Document Type : RESEARCH PAPER
Authors
1
Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
2
HealthPartners Orthopedics, Minneapolis, MN, USA.
3
University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
4
University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA.
5
1. University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA. 2. The CORE Institute, Phoenix, AZ, USA.
10.22038/abjs.2025.84756.3858
Abstract
Objectives: Despite the potential advantages of titanium plates in promoting fracture healing, some surgeons express concerns about the potential challenges with future hardware removals, such as screw stripping and cold welding. There is no consensus on whether the removal of titanium plates and screws is more challenging than that of stainless-steel implants. In this study, we compare the ease of implant removal, specifically examining the removal ofcomparing titanium and stainless-steel plates and screwsplate/screw removal following fixation of distal femur fractures.
Methods: In a retrospective cohort study, patients with distal femur fractures requiring implant removal who were either managed with a stainless-steel or a titanium plate were included. The primary outcome of interest was difficulty in hardware removal, such as implant cold-welding, screw stripping, intraoperative hardware breakage, and the need for advanced tools (screw removal set, trephine, metal cutting burr). The secondary outcome of the study was duration of surgery.
Results: In total, 72 patients were identified, 31 with stainless steel and 41 with titanium implant removal. The mean hardware in-vivo time was 421 ± 498 days in the stainless-steel group and 360 ± 409 days in the titanium group (P = 0.57). In total, 4/31 patients (132.9%) in the stainless-steel group and 5/41 patients (12.2%) in the titanium group had difficulties with implant removal (P=0.92). The broken screw removal set was utilized in three3 patients (9.7%) in the stainless-steel group and four4 patients (9.8%) in the titanium group (P = 0.99). Advanced extraction tools were employed in 3 patients from each group (P = 0.72). Cold-welded or stripped screws were reported in 2 patients from each group (P = 0.77). The mean operative time was 155 ± 80 minutes for the stainless-steel group and 118 ± 67 minutes for the titanium group (P = 0.06).
Conclusion: In distal femur fractures, removal of titanium plates is not associated with increased difficulty of implant removal compared to stainless steel implants.
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