Abstract

Introduction: Titanium screws sometimes become cold-welded to locking compression plates (LCP). Most methods describing removal of cold-welded screws generate considerable metal debris that induce and maintain chronic inflammation and fibrous encapsulation. We present a combined technique to diminish contamination of the wound. Operative technique: This technique was used in a single case in October 2017. Removal of a titanium LCP distal femur plate was indicated in a 15 year old male because of persistent complaints of pain. During removal, 3 screws were found to be cold-welded. After several unsuccessful attempts to remove the screws, the screw heads were stripped. A carbide drill was used to obliterate the screw heads. Before drilling, a plastic syringe was cut in half, and a hole was drilled in the top. The distal end of the syringe was placed over the carbide drill-bit as a collection basket. Surgical lubricant was then applied in the wound around the screw to intercept any excess metallic debris. While using the carbide drill, the metal debris was intercepted in the collection basket and its contents emptied in gauze. Afterwards, the wound was wiped with gauze and flushed with saline. No fragments remained after checking the wound area under fluoroscopy.

Conclusion: While obliterating the screw heads, contamination is limited by a plastic syringe that is placed over the carbide drill. It is an inexpensive and effective way to intercept and remove metal debris generated by obliterating titanium screws that can be used in different kinds of locking systems.