Article

Surgical Technique: Simple Technique for Removing a Locking Recon Plate With Damaged Screw Heads

Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, India.
Clinical Orthopaedics and Related Research (Impact Factor: 2.79). 12/2012; 471(5). DOI: 10.1007/s11999-012-2733-5
Source: PubMed

ABSTRACT BACKGROUND: The introduction of locking plates in the treatment of periarticular fractures was a major breakthrough in orthopaedic evolution. Removal of these implants is extremely difficult as a result of cold welding and stripping of screw heads. DESCRIPTION OF TECHNIQUE: A 31-year-old man had a schwannoma of the left C5-C6 nerve roots and upper trunk of the brachial plexus. One year before presentation he had undergone excision of the lesion through an approach using a clavicular osteotomy. The osteotomy had been fixed with a titanium locking recon plate. While surgically removing the implant, only one screw could be removed. The remaining five screws could not be turned owing to cold welding; repeated attempts at removing the screws damaged the screw heads. A large bolt cutter was used to cut the plate between the holes, and the resulting rectangular sections with the screws then were unscrewed from the bone. REVIEW OF LITERATURE: Limited literature is available regarding techniques for locking screw removal. These include using a carbide drill bit or diamond-tipped burr, high-speed disc, or conical extraction screw. CONCLUSIONS: Not all centers have specialized instruments such as carbide drill bits to remove screw heads, but a large bolt cutter usually is available when screws cannot be unscrewed owing to cold welding. The technique of cutting is easily reproducible and does not require additional soft tissue stripping.

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