Gyuricza Cassie, Carlson Michelle Gerwin, Weiland Andrew J, Wolfe Scott W, Hotchkiss Robert N, Daluiski Aaron
Hospital for Special Surgery, New York, NY, USA.
J Hand Surg Am. 2011 Jun;36(6):982-5. doi: 10.1016/j.jhsa.2011.03.032. Epub 2011 May 14.
We present our experience with removal of locked volar distal radius plates and screws and note the indications for removal, types of plates removed, completeness of hardware removal, and complications occurring during plate removal.
We reviewed all distal radial volar locking plates removed at our institution from 2004 to 2009. A total of 28 patients operated on by 5 hand surgeons were identified. We gathered information regarding the incidence of successful removal of hardware and operative findings in cases of difficult removal of hardware.
A total of 28 patients (16 women, 12 men) underwent removal of locked volar distal radius plates from 2004 to 2009. The mean length of implantation was 63 weeks (range, 3-223 wk). Reasons for removal of hardware included tenosynovitis, tendon rupture, pain, and prominent or intra-articular hardware. Of 28 cases of locked volar plate removal, 2 had complications. In the first case, a screw was cross-threaded in an earlier generation DVR Hand Innovations plate implanted in 2003. The plate and screw were removed by rotating them out as 1 unit. In the second case, in which the current generation DVR Hand Innovations plate was implanted in 2007, the recess in the screw head had been stripped on insertion. The plate was cut and the remaining fragment of plate and screw were removed together. Despite these difficulties, hardware was successfully removed completely in 28 patients.
This case series highlights the result that all removals of locked volar plates were successful. There were 2 complications, and strategies for removal are described.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
我们介绍了拆除锁定掌侧桡骨远端钢板及螺钉的经验，并指出拆除的适应证、所拆除钢板的类型、内固定物拆除的完整性以及钢板拆除过程中出现的并发症。
我们回顾了2004年至2009年在本机构拆除的所有桡骨远端掌侧锁定钢板。共确定了由5名手外科医生手术治疗的28例患者。我们收集了关于内固定物成功拆除的发生率以及内固定物拆除困难病例的手术发现等信息。
2004年至2009年，共有28例患者（16例女性，12例男性）接受了锁定掌侧桡骨远端钢板的拆除。植入的平均时长为63周（范围3 - 223周）。拆除内固定物的原因包括腱鞘炎、肌腱断裂、疼痛以及内固定物突出或位于关节内。在28例锁定掌侧钢板拆除病例中，有2例出现并发症。第一例中，一枚螺钉在2003年植入的早期一代DVR Hand Innovations钢板中出现螺纹交叉。钢板和螺钉作为一个整体旋转取出。第二例中，2007年植入的当前一代DVR Hand Innovations钢板，螺钉头部的凹槽在插入时被剥离。钢板被切断，剩余的钢板和螺钉碎片一起取出。尽管存在这些困难，28例患者的内固定物均成功完全拆除。
本病例系列突出了所有锁定掌侧钢板拆除均成功的结果。出现了2例并发症，并描述了拆除策略。
研究类型/证据水平：治疗性IV级。
