Implant removal matrix for the upper extremity orthopedic surgeon

Document Type: TECHNICAL NOTE

Authors

1 Department of Orthopaedic Surgery Massachusetts General Hospital

2 Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center

3 Department of Orthopaedic Surgery, Massachusetts General Hospital

4 Harvard Medical School, Beth Israel Deaconess Medical Center

Abstract

Purpose: 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.
Methods: 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.
Results: 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.
Conclusions: 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: Level V

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