Plate Removal Research Articles

Are large movements a risk factor for subsequent plate removal in bilateral sagittal split osteotomy?

Are large movements a risk factor for subsequent plate removal in bilateral sagittal split osteotomy?

Failure analysis of an overhead valve train system in urban buses

Abstract This work is focused on the study of the failures identified in the valve train system of two different types of engines, one diesel and one fed by compressed natural gas, both pertaining to a fleet of urban buses. The studied failure has been reported in >20 different units, the affected elements being both the cams (material removal at the cam nose) and the tappets (hard plate removal and strong tappet core deformation) and requiring the vehicles to be out of service until being repaired. In order to determine the root cause of the failure, the performed analyses have covered the lube oil characteristics, the kinematic chain status, highlighting the review of the camshaft modal response and the behaviour of the valves springs, and, finally, the verification of the selection regarding both the material and heat treatment of the camshaft.

Minimally Invasive Endoscopic-Assisted Technique for Implant Removal After Pelvic Bridge Plating.

Subcutaneous internal plate fixation for anterior pelvic ring injuries has become more common, but implants require removal, usually by 12 weeks. The purpose of this article is to report a novel, minimally invasive, endoscopic-assisted technique for the removal of subcutaneous anterior pelvic plates safely and atraumatically without violating the underlying fascia.

Delayed Removal of Clavicular Hook Plates; The Effect on Complications and Functional Outcome

This study aimed to determine whether leaving a clavicular hook plate in-situ for longer than six months is associated with a greater complication rate and reduced function compared to when removed within six months as recommended by manufacturer. Patients treated with a hook plate at our institute between January 2005 and October 2015 were categorised into two groups: removed within six months (group A); removed after six months (group B). Complications, ASES and SST score were compared between the groups. Fifty-two patients were identified with 30 patients in group A and 22 patients in group B. There was no significant difference between the groups in the outcome measures obtained from ASES or SST (p = 0.52; p = 0.33) or the complication rate (p = 0.83). Our study suggests that there is no difference between shoulder function and complication rate when the hook plate was removed after six months compared to when removed within six months.

Radiographic and histologic observations of sequential healing processes following ridge augmentation after tooth extraction in buccal-bone-deficient extraction sockets in beagle dogs.

To evaluate dimensional ridge alterations and sequential healing processes following ridge augmentation after tooth extraction in damaged extraction sockets with buccal-bone-deficiency. Bilateral dental roots of three mandibular premolars were extracted with entire removal of the buccal-bone plate in eight beagle dogs. Unilateral sites were grafted with biomaterials (test group) and contralateral sites were healed without grafting (control group). Observations were made after 1, 2, 4, and 8weeks, and all sites were distributed evenly (n=6 for each group and period). Radiographic/histomorphometric analyses were performed. In spontaneous healing of damaged extraction sockets, the dimension of regenerated alveolar ridge gradually increased until 4weeks and then remained stable, but radiographic/histomorphometric analyses revealed evident dimensional shrinkage compared to the pristine tissue at 8weeks in the coronal and middle areas. Bone grafting retained the pristine dimension of alveolar ridge, and newly formed bone area within the augmented space continuously expanded during the observational period to the outermost border of the space. Spontaneous healing of damaged extraction sockets caused substantial dimensional shrinkage. However, ridge augmentation can provide space into which new bone may grow continuously, resulting in the final dimensions comparable to those of the pristine alveolar ridge.

Design and Optimum of Dust Collector with Corrugated Plate for Underground Mine

A set of dust collectors was designed with corrugated plate for an underground metal mine, which has low ventilation resistance, simple maintenance, and strong environmental adaptability. A three-dimensional simulation model was built based on ANSYS-Fluent software, and it was used to analyze the influence law of key parameters on the comprehensive dust removal efficiency; the angle of corrugated plate to the horizontal plane, the surface characteristics of plate, pressure loss and dust removal efficiency were discussed. The optimal design scheme of the dust collector was determined according to the simulation results. The dust collection was carried out in the Fankou lead-zinc underground metal mine in China, and the total dust removal efficiency was more than 95%, and for respiratory dust, it was more than 85%. This dust collector can be widely used in similar underground metal mines.

Use of dorsal buttress plate fixation for ulnar carpometacarpal joint fracture dislocations for early mobilization: outcomes of 11 cases.

This study reviews the surgical outcomes of using dorsal buttress plate for open reduction and internal fixation of ulnar (5th, or 4th and 5th) CMCJ fracture subluxation or dislocations. A retrospective review of 11 patients at our center who underwent operative fixation with dorsal buttress plating technique was performed. The surgery was performed between February 2012 and March 2017. Outcome measurements include radiographic evaluation of time to union, grip strength, and range of motion of the wrist. Of 11 patients in our case series, eight had injuries involving both 4th and 5th CMCJs, while three had isolated involvement of 5th CMCJ. Mean time to union on radiographs was 48days (IQR 17.0; range 30-88). The median palmar flexion and dorsiflexion of the wrist were 56° (IQR 11.3; range 50°-80°) and 65° (IQR 10.0; range 60°-80°) respectively. Patients regained a median of 79% of grip strength (IQR: 36.0, range 43-100). All fingers achieved full range of motion, and no patient had scissoring of the fingers. Two patients had temporary mild numbness over the dorsoulnar aspect of the hand in the region of the 4th webspace. Five patients underwent removal of implants due to plate breakage (n = 2), or mild pain or pain with cold (n = 3). All patients were well after plate removal, and all the patients with pain had resolution of pain after implant removal. The dorsal buttress plate is a viable option for fixation of ulnar CMCJ fracture dislocations to allow early mobilization.

Medial submuscular plating of the femur after limb lengthening and correction with frame in patients with limb length discrepancy and/or angular deformity

Objective To evaluate the medial submuscular plating of the femur after limb lengthening and correction with frame in patients with limb length discrepancy and/or angular deformity. Methods A retrospective study was conducted involving 12 patients who had been referred to Department of Orthopaedic Trauma, Beijing Jishuitan Hospital from December 2009 to November 2016 for limb length discrepancy and/or angular deformity. They were 3 males and 9 females, with an average age of 23 years (from 14 to 32 years). Altogether 4 left and 8 right sides were involved. Of them, 11 got their length discrepancy and/or angular deformity secondary to injury to distal femoral epiphyseal plate caused by trauma in their childhood and one had length discrepancy and angular deformity following unsuccessful conservative treatment of superior condylar fracture of the femur. The femoral shortening ranged from 3 to 11 cm (average, 6.7 cm), and the varus or valgus deformity of the knee ranged from 8° to 18° (average, 12°). First, a monolateral fixator was installed on the lateral femur. The limb was lengthened from 7 to 14 days after diaphysis osteotomy. Femoral supracondylar osteotomy was conducted again in patients with knee angular deformity after the lengthening reached the expected length and the deformity was corrected with the aid of external fixator. After medial submuscular plating via the femoral lateral approach using minimally invasive techniques, the external frames were removed. The time for plate removal, limb lengthening and correction of the varus or valgus deformity were documented. Results The mean follow-up was 31 months (from 23 to 43 months) for the 9 patients who had their plates still in situ, and 6.5 months (from 2 to 14 months) for the 3 patients who had subsequently their plates removed. None had blood transfusion. All underwent distraction osteogenesis of the femur to their preoperatively expected length, ranging from 3 to 9 cm (mean, 6.2 cm). Both varus and valgus deformities were corrected. None developed a deep infection. The range of motion of the knee joint was similar to that before operation in all but one patient who had a range of motion 40° less than the pre-operative one. The time for external fixation averaged 91 days (from 46 to 113 days), with an external index of 22 d/cm. All patients were satisfied with their outcomes. Conclusion Medial femoral submuscular plating after limb lengthening and angular deformity correction with the external fixator on the lateral side is a useful technique for patients with femoral limb length discrepancy and/or angular deformity, significantly shortening the time for external fixation. Key words: Femur; External fixators; Bone plates; Surgical procedures, minimally; Abnormalities

Cutaneous paresthesia after internal plate fixation of clavicle fractures and underlying anatomical observations.

To assess the clinical and anatomical causes of cutaneous paresthesia after internal fixation of clavicle fractures.This study included 135 patients who underwent internal fixation of clavicle fractures from May 2013 to June 2016 at the First and Second Affiliated Hospital of Guangxi Medical University. The incidence of postoperative supraclavicular nerve injury, the duration of numbness, and improvements after plate removal were retrospectively analyzed. Seven human cadaver specimens were subsequently dissected to analyze the supraclavicular nerve and its relationship to numbness.Of the 135 patients who underwent internal fixation of clavicle fractures, 26 (19.3%) experienced postoperative cutaneous paresthesia, with 22 (16.3%) and 4 (2.8%) experiencing numbness and pain, respectively. The most intense numbness occurred during the first operative month. Of the 22 patients with numbness, 1 (4.5%), 1 (4.5%), and 20 (90.1%) patients reported mild, moderate, and severe numbness, respectively. Two patients described increased awareness of numbness when in contact with clothes, 2 were psychologically affected by numbness, and 20 (90.1%) reported reduced severity of numbness over time. At the last follow-up, numbness was found to persist in 2 (1.5%) patients. None of the patients was bothered by numbness. Cadaver dissection showed that the supraclavicular nerve emerged from the 1/2 posterior edge of the cervical sternocleidomastoid muscle and subsequently divided into 3 branches, with the lateral branch 2.26 ± 1.17 cm from the lateral margin of the acromion, the middle branch near the mid-clavicle, and the medial branch 2.03 ± 0.85 cm from the sternal lateral margin.Cutaneous paresthesia is common following internal fixation of the clavicle. Anatomic analysis showed that the nerve could be easily injured during clavicle operation. Numbness improved in most patients, but persisted for up to 2 years and was even permanent in a few. Most patients considered numbness as an insignificant factor in their daily lives.

Submuscular plates versus flexible nails in preadolescent diaphyseal femur fractures.

:PurposeTo compare patient characteristics, operative time, estimated blood loss (EBL), postoperative length of hospital stay (LOS) and complications after insertion and removal of submuscular plates (SMPs) versus flexible nails (FNs) for paediatric diaphyseal femur fractures.MethodsWe reviewed records of 58 children (mean age, 7.7 years SD 2.0) with diaphyseal femur fractures who underwent treatment with SMPs (n = 30) or FNs (n = 28) from 2005 to 2017 (mean follow-up, 22 months SD 28). Patients with pathological fractures or musculoskeletal comorbidities were excluded. Alpha = 0.05.ResultsInsertion of FNs was associated with shorter operative time (ß = –24 mins) and less EBL (ß = –38 mL) (both, p < 0.001) compared with insertion of SMPs, after adjusting for fracture type and time from beginning of study period. Removal of FNs was also associated with shorter operative time (ß = –15 min) compared with removal of SMPs (p < 0.001). EBL during removal was similar between groups (p = 0.080). The FN group had a shorter LOS after insertion (ß = –0.2 d) compared with the SMP group (p = 0.032). Four patients treated with SMPs and three treated with FNs developed surgical site infections. Two patients treated with SMPs and seven treated with FNs experienced implant irritation that resolved with removal. No other complications occurred.ConclusionCompared with SMPs, FNs were associated with shorter operative time (for insertion and removal), less EBL (for insertion) and shorter post-insertion LOS in patients with diaphyseal femur fractures.Level of Evidence:III

Complications Associated with Volar Locking Plate Fixation of Distal Radial Fractures.

* Volar locked plating is the most frequently utilized method for internal fixation of distal radial fractures.* The overall complication rate for volar plating of distal radial fractures appears to be relatively low compared with other operative fixation methods.* Carpal tunnel syndrome is the most commonly reported complication. However, this may occur after a distal radial fracture regardless of treatment method, with reported rates ranging from 0% to 20% with conservative management and 0% to 14% with volar plating.* Extensor tendon rupture has been reported at rates of 0% to 4% and is the most frequent complication requiring plate removal.* Variable-angle volar locking plates may be associated with fewer implant-related complications as a result of their greater degree of screw placement customization compared with fixed-angle volar locking plates.

PSS51 - ANALYSIS OF TOPICAL PREPARATIONS FOR TREATMENT OF ONYCHOMYCOSIS IN UKRAINE

Therapeutic options for onychomycosis include oral and topical antifungals. Since topical medicines are used both in monotherapy, and in combination therapy, the aim of this work was to conduct comparative analysis of topical preparations for treatment of onychomycosis included into clinical protocol and State Formulary of Ukraine. comparative analysis of topical medicines included into clinical protocol and State Formulary of Ukraine, 10th edition. Clinical protocol for treatment of onychomycosis (CP) was approved by Ministry of Health of Ukraine in 2012. It recommends three onycholytic preparations with urea to remove infected nail plate, and than to treat a nail bed with either antifungal lacquer or topical preparation with ketoconazole, terbinafine, oxiconazole, miconazole, chlornitrophenol, undecylenic acid, combination preparation with ketoconazole and salicylic acid. The last preparations are listed without indication of a preferred dosage form. State Formulary of Ukraine, 10th (SFU) was approved by Ministry of Health of Ukraine in 2018. SFU also recommends applying antifungals onto nail bed after nail plate removal, but it does not recommend any onycholytic preparations. Furthermore, among 42 topical antifungal preparations included into SFU, only four antifungals are recommended for onychomycosis treatment. These are bifonazole cream, econazole cream, gel and cream with miconazole. Neither ketoconazole nor other topical antifungal preparation listed in CP, except of miconazole, are specified by SFU to be effective for onychomycosis. Antifungal lacquers are not included into SFU at all. There are gaps between CP and SFU. CP should be reviewed in accordance to data of evidence-based medicine. Despite the fact that a new edition of SFU was recently published, it does not include antifungal lacquers, which are broadly used and recommended, for example, by British National Formulary. Thus, it is also necessary to analyze antifungal nail lacquers for making decision about including them into SFU.

Titanium Reconstruction Plate Exposure Following Mandibular Reconstruction in Malignancy – A Case Report and Review of Literature

Mandibular reconstruction with titanium reconstuction plate is modality whose main advantage lies in its cost effectiveness and lack of secondary morbidity. It is thus still in widespread use, inspite of the availability of large number of other more sucessful reconstructive options. However it is also associated with large number of complication. Plate exposure is not an uncommon complication necessitating plate removal. A case of carcinoma of the anterior alveolus of the mandible treated with supra omohyoid neck dissection and segmental resection of mandible on left side followed by reconstruction of the mandible with titanium reconstruction plate and nasolabial flap. Patient developed infection in surgical site and exposure of titanium reconstruction plate on 20th post-operative day. Subsequently reconstruction plate removed under GA and infection treated with antibiotics based on culture and sensitivity. Post-operative recovery following plate removal is uneventful. This case report discusses the complication of an infected plate following a major head and neck surgery and a review of literature of titanium plate reconstruction.

Clinical and Radiological Outcomes of Transfibular Total Ankle Arthroplasty.

Ankle arthritis is a highly limiting pathology that causes pain and functional limitation with subsequent deterioration of quality of life. With recent advances in surgical instrumentation and techniques, prosthetic replacement of the ankle has proven to be a valid alternative to arthrodesis with comparable outcomes. The purpose of this study was to evaluate clinical and radiological findings in a transfibular total ankle replacement with follow-up of at least 2 years. This prospective study included 89 patients who underwent transfibular total ankle arthroplasty from May 2013 to February 2016. The mean age was 53.2 ± 13.5 years. All patients were followed for at least 24 months postoperatively with an average follow-up of 42.0 ± 23.5 months. Patients were assessed clinically and radiographically preoperatively and at 6, 12, and 24 months postoperatively. At 24 months postoperatively, patients demonstrated statistically significant improvement in the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle Hindfoot Score from 33.8 ± 14.3 to 88.5 ± 6.6 ( P < .001), visual analog scale (VAS) from 80.5 ± 17.0 to 14.1 ± 9.2 ( P < .001), and Short Form-12 Physical and Mental Composite Scores from 29.9 ± 6.7 and 43.3 ± 8.6 to 47.0 ± 7.6 and 53.3 ± 8.1, respectively ( P < .001). In addition, ankle dorsiflexion and plantarflexion improved from 6.2 ± 5.5 and 9.6 ± 5.8 degrees to 24.2 ± 7.9 and 18.1 ± 7.6 degrees, respectively ( P < .001). Radiographically, patients demonstrated maintained neutral alignment of the ankle at 24 months. No patient demonstrated any radiographic evidence of tibial or talar lucency at final follow-up. Seven patients underwent reoperation for removal of symptomatic hardware (6 fibular plates, 1 syndesmotic screw); 2 patients experienced delayed wound healing. The first one was treated with plate removal and flap coverage. The second one required fibular plate removal. One patient developed a postoperative prosthetic infection requiring operative debridement, removal of implants, and placement of an antibiotic spacer. This study found that transfibular total ankle replacement was a safe and effective option for patients with ankle arthritis resulting in improvements in patient-reported outcomes, range of motion, and radiographic parameters. However, further studies are required to determine the mid- and long-term performance of these implants. Level IV, case series.

Deterioration of patellofemoral cartilage status after medial open-wedge high tibial osteotomy.

To identify parameters associated with deterioration of patellofemoral (PF) cartilage after open-wedge high tibial osteotomy (OWHTO) and determine predictive values. It was hypothesized that cartilage injuries in PF joints would progress after OWHTO in patients who need a large alignment correction. Fifty-two knees in 47 patients who underwent bi-planer OWHTO for the treatment of medial compartment osteoarthritis from 2012 to 2017 and received a second-look arthroscopy at the time of plate removal (mean 14 months post-OWHTO) were assessed. Clinical outcomes were evaluated by the Knee Society Scores. Cartilage status in PF joints were evaluated arthroscopically using the International Cartilage Repair Society (ICRS) grading system. Patients were divided into two groups and patients who had progressed PF cartilage injury (progressed group) were compared with those who did not have progressed PF cartilage injuries (non-progressed group) using various parameters. The relationships between medial opening gap or change in the medial proximal tibial angle (ΔmPTA) and progression of PF cartilage injuries were examined by receiver operating characteristic (ROC) curve analysis. The mean Knee Society Scores were significantly improved after surgery (P < 0.01). The grades for the patella and trochlea progressed in 12 (23.0%) and 16 knees (30.8%), respectively. The mean preoperative hip-knee-ankle (HKA) angle, mechanical axis, and mPTA in the progressed group were significantly smaller than those in the non-progressed group (P < 0.01). The mean medial opening gap and ΔmPTA in the progressed group were significantly larger than those in the non-progressed group (P < 0.01). ROC curve analysis showed that the cut-off values of the medial opening gap and ΔmPTA for progression of PF cartilage injuries were 13mm and 9°, respectively. Progression of PF cartilage injuries was more frequently observed in knees with a medial opening gap ≥ 13mm (P = 0.019, odds ratio = 4.60) or a ΔmPTA ≥ 9° (P = 0.003, odds ratio 6.93) than knees with those of < 13mm or 9°, respectively. Cartilage injuries in PF joints tended to progress after OWHTO in patients with medial opening gap ≥ 13mm or ΔmPTA ≥ 9°. If medial opening gap is ≥ 13mm or ΔmPTA is ≥ 9° in planning for OWHTO, other type of surgery may need to be considered to avoid early progression of PF cartilage injuries. Level IV, therapeutic case series.

Are clinical outcomes affected by type of plate used for management of mid-shaft clavicle fractures?

BackgroundOpen reduction and internal fixation (ORIF) using plate osteosynthesis for midshaft clavicle fractures is often complicated by the prominence of the implant due to the subcutaneous position of the clavicle. Reoperation rates for symptomatic clavicle plate removal have been reported to be as high as 53%. We sought to determine to which degree do clinical outcomes (all cause reoperation rate and rate of fracture union) differ between types of clavicle plates.Materials and methodsA retrospective chart review was performed using our hospital database for patients treated with ORIF for mid-shaft clavicle fractures (OTA/AO type 15-B). Implants included in this review were 2.7 mm reconstruction plates, 3.5 mm reconstruction plates, 3.5 mm precontoured clavicle plates and 3.5 mm locking compression plates. The primary outcome measure was the all cause reoperation rate. Secondary outcomes compared the rate fracture union, documented infection, hardware failures and clinical symptoms at the surgical site among the various plate types. Data was collected and descriptive statistics were analyzed. p values < 0.05 were considered statistically significant.ResultsA total of 102 midshaft clavicle fractures treated with ORIF were included in this study. The majority of patients were ≤ 50 years old (83.3%) and male (72.5%). The overall union rate for all plating constructs was 97.1%. We found that age, sex and smoking were not associated with the rate of re-operation. In addition, the fracture classification, type of implant used and number of screws used didn’t increase the risk of revision surgery. In addition, more than 50% of patients complaining of pain at 6 weeks post-operatively required a second surgery for removal of hardware. Moreover, there was no association between age, sex, smoking, fracture classification or plate type and the rate of union. Interestingly, clavicle fractures fixed with 3.5 mm reconstruction plates were more likely to have hardware failure due to plastic deformation, whereas 2.7 mm plates were more likely to fail by plate breakage.ConclusionAlthough different types of implants have different biomechanical properties, no difference in reoperation, union and plate removal rates were found between the various plate types. Future studies with a larger sample size are required to further examine these outcomes.Level of evidenceLevel III.

First metatarsophalangeal joint arthrodesis with two orthogonal two hole plates

ObjectiveFirst MTP joint fusion is a reliable procedure for advanced arthritis for the first MTP joint. There are many techniques described. The purpose of our study is to report clinical, radiological, functional outcomes and complications of first metatarsophalangeal joint fusion with hand preparation of the joint and fixation with two orthogonal locking plates without a compression screw. Methods32 feet in 26 consecutive patients under went first metatarsophalangeal joint fusion with above technique. There were 23 women and 3 men. Mean age was 64 years and mean follow-up was 49 months. 21 patients had osteoarthritis, 10 had rheumatoid arthritis and one had psoriatic arthritis. Clinical, radiological, American Orthopaedic Foot and Ankle Score and Foot and Ankle Disability Index clinical rating scales were used for evaluation. ResultsFusion was achieved in 27 feet. The incidence of radiological non-union was 15.7%. Mean AOFAS score improved from 37.1 to 80.7 (p < 0.0001) and mean FADI score improved from 40.3 to 86.9 postoperatively (p < 0.0001). Two patients with osteoarthritis and three with Rheumatoid arthritis did not unite. Four of these patients were managing hence revision surgery was not carried out but had low AOFAS and FADI scores. One patient with symptomatic non-union declined further surgery. One patient needed plate removal for a low grade infection and reoperation rate was 3.1%. ConclusionsIn our experience, first metatarsophalangeal joint arthrodesis using two orthogonal two hole plates without a compression screw is associated with a higher non-union rate in our cohort hence we do not recommend this technique. Level of evidenceLevel IV, therapeutic study.

Rebound of Frontal Plane Malalignment After Tension Band Plating.

Despite the popularity of tension band plating (TBP) current literature lacks clinical data concerning recurrence ("rebound") of frontal plane malalignment. This study investigated the rebound phenomenon after TBP in idiopathic genu varum/valgum deformities. We analyzed factors that may contribute to the development of rebound after removal of TBP. Patients who had correction of idiopathic valgus or varus deformities by TBP at the distal femoral and/or proximal tibial growth plate were selected from a prospective consecutive database. Only patients who had plates removed for at least 1 year and had a long standing radiograph of the lower limbs before plate removal were included. Patients who had presumably not yet reached skeletal maturity (age under 14 y for girls and under 16 y for boys) were excluded. The change of the mechanical axis from plate removal to follow-up after skeletal maturity was evaluated and a statistical analysis was performed. Twenty-nine patients (64 extremities) were eligible. The mean follow-up was 39.1 months (range, 12.3 to 67.3 mo). The mean mechanical axis deviation (MAD) was +0.8 mm (range, -26 to +22 mm) after plate removal and -2.4 mm (range, -29 to +27 mm) at follow-up, accounting for a significant change of MAD (P=0.046). We observed a mean, relative recurrence of frontal plate malalignment into valgus direction of -3.2 mm (range, -48 to +23 mm). Twenty extremities (31%) showed <3 mm of MAD change; 27 extremities (42%) showed >3 mm of MAD change into valgus, and 17 extremities (27%) >3 mm of MAD change into varus direction. Patients with <3 mm MAD change had only 0.8 years, and those >3 mm a mean of 2.0 years of remaining growth until skeletal maturity. Each additional m/kg of body mass index increased the risk of valgus recurrence by 12.1%. The 3 genua vara patients revealed to have an even higher rate of malalignment recurrence (4 of 6 limbs) at final follow-up. Given our strict criteria, there is a high rate of radiologic recurrence of frontal plane malalignment after TBP. Children who are more than 1 year before skeletal maturity at TBP removal, and those with increased body mass index are at higher risk for rebound growth. Level IV-consecutive therapeutic case series.

Is the removal of osteosynthesis plates after orthognathic surgery necessary? Retrospective long-term follow-up study

The removal of titanium miniplates is a controversial topic in oral and maxillofacial surgery. This retrospective study examined the timing of and reasons for titanium plate removal after orthognathic surgery. The study included 240 orthognathic surgery patients (71 male, 169 female; age range 16–55 years, mean 25.0±8.8 years) who had maxillofacial osteosynthesis plates inserted or inserted and then removed at the Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, between April 2003 and March 2017. During the study period, a total of 717 miniplates were inserted in the 240 patients, and 71 of the patients (29.6%) had 236 plates (32.9%) removed. Ten patients (14.1%) had their plates removed within a year due to early complications. Although no patient had their plate removed due to complications at 1–5 years postoperative, a further 14 patients (19.7%) had their plates removed after more than 5 years of long-term follow-up due to plate-related complications. Complications requiring plate removal were evidently biphasic, occurring within 1 year after the operation and at ≥5 years after the operation. Therefore, after confirming postoperative bone healing, it is necessary to explain to patients the risks of plate removal and the importance of long-term follow-up.

ДЕСТРУКТИВНИЙ УСКЛАДНЕНИЙ ПОЛІОНІХОМІКОЗ І ВРОСТАННЯ НІГТІВ: КЛІНІКО-БІОХІМІЧНІ ПАРАЛЕЛІ (КЛІНІЧНІ СПОСТЕРЕЖЕННЯ)

ДЕСТРУКТИВНИЙ УСКЛАДНЕНИЙ ПОЛІОНІХОМІКОЗ І ВРОСТАННЯ НІГТІВ: КЛІНІКО-БІОХІМІЧНІ ПАРАЛЕЛІ (КЛІНІЧНІ СПОСТЕРЕЖЕННЯ)