Fractures of bones are often surgically repaired through the use of plates and screws. Complications from these medical devices may occur, including inhibited movement, loosening of the screws and inflammation of the bone, muscle and tendons. The removal of plates and screws has been shown to alleviate many of these complications.
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Irritation to Tendons
The insertion of surgical plates to facilitate the healing of bone can induce irritation to the tendons and cause additional fractures by drilling holes for the screws. A study published in the June 2011 issue of the "Journal of Orthopedic Trauma" investigated the effects of 2.7mm smaller, low-profile locking plates to replace larger, 3.5mm traditional plates. The surgeons chose matching pairs of radii, a bone of the lower arm, and simulated a fracture in each. The crux of the study was to compare the smaller plate to the larger and to test locking screws in comparison to unlocking screws. The study concluded that locking screws were not as beneficial in comparison to using smaller plates when torsion strength and bending were rated.
Range of Motion
A controversy among surgeons exists as to whether the use of surgical locking plates to treat humeral fractures of the upper arm is beneficial over non-surgical treatments. A study appearing in the April 2011 issue of the "Journal of Shoulder and Elbow Surgery" compared the two treatment methods. The researchers investigated the outcomes of patients after one year and found no significant differences between the two for parameters of the study. However, the authors noted that the non-surgical treatment offered a greater range of motion as compared to the surgical option.
Complications with Absorbable Plates and Screws
Absorbable plates and screws are used in reconstructive surgery of the cranium and mandible (head and jaw). A study published in the March 2011 issue of the "Journal of Craniofacial Surgery" investigated complications associated with these surgical devices. The authors reviewed 430 instances where absorbable plates and screws were used for surgery and found five cases in which the patients developed an inflammatory reaction to the materials and reported infection of the sinuses. The study reported that symptoms cleared upon the removal of the devices and no infections were reported for the following 12 months.
Irritation to Muscle Tissue
The use of a plate and screws is common for the treatment of fractures of the distal radius, the furthest point of the lower arm from the body, and wrist. A study included in the May 2001 issue of the "Journal of Hand Surgery" reported that complications arise from the use of plates by screws penetrating the extensor muscles. The researchers examined 46 cases of distal radius fractures and found that of the 230 screws used in the procedures, 59 had protruded from the plate by more than 0.5mm. Of these 59, 18 had caused inflammation to the tendons of the extensor muscles.
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- "Journal of Hand Surgery -- Europe"; Screw Prominences Related to Palmar Locking Plating of Distal Radius; T. Sueguen et al.; May 2011
- "Journal of Craniofacial Surgery"; Cellulitis Related to Bioabsorbable Plate and Screws in Infraorbital Rim Fracture; H. Kwon et al.; March 2011
- "Journal of Shoulder and Elbow Surgery"; Locking Plate Versus Nonsurgical Treatment for Proximal Humeral Fractures: Better Midterm Outcome with Nonsurgical Treatment; R. Sanders et al.; April 2011
- "Journal of Orthopedic Trauma"; Can Locking Screws Allow Smaller, Low-Profile Plates to Achieve Comparable Stability to Larger, Standard Plates?; G. Garrigues et al.; June 2011