg S, et al. Difficulties encountered removing locked plates. Ann R Coll Surg Engl, 2012, 94(7):502-505.
10.	Hayes JS, Seidenglanz U, Pearce AI, et al. Surface polishing positively influences ease of plate and screw removal. Eur Cell Mater, 2010, 19:117-126.
11.	祝伟东. 钢板螺钉内固定骨折术后取出困难的处理. 中国伤残医学, 2006, 14(1):34.
12.	雷晓晶. 钢板螺钉取出困难应对策略. 中华创伤骨科杂志, 2007, 9(9):891-892.
13.	朱敏, 徐永清, 丁晶, 等. 一种取滑丝螺钉的方法. 中国骨与关节损伤杂志, 2012, 27(5):475.
14.	张国烈, 温羡宏, 冯文参, 等. 锁定钢板螺钉取出困难原因及解决方法的探讨. 临床医学工程, 2012, 19(2):210-211.
15.	杨明. 钢板螺钉取出困难的应对方法(附24例报告). 江西医药, 2012, (12):1074-1075.
16.	Suzuki T, Smith WR, Stahel PF, et al. Technical problems and complications in the removal of the less invasive stabilization system. J Orthop Trauma, 2010, 24(6):369-373.
17.	Ehlinger M, Adam P, Simon P, et al. Technical difficulties in hardware removal in titanium compression plates with locking screws. Orthop Traumatol Surg Res, 2009, 95(5):373-376.
18.	付义春, 陈检根. 改槽法在钢板螺钉取出困难中的临床应用. 临床骨科杂志, 2010, 16(4):312-313.
19.	王书军, 黄淦堂, 彭旭光, 等. 钢板螺钉内固定术后取出困难之对策. 中国骨与关节损伤杂志, 2007, 22(8):699-701.
20.	Kumar G, Dunlop C. Case report:A technique to remove a jammed locking screw from a locking plate. Clin Orthop Relat Res, 2011, 469(2):613-616.
21.	Kim SJ, Kim MU. A simple technique for removing a locking compression plate with a stripped locking screw. J Orthop Trauma, 2012, 26(6):e51-53.
22.	Gopinathan NR, Dhillon MS, Kumar R. Surgical technique:Simple technique for removing a locking recon plate with damaged screw heads. Clin Orthop Relat Res, 2013, 471(5):1572-1575.
23.	Gupta R, Singh H, Singh A, et al. Hollow mill for extraction of stripped titanium screws:an easy, quick, and safe technique. Surg Tech Case Rep, 2014, 6(1):9-11.
24.	宋连新, 彭阿钦, 郝建东, 等. 骨折愈合后390枚锁定螺钉取出术的研究分析. 中国矫形外科杂志, 2010, 19(18):1559-1562.
25.	王华溢, 杨重飞, 朱庆生, 等. 锁定螺钉取出困难的原因分析及解决方案. 中国骨与关节损伤杂志, 2013, 28(3):292-293.
26.	徐亮, 朱海涛, 储海军, 等. 锁定螺钉拆除困难的术中对策及初步原因分析. 中国骨与关节损伤杂志, 2010, 25(12):1139-1140.
27.	Maehara T, Moritani S, Ikuma H, et al. Difficulties in removal of the itanium locking plate in Japan. Injury, 2013, 44(8):1122-1126.
28.	吴佳俊, 朱越. 锁定加压钢板及锁定螺钉取出困难相关因素分析. 中华临床医师杂志(电子版), 2013, 7(24):394-395.
29.	Höntzsch D, Stuby FM. Removal of plates and screws. Tips and tricks for problematic cases. Unfallchirurg, 2012, 115(4):291-298.
30.	Musters GD, van Hensbroek PB, Ponsen KJ, et al. Locking compression plates are more difficult to removethan conventional non-locking plates. Eur J Trauma Emerg Surg, 2013, 39(2):159-162.
31.	Lovald S, Mercer D, Hanson J, et al. Hardware removal after fracture fixation procedures in the femur. J Trauma Acute Care Surg, 2012, 72(1):282-287.

1. Sanderson PL, Ryan W, Turner PG. Complications of metalwork removal. Injury, 1992, 23(1):29-30.
2. Georgiadis GM, Gove NK, Smith AD, et al. Removal of the less invasive stabilization system. J Orthop Trauma, 2004, 18(8):562-564.
3. Cole PA, Zlowodzki M, Kregor PJ. Treatment of proximal tibia fractures using the less invasive stabilization system:surgical experience and early clinical results in 77 fractures. J Orthop Trauma, 2004, 18(8):528-535.
4. Bae JH, Oh JK, Oh CW, et al. Technical difficulties of removal of locking screw after locking compression plating. Arch Orthop Trauma Surg, 2009, 129(1):91-95.
5. Hamilton P, Doig S, Williamson O. Technical difficulty of metal removal after LISS plating. Injury, 2004, 35(6):626-628.
6. Ehlinger M, Adam P, Simon P, et al. Technical difficulties in hardware removal in titanium compression plates with locking screws. Orthop Traumatol Surg Res, 2009, 95(5):373-376.
7. Hak DJ, McElvany M. Removal of broken hardware. J Am Acad Orthop Surg, 2008, 16(2):113-120.
8. Tan SL, Balogh ZJ. Indications and limitations of locked plating. Injury, 2009, 40(7):683-691.
9. Raja S, Imbuldeniya AM, Garg S, et al. Difficulties encountered removing locked plates. Ann R Coll Surg Engl, 2012, 94(7):502-505.
10. Hayes JS, Seidenglanz U, Pearce AI, et al. Surface polishing positively influences ease of plate and screw removal. Eur Cell Mater, 2010, 19:117-126.
11. 祝伟东. 钢板螺钉内固定骨折术后取出困难的处理. 中国伤残医学, 2006, 14(1):34.
12. 雷晓晶. 钢板螺钉取出困难应对策略. 中华创伤骨科杂志, 2007, 9(9):891-892.
13. 朱敏, 徐永清, 丁晶, 等. 一种取滑丝螺钉的方法. 中国骨与关节损伤杂志, 2012, 27(5):475.
14. 张国烈, 温羡宏, 冯文参, 等. 锁定钢板螺钉取出困难原因及解决方法的探讨. 临床医学工程, 2012, 19(2):210-211.
15. 杨明. 钢板螺钉取出困难的应对方法(附24例报告). 江西医药, 2012, (12):1074-1075.
16. Suzuki T, Smith WR, Stahel PF, et al. Technical problems and complications in the removal of the less invasive stabilization system. J Orthop Trauma, 2010, 24(6):369-373.
17. Ehlinger M, Adam P, Simon P, et al. Technical difficulties in hardware removal in titanium compression plates with locking screws. Orthop Traumatol Surg Res, 2009, 95(5):373-376.
18. 付义春, 陈检根. 改槽法在钢板螺钉取出困难中的临床应用. 临床骨科杂志, 2010, 16(4):312-313.
19. 王书军, 黄淦堂, 彭旭光, 等. 钢板螺钉内固定术后取出困难之对策. 中国骨与关节损伤杂志, 2007, 22(8):699-701.
20. Kumar G, Dunlop C. Case report:A technique to remove a jammed locking screw from a locking plate. Clin Orthop Relat Res, 2011, 469(2):613-616.
21. Kim SJ, Kim MU. A simple technique for removing a locking compression plate with a stripped locking screw. J Orthop Trauma, 2012, 26(6):e51-53.
22. Gopinathan NR, Dhillon MS, Kumar R. Surgical technique:Simple technique for removing a locking recon plate with damaged screw heads. Clin Orthop Relat Res, 2013, 471(5):1572-1575.
23. Gupta R, Singh H, Singh A, et al. Hollow mill for extraction of stripped titanium screws:an easy, quick, and safe technique. Surg Tech Case Rep, 2014, 6(1):9-11.
24. 宋连新, 彭阿钦, 郝建东, 等. 骨折愈合后390枚锁定螺钉取出术的研究分析. 中国矫形外科杂志, 2010, 19(18):1559-1562.
25. 王华溢, 杨重飞, 朱庆生, 等. 锁定螺钉取出困难的原因分析及解决方案. 中国骨与关节损伤杂志, 2013, 28(3):292-293.
26. 徐亮, 朱海涛, 储海军, 等. 锁定螺钉拆除困难的术中对策及初步原因分析. 中国骨与关节损伤杂志, 2010, 25(12):1139-1140.
27. Maehara T, Moritani S, Ikuma H, et al. Difficulties in removal of the itanium locking plate in Japan. Injury, 2013, 44(8):1122-1126.
28. 吴佳俊, 朱越. 锁定加压钢板及锁定螺钉取出困难相关因素分析. 中华临床医师杂志(电子版), 2013, 7(24):394-395.
29. Höntzsch D, Stuby FM. Removal of plates and screws. Tips and tricks for problematic cases. Unfallchirurg, 2012, 115(4):291-298.
30. Musters GD, van Hensbroek PB, Ponsen KJ, et al. Locking compression plates are more difficult to removethan conventional non-locking plates. Eur J Trauma Emerg Surg, 2013, 39(2):159-162.
31. Lovald S, Mercer D, Hanson J, et al. Hardware removal after fracture fixation procedures in the femur. J Trauma Acute Care Surg, 2012, 72(1):282-287.

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