Implant Removal Matrix for the Upper Extremity Orthopedic Surgeon

Document Type: TECHNICAL NOTE

Authors

1 Harvard University, Combined Orthopaedic Residency Program, Boston, MA, USA

2 Beth Israel Deaconess Medical Center, Department of Orthopaedic Surgery, Boston, MA, USA

Abstract

Orthopedic implant removal is a commonly performed procedure. While implant removal can be associated with
improved symptoms, risks of the surgery are notable. Stripped screws, broken and retained hardware, and morbidity
associated with soft tissue compromise during difficult removal are all common. Familiarity with the instruments is
critical to procedure success. The purpose of this study is to assist removal of unfamiliar screws in upper extremity
surgery by offering a reference for screw and driver compatibility across manufacturers.
Inclusion of device manufacturers was determined by market share. Screw size, drive configuration, and screw removal
system compatibility data was collected and recorded. Screw, guide-wire, and screwdriver compatibility was assessed
and compared to two commonly utilized universal implant-removal sets.
Eight upper extremity implant vendors were included. The data was compiled in table format according to manufacturer
and sub-categorized to facilitate screw identification according to radiographically identifiable characteristics.
The diversity of orthopaedic implants in upper extremity surgery requires careful preoperative planning to identify the
appropriate equipment for implant removal.
The goal of this work is to provide a centralized reference of commonly implanted screws, guide-wires, and drivers for
the upper extremity to facilitate removal.
Level of evidence: V

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