Technical difficulties in hardware removal in titanium compression plates with locking screws.

UNLABELLED: With the advent of locking screws fixation devices, came new problems when removing internal fixation hardware. The objective of this study was to evaluate these problems and their possible solutions. The first problem was screws jamming on the plate, secondary to either initial poor screwing technique (with inadequate placement of the targeting device) or use of excessive force (when screwing in the screws without using the torque-controlling screwdriver). Treatment consists of destroying the screw heads using tungsten drills. The screw bodies can then be extracted using a trephine drill. The second problem involves destruction of the recess of the screw head. It can be secondary to overly forceful screw insertion or risky screw extraction. This can be treated using a specific conical left-turn screwdriver, assuming that the screw/plate thread is still intact. Finally, the screw recess can be filled. The plate itself may be a source of problems when being extracted because the screw holes left free also have been filled. Lever arm maneuvers to raise the fibrous bridges and substantial traction along the axis can be useful. These problems are more frequent with minimally invasive surgery. The consequences of this fixation type's hardware removal surgery are multiple: lengthened operative time, risk of secondary maximally invasive surgery, presence of metallic shavings residues in cases of screw head destruction, and the risk of iterative fracture secondary to trephine drill use. Prevention is thus essential. It is based on rigorous technique in placing the targeting device, drilling, and inserting screws, the systematic use of the torque-controlling screwdriver, and the verification of proper screw position. The locking compression plate (LCP) material is highly effective but its removal should not become challenging. LEVEL OF EVIDENCE: Level V. 2009 Elsevier Masson SAS. All rights reserved.