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Difficulties encountered removing locked plates.
S Raja1, A M Imbuldeniya, S Garg
1James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, Norfolk, UK. sraja@doctors.org.uk
Annals of the Royal College of Surgeons of England
|October 4, 2012
Summary
Removing locked plates can be challenging, with a 47% complication rate due to difficulties with screw and implant removal. Surgeons should be prepared for potential intraoperative issues when extracting these implants.
Area of Science:
- Orthopedic Surgery
- Biomaterials Engineering
Background:
- Locked plates are widely used for periarticular fractures, including in osteoporotic bone, offering stable fixation.
- Over 150 locked plates were used in knee and ankle fractures over three years with varied success.
- Clinical experience with locked plate removal in adult patients is reported, addressing indications like implant failure, infection, and non-union.
Purpose of the Study:
- To report clinical experience and difficulties encountered during locked plate removal.
- To analyze the complication rate associated with locked plate removal.
- To provide recommendations for surgeons regarding locked plate removal procedures.
Main Methods:
- Retrospective analysis of 36 consecutive adult patients undergoing locked plate removal.
- Data collected included indication for fixation and removal, implant duration, surgeon grade, and removal difficulties.
- Prospective database enrollment for data collection.
Main Results:
- A 47% complication rate was observed during implant removal.
- Difficulty in removing locked screws and the plate itself were major problems.
- Ten cold-welded screws were found in eight cases; removal tools were essential.
Conclusions:
- Intraoperative difficulties are increasingly common with the popularity of locked plates.
- Surgeons must be aware of potential complications during locked plate removal.
- Availability of fluoroscopic control and specialized equipment like metal cutting burrs and screw removal sets is recommended.
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