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Possible predictors for difficult removal of locking plates: A case-control study.

Yun Fei Hou1, Fang Zhou1, Yun Tian1

  • 1Orthopedic Trauma, Peking University Third Hospital, No. 49, North Garden Rd, HaiDian District, Beijing 100191, China.

Injury
|March 31, 2015
PubMed
Summary

Difficult removal of locking plates, including less invasive stabilisation systems (LISS) and locking compression plates (LCP), can occur. Factors like longer intervals between surgery and removal, younger age, and specific screw types influence difficulty, especially in upper extremities.

Keywords:
Correlated factorsDifficult removalLCPLISSPrevention

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Area of Science:

  • Orthopedic surgery
  • Biomaterials engineering

Background:

  • Difficult removal of locking plates (LCP/LISS) is a recognized clinical challenge.
  • Limited research exists on the factors contributing to complicated implant removal.
  • Understanding these factors is crucial for improving patient outcomes and surgical decision-making.

Purpose of the Study:

  • To identify factors correlated with difficult removal of locking compression plates (LCP) and less invasive stabilisation systems (LISS).
  • To provide insights for optimizing implant removal decisions and preventing complications.

Main Methods:

  • Retrospective analysis of 308 patients undergoing LCP/LISS removal.
  • Statistical analysis (Mann-Whitney U, Chi-square tests) to correlate removal difficulty with patient age, time to removal, implant type, screw size, insertion technique, and fracture location.
  • Separate analysis for upper and lower extremities.

Main Results:

  • Thirty-seven patients (12%) experienced intra-operative difficulties; six had postoperative complications.
  • Difficult removal in upper extremities was associated with longer intervals between open reduction and internal fixation (ORIF) and removal, younger age, and bicortical screws.
  • In lower extremities, predictors of difficult removal included longer duration to removal, small-diameter locking head screws (LHS), and minimally invasive insertion techniques.

Conclusions:

  • Implant removal, particularly LCP/LISS, is not a routine procedure and carries risks of complications.
  • Early removal upon radiographic evidence of fracture healing is recommended.
  • Tailored approaches are necessary for implant removal based on specific fracture sites and patient factors.