Removal of femoral sherman plates--not a simple operation

Surgical removal of a Sherman plate from the femur in an adult treated in childhood for Perthes' disease or developmental dysplasia of the hip (DDH) can be time-consuming and difficult. We analyzed the factors that govern the complexity and complications of plate removal. The notes, operative details, and radiographs of 77 operations for removal of a Sherman plate inserted at the first femoral osteotomy for DDH were assessed. The plates had been in place for 1-32 years and were either completely buried in bone or endosteal in 24%, depending on the time elapsed before removal. Approximately one in five screw heads sheared or required excision, the screw shanks subsequently had to be cored from the bone. The operation took > 90 min in more than one quarter of the patients. The procedure is far from benign. Sherman plates should be removed early when possible, and joint replacement should not be planned to coincide with plate removal. The risks of plate removal must be explained to patients.