Removal of locking plates: new implant, new challenges and new solutions

Removal of locking plates in many ways poses novel challenges compared to conventional plates. None of the techniques described for the removal of locking plates are adequate for all situations. We report our experience of 27 patients from whom a total of 33 locking plates were removed. We also describe a novel technique for the removal of locking plates which in our experience could be used in most of these patients because it is appropriate for all situations and, from a technical point of view, is easy to use. Our new technique consists of removing the problematic locking screw by cutting the plate on both sides of the screw hole and using the screw head-plate hole unit for removal. We analyzed all these patients for the location of the plate, number of locking screws, time of implant removal since the initial surgery, reason for removal of the plate, nature of the difficulties encountered during surgery, and any perioperative complications. A total of 43 (17.34%) screws were difficult to remove. Twenty screws were found to be stripped, 15 were jammed and 8 were broken. Fourteen of the 20 stripped screws and all 15 jammed screws were removed using our technique. We found this technique of locking plate removal to be very versatile and useful in most of the cases in which removal was difficult. At the same time, it also causes less damage to the bone compared to other techniques.