Technical Problems and Complications in the Removal of the Less Invasive Stabilization System
- 1 June 2010
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of Orthopaedic Trauma
- Vol. 24 (6), 369-373
- https://doi.org/10.1097/bot.0b013e3181c29bf5
Abstract
Objectives: This study was designed to evaluate the frequency of intraoperative problems and complications involved with Less Invasive Stabilization System (LISS) plate removal. Design: Retrospective study. Setting: Single academic level I trauma center. Methods: Medical records were reviewed for demographics, surgical technique, plate length, number and position of screws, time from internal fixation to plate removal, reason for removal, operating time for removal, and perioperative complications. Pre- and post-op radiographs were also reviewed to confirm plate and screw positions. The independent factors including age, sex, plate site, plate screws placed/available holes, union status, and time from internal fixation to removal were compared between patients in whom screw removal was complicated to those in whom screw removal proceeded without difficulty. Mann-Whitney and Fisher Exact tests were calculated with the level of significance at P < 0.05. Results: There were 33 patients (24 men and 9 women) that underwent LISS plate removal from 36 extremities (15 tibias and 21 femurs). The average time from internal fixation to removal was 13.2 months. The plates removed were 13-hole plates (16 cases), 9-hole plates (18 cases), and 5-hole plates (2 cases), which included a total of 349 screws. The specific reasons for plate removal were symptomatic implants after bone union (21 cases), nonunion requiring additional fixation (12 cases), early loss of fixation (2 cases), and a peri-implant fracture after bone union (1 case). The average operating time for plate removal was 71.3 minutes (range, 28-180 minutes). Five cases required more than 120 minutes. Difficulty with screw removal was encountered in 37 screws (10.6%) from 14 cases (38.9%). Two plates and 11 screw heads required cutting using a carbide or diamond tipped burr. Six cases required tearing the plate off bone by levering with a total of 10 screws still attached. Five screws were cut using a large bolt cutter. The other screws were stripped and removed with a stripped screw removal tap. Two patients developed a postoperative superficial wound infection that required treatment with oral antibiotics. One patient had a postoperative peroneal nerve palsy that recovered spontaneously. There were no statistical differences in predictors for patients with screw removal difficulty. Conclusions: Difficulty with removal due to cold welding or screw head stripping is common in locking LISS plate screws. LISS plate removal can often require prolonged operating time and the use of specialized removal tools. Surgeons should anticipate the possibility of difficulties when removing these implants and be appropriately prepared.Keywords
This publication has 22 references indexed in Scilit:
- Locking PlatesThe Journal of Bone & Joint Surgery, 2007
- Complications of Locking Plate Fixation in Complex Proximal Tibia InjuriesJournal of Orthopaedic Trauma, 2007
- Single Lateral Locked Screw Plating of Bicondylar Tibial Plateau FracturesClinical Orthopaedics and Related Research, 2005
- Use of the Less Invasive Stabilization System (LISS) in patients with distal femoral (AO33) fractures: a prospective multicenter studyArchives of orthopaedic and trauma surgery, 2005
- Treatment of Complex Proximal Tibia Fractures With the Less Invasive Skeletal Stabilization SystemJournal of Orthopaedic Trauma, 2004
- The Less Invasive Stabilization System in the Treatment of Complex Fractures of the Tibial Plateau: Short-term ResultsJournal of Orthopaedic Trauma, 2004
- Treatment of Proximal Tibia Fractures Using the Less Invasive Stabilization SystemJournal of Orthopaedic Trauma, 2004
- Treatment of Distal Femur Fractures Using the Less Invasive Stabilization SystemJournal of Orthopaedic Trauma, 2004
- Treatment of Complex Tibial Plateau Fractures Using the Less Invasive Stabilization System Plate: Clinical Experience and a Laboratory Comparison with Double PlatingJournal Of Trauma-Injury Infection and Critical Care, 2004
- Minimal-invasive treatment of distal femoral fractures with the LISS (Less Invasive Stabilization System)A prospective study of 30 fractures with a follow up of 20 monthsActa Orthopaedica, 2004