PROCESSING STRATEGY OF DIFFICULT REMOVAL OF SCREWS IN PLATE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 YINQudong , GUSanjun , SUNZhenzhong , RUIYongjun , KONGYouyi

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

Corresponding?author：

YINQudong, Email: yinqudong@sina.com

Keywords：

Internal fixation; Difficult removal; Complication

DOI：

10.7507/1002-1892.20150030

Video：

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Objective To investigate the countermeasures for difficult removal of screws in the plate. Methods The clinical data were retrospectively analyzed from 47 patients having difficult removal of screws in the plate between January 2004 and May 2014. There were 30 males and 17 females, aged 16-58 years (mean, 34 years). The time from internal fixation to removal of internal fixation was 10 months to 20 years (mean, 22 months). The locations of internal fixation were upper extremity in 25 cases and lower extremity in 22 cases. The number of difficult removal screws in the plate was 1 in 18 cases, 2 in 15 cases, 3 in 9 cases, and 4 in 5 cases. The plate types included general plate in 15 cases and locking plate in 32 cases; stainless steel plate in 10 cases and titanium plate in 37 cases. The reason for difficult removal, plate, screw, incision, and bone quality of patient were comprehensively analyzed, and different methods for difficult removal were chosen according to the principle that first simply then complicated. Results All plates and screws were removed, and no iatrogenic fracture or nerve and vascular injuries occurred. The operation time was 65-270 minutes (mean, 125 minutes). The blood loss was 80-775 mL (mean, 157 mL). The postoperative drainage was 20-250 mL (mean, 92 mL). The incision healing by first intention was obtained in 39 cases, and delayed healing in 8 cases. The patients were followed up 3-24 months (mean, 10 months). No infection or re-fracture was observed. Conclusion There are many countermeasures for difficult removal of screws in the plate, but each has indication. As long as a well arranged preoperative condition, mastering a variety of methods, and being familiar with its indication, as well as reasonably choosing method based on the specific situations, the plate and screw maybe smoothly removed.

Citation： YINQudong, GUSanjun, SUNZhenzhong, RUIYongjun, KONGYouyi. PROCESSING STRATEGY OF DIFFICULT REMOVAL OF SCREWS IN PLATE. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(2): 141-144. doi: 10.7507/1002-1892.20150030 Copy

1.	王書軍, 黃淦堂, 彭旭光, 等. 鋼板螺釘內固定術后取出困難之對策. 中國骨與關節損傷雜志, 2007, 22(8):699-701.
2.	王華溢, 楊重飛, 朱慶生, 等. 鎖定螺釘取出困難的原因分析及解決方案. 中國骨與關節損傷雜志, 2013, 28(3):292-293.
3.	朱敏, 徐永清, 丁晶, 等. 一種取滑絲螺釘的方法. 中國骨與關節損傷雜志, 2012, 27(5):475.
4.	張國烈, 溫羨宏, 馮文參, 等. 鎖定鋼板螺釘取出困難原因及解決方法的探討. 臨床醫學工程, 2012, 19(2):210-211.
5.	Maehara T, Moritani S, Ikuma H, et al. Difficulties in removal of the titanium locking plate in Japan. Injury, 2013, 44(8):1122-1126.
6.	楊明. 鋼板螺釘取出困難的應對方法(附24例報告). 江西醫藥, 2012, 47(12):1074-1075.
7.	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.
8.	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.
9.	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.
10.	吳佳俊, 朱越. 鎖定加壓鋼板及鎖定螺釘取出困難相關因素分析. 中華臨床醫師雜志(電子版), 2013, 7(24):11858-11860.
11.	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.
12.	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.
13.	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.
14.	Gupta R, Singh H, Singh A, et al. Hollow mill for extraction of stripped titanium screws:an easy, quick, and safe technique. J Surg Tech Case Rep, 2014, 6(1):9-11.
15.	Schwarz N, Euler S, Schlittler M, et al. Technical complications during removal of locking screws from locking compression plates:a prospective multicenter study. Eur J Trauma Emerg Surg, 2013, 39(4):339-344.
16.	H?ntzsch D, Stuby FM. Removal of plates and screws. Tips and tricks for problematic cases. Unfallchirurg, 2012, 115(4):291-298.
17.	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. 王書軍, 黃淦堂, 彭旭光, 等. 鋼板螺釘內固定術后取出困難之對策. 中國骨與關節損傷雜志, 2007, 22(8):699-701.
2. 王華溢, 楊重飛, 朱慶生, 等. 鎖定螺釘取出困難的原因分析及解決方案. 中國骨與關節損傷雜志, 2013, 28(3):292-293.
3. 朱敏, 徐永清, 丁晶, 等. 一種取滑絲螺釘的方法. 中國骨與關節損傷雜志, 2012, 27(5):475.
4. 張國烈, 溫羨宏, 馮文參, 等. 鎖定鋼板螺釘取出困難原因及解決方法的探討. 臨床醫學工程, 2012, 19(2):210-211.
5. Maehara T, Moritani S, Ikuma H, et al. Difficulties in removal of the titanium locking plate in Japan. Injury, 2013, 44(8):1122-1126.
6. 楊明. 鋼板螺釘取出困難的應對方法(附24例報告). 江西醫藥, 2012, 47(12):1074-1075.
7. 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.
8. 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.
9. 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.
10. 吳佳俊, 朱越. 鎖定加壓鋼板及鎖定螺釘取出困難相關因素分析. 中華臨床醫師雜志(電子版), 2013, 7(24):11858-11860.
11. 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.
12. 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.
13. 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.
14. Gupta R, Singh H, Singh A, et al. Hollow mill for extraction of stripped titanium screws:an easy, quick, and safe technique. J Surg Tech Case Rep, 2014, 6(1):9-11.
15. Schwarz N, Euler S, Schlittler M, et al. Technical complications during removal of locking screws from locking compression plates:a prospective multicenter study. Eur J Trauma Emerg Surg, 2013, 39(4):339-344.
16. H?ntzsch D, Stuby FM. Removal of plates and screws. Tips and tricks for problematic cases. Unfallchirurg, 2012, 115(4):291-298.
17. 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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PROCESSING STRATEGY OF DIFFICULT REMOVAL OF SCREWS IN PLATE

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