Surface polishing positively influences ease of plate and screw removal

Difficulties removing temporary fracture fixation devices due to excessive bony on-growth results in extended surgical time leading to excessive blood loss, debris contamination and potentially refracture. Commercially available locking plates and screws are manufactured for clinics with a micro-rou...

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Bibliographic Details
Published in:	European cells & materials Vol. 19; pp. 117 - 126
Main Authors:	Hayes, J S, Seidenglanz, U, Pearce, A I, Pearce, S G, Archer, C W, Richards, R G
Format:	Journal Article
Language:	English
Published:	Switzerland Forum Multimedia Publishing LLC 26-02-2010
Subjects:	Animals Biocompatible Materials - chemistry Bone and Bones - physiology Bone and Bones - surgery Bone Plates - adverse effects Bone Plates - standards Bone Screws - adverse effects Bone Screws - standards commercially pure titanium Device Removal - adverse effects Device Removal - methods Female Foreign-Body Reaction - physiopathology Foreign-Body Reaction - prevention & control Fracture Fixation - adverse effects Fracture Fixation - methods implant removal in vivo Industrial Oils locking compression plate Materials Testing - methods Osteogenesis - physiology Prosthesis Design - methods Prosthesis Fitting - methods Reoperation screw removal Sheep, Domestic Titanium - adverse effects Titanium - standards titanium-6%aluminium-7%niobium
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Summary:	Difficulties removing temporary fracture fixation devices due to excessive bony on-growth results in extended surgical time leading to excessive blood loss, debris contamination and potentially refracture. Commercially available locking plates and screws are manufactured for clinics with a micro-rough surface, which contributes to the excessive bony on-growth reported. We have applied polishing technology to commercially pure titanium locking compression plates (LCP) and titanium-6%aluminium-7%niobium (TAN) plates and screws to assess if it can alleviate problems with strong bony overgrowth. Samples were implanted for 6, 12 and 18 months in a bilateral sheep tibia non fracture model and assessed for screw removal torque, percentage of bone contact and tissue-material response. Both electropolishing (p=0.001) and paste polishing (p=0.010) of TAN screws significantly reduced the mean torque required for removal compared to their micro-rough counterparts. This was accompanied by a trend for a lower percentage of bone contact for polished screws. This difference in bone contact was significant for paste polished TAN screws (p<0.001 parallel but not electropolished TAN screws (p=0.066). Ex vivo, soft tissue removal was much easier (approximately five minutes) for polished constructs, which was difficult and at least four times longer for standard micro-rough constructs. We suggest that polishing of locked plate/screw systems will improve ease of removal and reduce implant related removal complications encountered due to excessive strong bony on-growth while maintaining biocompatibility and implant stability. Future studies aim to assess the potential of this technology in the next level of complication, a fracture model.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1473-2262 1473-2262
DOI:	10.22203/eCM.v019a12