title: Complications during removal of conventional versus locked compression plates: is there a difference?
abstract: Osteosynthesis plate removal is one of the most commonly performed procedures in orthopaedic surgery. Due to technological advances and the quality of increasing osteosynthesis material, more and more locked plates have been implanted over the last 20 years. The aim of this study was to determine whether the complication rate during plate removal differs between conventional and locked plates.
  
  
  
  In this retrospective cohort study, 620 patients were included and divided into two groups based on the type of plate (locked and conventional). Technical complications during implant removal included screw breakage, destroyed screw head, implant breakage, remaining implant material, refracture, bony or soft tissue overgrowth. The following plate-associated complications were identified: osteosynthesis plate not detachable, plate bent or broken, necessity of special tools or plate loosened. Three types of screw-related complications were observed: screw not detachable, screw broken or screw dislocated.
  
  
  
  Overall, complications related to the plate or screws were documented in 110 of the 620 cases. These complications occurred in 48 of the 382 cases involving conventional osteosynthesis (7.7% of all removals, 12.6% of all conventional removals) and in 62 of the 238 cases involving locked plate osteosynthesis (10.0% of all removals, 26.1% of all locked plate removals). The statistical analysis showed a significantly higher implant-related complication rate with locked plates compared to the conventional plates (p < 0.01).
  
  
  
  Hardware removal can be a complication-afflicted operation, especially cases involving locked-plate removal should only be performed if a strong indication is evident. Possible benefits of the procedure should be considered carefully, taking the cost-benefit ratio into account.
authors.affiliation: Department of Traumatology, Orthopaedics and Sports Traumatology, BG Trauma Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany.
authors.forename: Hanjo
authors.initials: H
authors.lastname: Neumann
authors.affiliation: Department of Orthopaedics and Trauma Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.
authors.forename: Anne
authors.initials: A
authors.lastname: Stadler
authors.affiliation: Department of Traumatology, Orthopaedics and Sports Traumatology, BG Trauma Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany.
authors.forename: Hinrich
authors.initials: H
authors.lastname: Heuer
authors.affiliation: Department of Traumatology, Orthopaedics and Sports Traumatology, BG Trauma Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany.
authors.forename: Marc
authors.initials: M
authors.lastname: Auerswald
authors.affiliation: Department of Orthopaedics and Trauma Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.
authors.forename: Justus
authors.initials: J
authors.lastname: Gille
authors.affiliation: Department of Orthopaedics and Trauma Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.
authors.forename: Arndt Peter
authors.initials: AP
authors.lastname: Schulz
authors.affiliation: Department of Traumatology, Orthopaedics and Sports Traumatology, BG Trauma Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany. b.kienast@bkh-hamburg.de.|Department of Orthopaedics and Trauma Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck, Germany. b.kienast@bkh-hamburg.de.
authors.forename: Benjamin
authors.identifier: 0000-0003-0598-3440
authors.initials: B
authors.lastname: Kienast
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates / Q000009:adverse effects*; D001863:Bone Screws / Q000009:adverse effects*; D015331:Cohort Studies; D020878:Device Removal / Q000009:adverse effects*; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D055815:Young Adult
keywords: Complication; Locked plate; Plate osteosynthesis; Plate removal