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CASE REPORT
Year : 2018  |  Volume : 10  |  Issue : 2  |  Page : 142-144

Technique for the removal of a locking screw from a broken locking plate following cold welding


Department of Orthopaedics, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India

Correspondence Address:
Dr. Mangesh Mahadeo Chandewar
Department of Orthopaedics, All India Institute of Medical Sciences, Raipur, Chhattisgarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jotr.jotr_26_18

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The advent of locking plates has brought new problems in implant removal. Difficulties include cold welding between the screw head and locking screw hole, stripping of the recess of the screw head for the screwdriver, and cross-threading between threads in the screw head and screw hole. We are describing a technique which allowed us to remove such cold-welded, jammed single screw with simple instruments at hand and complete the prescribed operation smoothly. A 32-year-old female patient reported to us with a broken clavicle locking plate, who was operated 3 years back for fracture clavicle right side. The patient had complaints of pain and deformity in the right clavicle region for 3 months following lifting heavy weight. X-ray showed broken implant with nonunion of clavicle. The patient was planned for implant removal, freshening of edges, and fixation with anatomical clavicle plate with bone grafting. All the screws were removed with standard screw driver when it was found that the second screw of medial broken plate was jammed, round headed, and cold welded. We bent both ends of broken medial plate around screw and removed screw by just rotating bent plate anticlockwise. Fracture ends were freshened and fixation was done with anatomical clavicle locking plate and bone grafting. The patient did not develop any postoperative complication. This technique is very quick, easy to perform, and inexpensive without the use of plate cutting blade, burr, hollow mill, and other instrumentation. This technique can be used in peripheral hospitals in India where advanced gadgetries may not be available. There is no problem of thermal necrosis to the bone or the surrounding soft tissue. Osteoporotic bone is a limitation of the above method as the bone may break while bending the plate and is possible only with a single locking screw.


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