A safe technical modification and mid-term results in the removal of locking screws with damaged heads

This study aims to describe a safe method, which does not require additional instruments, for the removal of titanium locking screws with stripped or cold welded heads. Additionally, it evaluates the outcomes of patients in whom this method was applied.

The proposed method involves using a 3.0 ball-type abrader attached to a standard orthopedic machine to abrade the screw head until it completely separates from the plate hole. This technique was compared to the conventional high-speed burr method, focusing on the maximum temperature generated during the process, as measured with a thermal camera on an artificial bone model. Additionally, the outcomes of 22 patients treated with this technique and followed for at least 12 months were evaluated.

The surface temperature of the plate reached 101.4 °C during the high-speed burr technique. In contrast, when the same technique was performed using the orthopedic machine, the plate surface temperature increased to 62.4 °C. This technique was applied to 22 patients, with an average age of 37 years, and a mean follow-up period of 18.5 months. No complications were reported in any of the patients. Among the removed screws, 14 (63.7%) were 3.5 mm, 4 (18.2%) were 2.7 mm, 3 (13.6%) were 2.4 mm, and 1 (4.5%) was 4.5 mm. Cold welded was observed in only one 4.5 mm screw, while head stripping was observed in all other cases.

This modified technique, using a standard orthopedic machine and burr tip, provides a safe and effective method for removing damaged screws that does not require complex or additional instruments.