title: Surgical technique: Simple technique for removing a locking recon plate with damaged screw heads.
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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, India.
authors.forename: Nirmal Raj
authors.initials: NR
authors.lastname: Gopinathan
authors.forename: Mandeep Singh
authors.initials: MS
authors.lastname: Dhillon
authors.forename: Rajesh
authors.initials: R
authors.lastname: Kumar
mesh_terms: D000328:Adult; D001860:Bone Plates; D001863:Bone Screws; D002968:Clavicle / Q000000981:diagnostic imaging / Q000601:surgery*; D020878:Device Removal / Q000295:instrumentation / Q000379:methods*; D005593:Fracture Fixation, Internal / Q000009:adverse effects* / Q000295:instrumentation*; D006801:Humans; D008297:Male; D010027:Osteotomy; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011859:Radiography; D012086:Reoperation; D014025:Titanium; D016896:Treatment Outcome
chemical_list: D014025:Titanium