J Orthop Trauma. 2025 Oct 6. doi: 10.1097/BOT.0000000000003093. Online ahead of print.
ABSTRACT
OBJECTIVES: To investigate the occurrence and risk factors for breakage of 2.7 mm variable angle (VA) locking screws from Depuy – Synthes during removal.
METHODS: Design: Retrospective cohort study.
SETTING: Two urban tertiary care hospitals in India.
PATIENT SELECTION CRITERIA: Patients from 2018 to 2024, undergoing removal of VA locked implants after healing of distal humerus (AO/OTA 13 – A2,3 and 13 – C1,2,3) and distal tibia fractures (AO/ OTA 43 – A1,2,3 and C2,3).Outcome measures and comparisons: The primary outcome measure was breakage of 2.7 mm VA locked screws. Difference in breakage between titanium and stainless-steel screws were examined. Age, gender, bone quality (measured in Hounsfield units using preoperative computerised tomography), body mass index, screw length, and time between surgery and implant removal were analysed for association with screw breakage.
RESULTS: Of 28 patients included, 16 patients underwent removal of titanium implants from the distal humerus and 12 patients underwent removal of stainless-steel implants from the distal tibia. There were 16 males and 12 females with mean age of 41years (range 20-20, SD 15). 95 out of 254 VA locking screws were reported broken during removal. 46 out of 105 (43.8%) stainless steel screws broke compared to 49 out of 149 (32.8%) titanium screws. This difference was not statistically significant (p = 0.234). Younger age (β = -0.48, SE = 0.2, p = 0.022), longer screw length (β = 0.21, SE = 0.23, p = 0.038) and a longer interval between surgery and removal (β = 0.43, SE = 0.42, p = 0.002) were associated with a higher incidence of screw breakage.
CONCLUSIONS: A high incidence of breakage was observed during removal of 2.7 mm VA titanium and stainless-steel locking screws. Younger patients, longer screws and late removal were associated with more risk for breakage. It is important for patients undergoing removal of these implants to be adequately informed and surgeons should be prepared to address this challenge intraoperatively.
LEVEL OF EVIDENCE: IV Retrospective cohort study.
PMID:41056442 | DOI:10.1097/BOT.0000000000003093
