Background: Locking titanium plates revolutionized the treatment of osteoporotic and metaphyseal fractures of long bones. However as with any innovation, with time new complications are identified. One of the problems with titanium locking plates is removal of screws, often attributable to cold welding of screw heads into the locking screw holes. Several techniques have been described to overcome this problem. We describe a new easy technique to remove a jammed locking screw in a locking plate that is easily reproducible and suggest an algorithm to determine the method to remove screws from locking plates.
Case description: A 57-year-old man underwent removal of a locking titanium plate from the distal femur. Because the screws could not be readily removed, we used a new technique to remove the jammed locking screws. A radial cut was made in the plate into the locking screw hole and wedged with an osteotome. This released the screw head from the locking screw hole. The screw holes were connected with radial cuts and jammed locking screws were removed in a similar fashion.
Literature review: Instruments used for removal of locking screws, including conical extraction screws, hollow reamers, extraction bolts, modular devices, and carbide drill bits, have been described. However, these do not always work.
Purposes and clinical relevance: Removing screws from locking titanium plates can be difficult. There is no method of implant removal that can be universally applied. Therefore, this new technique and our algorithm may be used when removing screws from locking titanium plates.