J Korean Fract Soc.  2011 Apr;24(2):169-173. 10.12671/jkfs.2011.24.2.169.

Failure of Removal of Stripped Locking Screw after Locking Compression Plating

• Kim SJ
• Lee KJ

• KMID: 2183860
• DOI: http://doi.org/10.12671/jkfs.2011.24.2.169

Abstract

PURPOSE
The purpose of this study was to evaluate the incidence and possible causes of stripped locking screws that make difficult to remove the locking compression plate. We also tried to find the useful methods to remove the stripped locking screws.
MATERIALS AND METHODS
Between May 2005 and January 2009, 84 patients who underwent operations for removal of locking compression plate were included in this study. We removed 298 3.5-mm locking screws and 289 5.0-mm locking screws in these patients. We retrospectively investigated the incidence and possible causes of stripped locking screws and evaluated the pros and cons of the methods that we have used to remove the stripped locking screws.
RESULTS
17 out of 298 3.5-mm locking screws (5.7%) and 2 out of 289 5.0-mm locking screws (0.7%) were encountered with difficulties by hexagonal driver during removal because of the stripping of the hexagonal recess. First we used the conical extraction screw for all the stripped locking screws and only 3 screws were removed successfully. We removed 3 screws by cutting the plate around the stripped locking screw and twisting the plate with the screw and we removed 1 screw by the use of hallow reamer after cutting the plate. Twelve screw shafts were left except grinding of screw head by metal-cutting burr. There was one iatrogenic re-fracture in whom we have used with hallow reamer.
CONCLUSION
At the time of locking compression plate removal, difficulties of locking screw removal due to the stripping of the hexagonal recess should be expected and surgeon must prepare several methods to solve this problem.

Keyword

Locking compression plate; Locking screw; Failure of removal

MeSH Terms

Head
Humans
Incidence
Retrospective Studies

Figure

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  Fig. 1 The conical extraction screw can be used for the removal of stripped locking screws at the first attempt.

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  Fig. 2 (A) and (B) Stripped locking screws can be removed by cutting the plate around the screw and twisting the plate with the screw. There are a lot of metal particles around the plate (black arrows).

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  Fig. 3 (A) Stripped locking screw was removed with the hallow reamer in patient who is 21-years old male. There is cortical defect where hallow reamer was used (white arrow). (B) After one month after plate removal, re-fracture was developed without trauma.

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  Fig. 4 (A) 29-years old male who had distal humerus fracture was treated with small locking compression plate. (B) After 24 months after initial operation, the plate was removed. There shows two remained locking screw shaft because of stripped locking screw head.

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  Fig. 5 (A) and (B) The targeting device can be locked in locking compression plate with wrong angle and it can causes wrong insertion angle of locking screws.

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