title: Difficulties in removal of the titanium locking plate in Japan.
abstract: OBJECTIVE
  This study was designed to evaluate the frequency of intraoperative complications associated with titanium locking compression plate (LCP) removal.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Medical records were reviewed for surgical technique, plate types used, position and number of screws, time from internal fixation to plate removal, and intraoperative complications. Radiographs were reviewed to evaluate the position of the plates and screws and the accuracy of the screw direction. Mann-Whitney and Yates Chi-square tests were calculated with the level of significance at P < 0.05.
  
  
  RESULTS
  All LCPs could be removed. Of the 342 locking head screws (LHSs), a total of 21 (6.1%) screws, 3 (2.0%) 5.0 mm screws (3/153) and 18 (10.7%) 3.5 mm screws (18/169), were difficult to remove. The frequency of difficulty associated with the 3.5 mm LHSs was significantly higher than that of the 5.0 mm LHSs (P < 0.01). The frequency of difficulty associated with the removal of LHSs at the diaphysis was higher than that of LHSs at the epiphysis (P < 0.01), especially with 3.5 mm LHSs. The mean age was significantly lower in the patients in whom removal was difficult (P < 0.05). Our analysis revealed that the frequency of removal difficulty was high when a 3.5 mm LHS was inserted into the diaphysis of young patients.
  
  
  CONCLUSIONS
  We should recognize that the removal of LCPs can involve numerous problems and great care should be exercised, especially in cases involving 3.5 mm LHSs.
authors.affiliation: Department of Orthopedic Surgery, Kagawa Rosai Hospital, Japan. maehara@kagawah.rofuku.go.jp
authors.forename: Takashi
authors.initials: T
authors.lastname: Maehara
authors.forename: Shirou
authors.initials: S
authors.lastname: Moritani
authors.forename: Hisanori
authors.initials: H
authors.lastname: Ikuma
authors.forename: Kensuke
authors.initials: K
authors.lastname: Shinohara
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Yokoyama
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D001863:Bone Screws / Q000706:statistics & numerical data*; D020878:Device Removal / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D006801:Humans; D007431:Intraoperative Complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D014025:Titanium
chemical_list: D014025:Titanium