Causes for difficulty in removal of locking plate and screws and their handling skills

As locking plate is widely used in periarticular and comminuted fractures as well as in fixation of osteoporotic bone, the events involving difficulty in removal of a locking plate increase gradually. Little research addresses the difficulty in implant removal. Stripping of the recess of the screw head, cross-threading between threads in the screw head and screw hole and cold welding are the main causes for difficulty in removing screws from a locking plate. Skills for implant removal include simple ones that require no use of special devices and complex ones that require use of special devices. Difficult implant removal will result in lengthened operation time, increased risk of secondary invasive surgery, residues of metallic shavings and so on. Prevention is the most effective countermeasure. This review summarizes the cause for difficult removal of locking plate and screws as well as the removing skills to help orthopedic surgeons prevent and respond to the difficulties intraoperatively. Key words: Bone plates; Fractures fixation, internal; Skills; Causes