title: Complications and associated risk factors at screw removal in slipped capital femoral epiphysis treated by cannulated stainless steel screws.
abstract: OBJECTIVE
  The aim of our study is to report our complication rate and analyze the associated risk factors when removing cannulated stainless steel screws for SCFE fixation.
  
  
  METHODS
  This was a multicenter retrospective study of patients who underwent removal of cannulated stainless steel screws after a mean time of 2.03 years of implantation. Thirty-two patients were included (38 hips) with a mean of 13.7 years of age during screw removal surgery. The mean post-removal follow up time was 1.6 years. In all cases the removal of screws was done systematically. Demographic data, possible risk factors related to removal failure, as well as post-removal complications such as post-removal fractures, infections and scar issues were recorded.
  
  
  RESULTS
  A removal failure rate of 15.79 % (6/38) was found. The removal surgical time was longer than the initial fixation time but without statistical significance (70.78 vs 61.84 m, p = 0.196). However, the duration of screw implantation (r (2): 7.09; IC: 1.12-13.06) and screw head bony coverage (r (2): 21.32; IC: 5.58-37.06) were both related to this prolonged time. Multivariant analysis revealed that a fully threaded cannulated screw had the lowest removal failure risk (OR: 0.3; IC: 0.14-0.61). There were no postremoval complications recorded.
  
  
  CONCLUSIONS
  We recommend to use full threaded cannulated stainless steel screws and to perform the procedure as soon as the physis are closed to decrease the surgical time. It is a safe procedure based on a low rate of complications such as post-removal fractures, infection and scar issues.
authors.affiliation: Pediatric Orthopaedic Division, Hospital Universitario 12 de Octubre, Avda. de Córdoba s/n, 28041 Madrid, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Pretell-Mazzini
authors.forename: Victor
authors.initials: V
authors.lastname: Rodriguez-Vega
authors.forename: Jorge
authors.initials: J
authors.lastname: Muñoz-Ledesma
authors.forename: Eva María
authors.initials: EM
authors.lastname: Andrés-Esteban
authors.forename: Rafael
authors.initials: R
authors.lastname: Marti-Ciruelos
authors.forename: José Luis
authors.initials: JL
authors.lastname: González-López
authors.forename: Angel
authors.initials: A
authors.lastname: Curto-De la Mano
keywords: Full threaded screws; Removal failure rate; Slipped capital femoral epiphysis; Stainless steel screws; Titanium screws
references.citation: J Pediatr Orthop. 1986 May-Jun;6(3):265-73
references.pmid: 3711316
references.citation: J Pediatr Orthop. 1994 Mar-Apr;14(2):229-37
references.pmid: 8188840
references.citation: Injury. 1975 May;6(4):277-85
references.pmid: 1095476
references.citation: Pediatrics. 2004 Apr;113(4):e322-5
references.pmid: 15060261
references.citation: J Pediatr Orthop. 1996 Jan-Feb;16(1):49-52
references.pmid: 8747353
references.citation: J Pediatr Orthop. 1990 Nov-Dec;10(6):764-8
references.pmid: 2250062
references.citation: Instr Course Lect. 2008;57:473-98
references.pmid: 18399603
references.citation: J Pediatr Orthop B. 1999 Apr;8(2):144-6
references.pmid: 10218181
references.citation: J Bone Joint Surg Am. 2006 Jan;88(1):97-105
references.pmid: 16391254
references.citation: J Pediatr Orthop. 1991 Jan-Feb;11(1):72-6
references.pmid: 1988482
references.citation: J Pediatr Orthop. 2008 Oct-Nov;28(7):701-4
references.pmid: 18812893
references.citation: J Bone Joint Surg Br. 1994 Sep;76(5):844-5
references.pmid: 8083282
references.citation: Injury. 1998 Jul;29(6):439-41
references.pmid: 9813700
references.citation: Clin Orthop Relat Res. 1978 Nov-Dec;(137):148-53
references.pmid: 743821
references.citation: J Bone Joint Surg Br. 1988 Aug;70(4):517-20
references.pmid: 3403590
references.citation: Arch Orthop Trauma Surg. 2006 Aug;126(6):359-63
references.pmid: 16721619