Retirada de elementos de osteosíntesis asociados a cirugías de trauma maxilofacial en hospital público de Santiago de Chile. Estudio retrospectivo de 4 años / Removal of osteosynthesis elements associated with maxillofacial trauma surgery in a public hospital in Santiago, Chile. Retrospective study of 4 years

Introducción: El manejo quirúrgico del trauma maxilofacial implica el uso elementos de osteosíntesis (OTS) para la reducción abierta y fijación interna rígida. Sin embargo, existen razones que determinan su retirada. El objetivo de este estudio fue evaluar la prevalencia de la retirada del material de osteosíntesis y sus causas en el Hospital San José de Santiago de Chile entre los años 2018 y 2021.Metodología: Estudio retrospectivo descriptivo. Se seleccionaron pacientes intervenidos quirúrgicamente por trauma maxilofacial durante el periodo de 4 años. Se analizaron número de pacientes operados, edad, género, comorbilidades, sitio de fractura, cantidad de cirugías de retirada y tiempo en posición de dichos elementos. Referente a la remoción, se obtuvo localización y etiología.Resultados: Las cirugías por trauma maxilofacial correspondieron a 176; de estas, 17 (9,66 %) requirieron la retirada de OTS, retirando un total de 19 elementos. La edad promedio fue 36,5 años. El género masculino predominó sobre el femenino (3,25:1). La zona anatómica frecuente de retirada fue la mandíbula (94,7 %), especialmente el ángulo mandibular. Las principales causas fueron exposición de placa y/o tornillos y la infección del sitio quirúrgico (36,8 %). La mayoría de las retiradas de OTS ocurrieron antes de los 12 meses (84 %) con un tiempo promedio en posición de 10,23 meses.Conclusiones: Los resultados encontrados muestran una baja prevalencia de la retira de OTS, los hombres son los más afectados, el sitio anatómico de retiro frecuente es el hueso mandibular, las causas principales son la exposición de la placa o infección. Estos hallazgos son concordantes con lo reportado en la literatura. (AU)

Introduction: Surgical management of maxillofacial trauma involves the use of osteosynthesis elements (OTS) for open reduction and rigid internal fixation. However, there are reasons that determine their removal. The aim of this study was to evaluate the prevalence of osteosynthesis material removal and its causes at Hospital San José in Santiago de Chile between 2018 and 2021.Methodology: Retrospective descriptive study. Patients who underwent surgery for maxillofacial trauma during the 4-year period were selected. The number of operated patients, age, gender, comorbidities, fracture site, number of removal surgeries and time in position of these elements were analyzed. Regarding removal, location and etiology were obtained.Results: There were 176 surgeries for maxillofacial trauma, of which 17 (9.66 %) required the removal of OTS, removing a total of 19 elements. The average age was 36.5 years. The male gender predominated over the female (3.25:1). The frequent anatomical area of removal was the mandible (94.7 %), especially the mandibular angle. The main causes were plaque and/or screw exposure and surgical site infection (36.8 %). Most OTS removals occurred before 12 months (84 %) with an average time in position of 10.23 months.Conclusions: The results found show a low prevalence of OTS removal, males are the most affected, the frequent anatomical site of removal is the mandibular bone, the main causes are plaque exposure or infection. These findings are consistent with those reported in the literature. (AU)

Higher Soong grade predicts flexor tendon issues after volar plating of distal radius fractures - a retrospective cohort study.

BACKGROUND AND PURPOSE: Soong classification is used to estimate volar locking plate prominence and evaluate the risk for flexor tendon ruptures after surgical treatment of distal radius fractures (DRFs). However, the scientific community has questioned the Soong classification due to lacking evidence. Therefore, this study aimed to evaluate the accuracy of Soong grading as a predictor for flexor tendon issues and plate removal. PATIENTS AND METHODS: We performed a retrospective single-center review of adult distal radius fracture patients treated with a volar locking plate between 2009 and 2019. In total, 2779 patients were included in the study. The primary outcome was a flexor tendon issue (flexor tendon rupture, tendinitis, or flexor irritation), whereas plate removal was a secondary outcome. Using Soong grade 0 as a reference, we used univariable and multivariable logistic regression to calculate odds ratios (OR) with 95% confidence intervals (CI) for flexor tendon issues and plate removal. RESULTS: In total, 756 (27%) patients were graded as Soong 0, 1679 (60%) Soong 1, and 344 (12%) Soong 2, respectively. There were 32 (1.2%) patients with flexor tendon issues, of which 4 were flexor tendon ruptures, 8 tendinitises, and 20 flexor irritations. The adjusted OR for flexor tendon issues was 4.4 (CI 1.1-39.7) for Soong grade 1 and 9.7 (CI 2.2-91.1) for Soong grade 2. The plate was removed from 167 (6.0%) patients. Soong grade 1 had a univariable OR of 1.8 (CI 1.2-2.8) for plate removal, and Soong grade 2 had an OR of 3.5. (CI 2.1-5.8), respectively. CONCLUSION: Flexor tendon ruptures are rare complications after the volar plating of DRFs. A higher Soong grade is a risk factor for flexor tendon issues and plate removal. TRIAL REGISTRATION: The trial was retrospectively registered.

Radius palmar plate removal without carpal tunnel release: Correlation between plate position and median nerve symptoms.

We aimed to report the clinical results of volar plate removal without carpal tunnel release in patients with late-onset median neuropathy and to evaluate the relationship between plate position and median nerve symptoms. Part I. Twelve consecutive patients with late-onset median neuropathy treated with volar plate removal without carpal tunnel release were enrolled for analysis. Pre- and post-operative Tinel sign, Phalen and Ten test, subjective rating of tingling sensation, Mayo wrist score and Disabilities of the Arm, Shoulder and Hand (DASH) score were collected. Part II. 232 consecutive patients underwent volar plating for distal radius fracture. The relationships between median nerve symptoms and volar plate prominence on the Soong classification, fracture classification, gender and age were investigated. All cases except one showed complete symptom resolution at final follow-up, with negative Tinel sign and Ten test score of 10/10. Tingling was rated 0 at final follow-up. Mean Mayo wrist and DASH scores improved to 86.7 and 23.1, respectively. The incidence of the median nerve symptoms in our cohort was 5.6%. Even though the odds ratio in Soong grade 2 was 4.0957 (95% CI, 0.93-16.9) compared to the combination of grades 0 and 1, no statistically significant relationship was found between the median nerve symptoms and volar plate prominence (p > 0.05). Plate removal without carpal tunnel release adequately relieved symptoms of late-onset median neuropathy after volar plating in patients with distal radius fracture. LEVEL OF EVIDENCE: IV; Therapeutic.

A 7-Year Retrospective Analysis of Titanium Plates Removal Following Orthognathic Surgery.

Objective: The aim of this study was to investigate the incidence of plate removal in orthognathic surgery patients and the reasons for their removal and to potentially identify the factors that may contribute to it. Methods: A retrospective study included all patients who underwent orthognathic surgery at Selayang Hospital from January 2011 to December 2017. The variables of interest recorded included patient age, gender, the existing skeletal deformity, type of surgery undertaken and number and location of plates inserted and removed. In addition, the reasons for plate removal and duration between plate insertion and removal were also recorded. Results: Ninety-seven patients with a mean age of 21.33 were included in the study. Nine patients with total of 33 plates had their miniplate fixation removed. Three patients underwent bi-maxillary surgery, and six patients underwent BSSO. The average time from insertion to removal was 22.33 months. The reasons for removal included pain, palpable and exposed plates, infection and on patient request. Conclusion: We report a 9.28% incidence of plate removal in patients who undergo orthognathic surgery which is comparable to the existing literature.

Forearm Plate Fixation: Should Plates Be Removed?

Background: Refracture after both bone forearm fracture fixation may vary with or without plate removal. We tested the null hypothesis that there is no difference in the rate of refracture in patients who have undergone open reduction and internal fixation of a diaphyseal forearm bone who have retained implants versus removed implants. We also studied factors associated with plate removal. Methods: We retrospectively identified 645 adult patients with a total of 925 primary fractures that underwent primary plate fixation of an ulnar or radial shaft fracture between 2002 and 2015 at a single institutional system. Patients with nonunion, pathological fracture or infection were excluded. Independent factors associated with refracture and plate removal were identified using multivariable analysis. Results: Refractures occurred in 6.3% of the fractures that had forearm implant removal, compared to 2.1% of the fractures with retained plates. Refractures were independently associated with plate removal (OR: 3.7, 95% CI: 1.2-11.7, P=0.023) and was more frequent in the radius (OR: 2.4, 95% CI: 1.0-5.8, P=0.06). A refracture after implant removal occurred within 3 months after removal. Ulnar plates were removed more often compared to radial plates (OR: 2.6, 95% CI: 1.4-4.7, P=0.002) as were plates used for type A fractures compared to type C fractures (OR: 3.2, 95% CI: 1.1-9.2, P=0.032). Conclusion: The rate of refracture is higher after plate removal compared to patients who did not have plates removed. Although uncommon, refractures of the radius tend to be more common than a refracture of the ulna. If the implant is symptomatic on the ulnar side, it may be preferable to remove the ulnar implant and retain the radius implant rather than remove both plates when possible. Furthermore, limiting strenuous activity for three months after implant removal is a consideration.

Retiro de elementos de osteosíntesis en trauma maxilofacial / Osteosynthesis elements removal in maxillofacial trauma

Resumen Objetivo: Analizar la prevalencia y los factores en la remoción de elementos de osteosíntesis (OTS) de pacientes tratados quirúrgicamente debido a fracturas maxilofaciales. Materiales y Método: Estudio retrospectivo descriptivo, donde fueron incluidos todos los pacientes con diagnóstico de fractura maxilofacial y tratados mediante reducción abierta y fijación interna rígida en un intervalo de 10 años, en el Servicio de Cirugía Oral y Maxilofacial en el Hospital Clínico Mutual de Seguridad (HCMS). Resultados: En un total de 807 pacientes intervenidos, con un rango etario entre 22-66 años, fueron utilizados 2.421 OTS. Entre ellos, 58 pacientes (7,2%) fueron sometidos a un segundo procedimiento quirúrgico, retirándose un total de 129 OTS (5,3%). La principal causa de retiro fue infección (41,1%), comúnmente de carácter tardío. El tercio inferior facial fue el más afectado, específicamente, la zona parasinfisiaria. El 39% fue retirado antes de los 12 meses de posicionados. Conclusiones: El retiro de OTS, posterior a trauma maxilofacial tiene una baja prevalencia. El sitio más afectado es el hueso mandibular y la mayoría se retira dentro de los primeros 12-24 meses. La etiología es variable, sin embargo, la infección se mantiene como una de las principales. Los hallazgos sugieren que no sería recomendable realizar este procedimiento de forma universal para todos los pacientes.

Aim: To analyse the prevalence and factors regarding to osteosynthesis elements (OTS) removal from patients surgically treated due to maxillofacial fractures. Materials and Method: Retrospective study in which all patients with diagnosis of maxillofacial fractures and treated with open reduction and internal rigid fixation were included, in an interval of 10 years, in the Maxillofacial Surgery Service of HCMS. Results: In 807 surgically treated patients, with an age between 22-66 years, 2.421 OTS were used. Among them, 58 patients (7.2%) underwent a second surgical procedure, with a total of 129 OTS removed (5.3%). The main cause of removal was infection (41.1%), commonly of a chronic nature. The lower third of the face was the most affected, specifically, the parasymphysis region. 39% of OTS were withdrawn before 12 months. Conclusions: OTS removal after maxillofacial trauma has a low prevalence, the most affected site is the mandibular bone, within the first 12-24 months. The aetiology is variable, however, infection remains one of the main. The findings suggest that it would not be advisable to perform this procedure universally for all patients.

Factors Influencing Clinical After Effects of Post Orthognathic Surgery - An Observational Clinical Study.

BACKGROUND: For maintaining the occlusion, screws to anchor bones are needed to be used in transalveolar manner to get the intermaxillary fixation in participants with no preoperative orthodontic treatment or participants with loose or broken appliances. AIMS: The present clinical trial was hence aimed to assess the postoperative complications following orthognathic surgical repair of skeletal malocclusion. MATERIALS AND METHODS: Forty-two participants were divided into two groups (n = 22). In Group I, predrill was done to create the holes in transalveolar position before screw insertion. For Group II, self-cutting screws were used without the drills. The radiographs were then taken to assess the associated root injuries. To evaluate the effect of different steroid doses on the pain, nerve healing, and swelling, the participants were divided into three groups (n = 14). Plate removal and associated factors were also evaluated. Collected data were statistically analyzed. RESULTS: In Group where no predrill was done, no root injuries were seen. Considerably less facial edema was observed in Group II and III compared to control Group I. This difference was statistically significant with a P value of 0.2057. At 1 week, 3 months, and 6-month postoperatively in Group II and Group III, no significant difference was seen. No significant difference in the postoperative pain between the groups was seen (P = 0.85103). Neurosensory Visual Analog Score measurement revealed no significant difference between three groups at 6 months with the P value of 0.81821. CONCLUSION: The present study concludes that risk for the root injury is possessed by the screws that require predrill, whereas the self-drilling screws had no risk for root injury.

Association of Gap Healing With Angle of Correction After Opening-Wedge High Tibial Osteotomy Without Bone Grafting.

BACKGROUND: Studies have reported that opening wedge high tibial osteotomy (OWHTO) without bone grafting has outcomes that are similar to or even better than those of OWHTO with bone grafting, especially after use of a locking plate. However, a consensus on managing the gap after OWHTO has not been established. PURPOSE: To determine the degree of gap healing achieved without bone grafting, the factors associated with gap healing, and whether additional gap healing would be obtained after plate removal. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: This retrospective study included 73 patients who underwent OWHTO without bone grafting between 2015 and 2018. Patients in the study were divided into 2 groups based on the correction angle: small correction group (<10°; SC group) and large correction group (≥10°; LC group). The locking plate used in OWHTO was removed at a mean of 13.5 months after surgery in 65 patients. Radiographic indexes were measured: gap filling height, gap vacancy ratio (GVR), and osteotomy filling index. The acceptable gap healing was defined as an osteotomy filling index ≥3. The factors related to gap healing around the osteotomy site were selected after multicollinearity analysis. RESULTS: Although both groups achieved acceptable gap healing regardless of the correction angle, the SC group showed higher and earlier gap healing than did the LC group (gap healing rate 81.4% in the SC group vs 41.7% in the LC group at 3 months postoperatively). The GVR was 8.6% in the SC group and 15.3% in the LC group at 12 months after surgery (P = .005). Both the amount of time that elapsed after surgery and the correction angle were associated with gap healing (P < .05). Additional gap healing was observed after plate removal, as the GVR decreased 2.7% more in the patients with plate removal than in patients who did not have plate removal (P = .012). CONCLUSION: All patients achieved acceptable gap healing without bone graft. The degree of gap healing was higher in the SC group and increased over time. Gap healing was promoted after plate removal. Considering the results of this study, a bone graft is not necessary in routine OWHTO in terms of gap healing.

Incidence for volar locking plate removal following distal radius fracture surgery.

INTRODUCTION: Distal radius fracture is the most common fracture in adults. The most common treatment for distal radius fracture is non-operative cast immobilization, although there are injuries that require surgical treatment. During the past decade, studies have reported a large increase in the surgical treatment of distal radius fractures with open reduction and internal fixation using volar locking plates. The aim of this study was to investigate the incidence and trends for plate removal after plate fixation of distal radius fractures. MATERIALS AND METHODS: The study covered all patients 18 years of age and older who had a surgically treated distal radius fracture with open reduction and internal fixation in Finland between 1998 and 2016. Patient data were obtained from the Finnish National Hospital Discharge Register. The association between increased number of platings and plate removals was examined by calculating the removal rates. The study population comprises all patients on a national level, and therefore we did not use statistical testing to analyze the data. RESULTS: A total of 18,298 patients had surgically treated distal radius fracture with volar plate in Finland during the 19-year study period from January 1, 1998 to December 31, 2016. The number of plate removal operations over the same time period was 2560. The removal rates decreased from over 20% in 1998 to less than 12% in 2016. The mean time period between plating and plate removal operations was 367 days. Most of the plate removals (n = 2235; 87.3%) were conducted during the first 2 years after plating. CONCLUSION: Plate removals have not increased as rapidly as plating operations. The removal rate has declined markedly during the last decade. Nowadays, approximately 11% of distal radius plates are removed.

Selective Glenohumeral external rotation deficit - sequelae of post-ORIF deltoid adhesions after treatment of the proximal humerus fracture.

BACKGROUND: The deltopectoral approach is commonly used for plate stabilization of proximal humerus fracture. Although adhesions between the deltoid, plate, and humerus are common sequelae of plate ORIF, little is known about their effect on the range of movement and a function of the shoulder. To confirm their impact, the preoperative and intraoperative evaluation of the range of motion (ROM) was measured during the sequential arthroscopic release of adhesions, with special regard to external rotation. Postoperative ROM and subjective shoulder function were also evaluated. METHODS: Eighteen patients treated with ORIF of the proximal humerus were scheduled to the unified arthroscopic procedures comprising sequential limited subacromial bursectomy, removal of the adhesions between the deltoid, plate, and humerus, as well as the plate removal. The ROM of the operated and opposite shoulders were assessed before surgery, intraoperatively and after a minimum two-year follow-up, with special regard to external rotation in adduction (AddER) and abduction (AbdER). Besides, the Constant-Murley score and Subjective Shoulder Value (SSV) were evaluated before a plate removal and after a minimum two-year follow-up after the surgery. RESULTS: Deltoid adhesion release correlated with considerable and statistically significant improvement of AddER (p < 0.0002) but not with the intraoperative range of AbdER. Significant improvement of AddER, but also of AbdER and other range of motion was noted at the follow-up. The improvement of the affected shoulder function following arthroscopic plate removal was considerable and statistically significant according to the modified Constant-Murley score (p < 0,01) and SSV (p < 0.0000) after a minimum of two-year follow-up. CONCLUSIONS: Our findings are the first to highlight the influence of deltoid muscle, plate, and humerus adhesions on limiting external rotation in adduction after ORIF treatment of proximal humerus fractures. These observations allow the identification of a new shoulder evaluation symptom: Selective Glenohumeral External Rotation Deficit (SGERD) as well as functional deltohumeral space.

Clinical and ultrasonographical follow-up after standard removal of distal radius volar plates positioned distal to the watershed line.

Marginal fracture types of the distal radius may require volar plate positioning distal to the watershed line. Subsequently, plate prominence with direct friction with the flexor tendons occurs which is associated with flexor tendon pathology. Standard plate removal can be proposed. This cohort study examined clinical outcome, patient satisfaction and ultrasonographical assessment of the relation of the flexor pollicis longus (FPL) and the volar rim after standard plate removal. Twenty patients with volar plate prominence after osteosynthesis for distal radius fractures were included. Plate removal was performed at least 4 months after initial surgery. The mean age was 60 years (range 39-84). The average delay from hardware removal to assessment was 2.9 years (range 1.0-5.0 years). Mean flexion, extension and radial deviation were significantly decreased (p < 0.05) compared to the contralateral side, while ulnar deviation, pro- and supination and grip strength were not. Mean QuickDASH score was 21.5. 85% of patients described their result as good to excellent. 80% would undergo the intervention again. During ultrasonography, distance from FPL to volar rim remained significantly decreased compared to the uninjured side in neutral and flexed position (p < 0.05) despite plate removal. The largest distance between the FPL and the volar cortical bone, which is mainly occupied by the pronator quadratus, did not differ. In this study, the range of motion and FPL distance to the distal radius normalized only partially compared to the uninjured wrist after standard plate removal.

Long-term Stability after Reduction of Mandible Fracture by Keyhole Plate: Evaluation at the Time of Plate Removal.

BACKGROUND: Various types of miniplates have been developed and used for the reduction of facial bone fractures. We introduced Yang's Keyhole (YK) plate, and reported on its short-term stability. The purpose of this study was to evaluate the long-term stability of the YK plate, as a follow-up study, by examining the patients who had used the YK plate among the patients with the reduction of mandible fractures and who visited for plate removal. METHODS: We reviewed the medical records of 16 patients who underwent mandibular fracture fixation using a YK plate (group I) and 17 patients who underwent mandibular fracture fixation using a conventional plate (group II). Assessment was then made on malunion, occlusal stability, discomfort during the application, and clinical symptoms. RESULTS: From January 2015 to December 2017, a total of 36 patients underwent mandibular fracture surgery using a YK plate. A total of 16 patients received plate removal. Among them, 15 were male and 1 female. The average age was 26 years. The applied surgical sites were the 12 on mandibular angle, 4 on mandibular symphysis, and 2 on subcondyle. The application period of YK plate was an average of 335 days. During the same period, 45 people underwent surgery on the conventional plate. A total of 17 patients received plate removal. Among them, 15 were male and 2 females. The average age was 36 years. The applied surgical sites were the 8 on mandibular angle, 4 on mandibular symphysis, and 2 on subcondyle. The application period of the conventional plate was an average of 349 days. No malocclusion occurred at the time of removal, and occlusion was stable. No patient complained of joint disease or discomfort. CONCLUSION: The YK plate system, in which the screw was first inserted and the plate was applied, for clinical convenience did not cause any particular problem and no significant difference from the conventional plate.

Plate removal without loss of correction after open-wedge high tibial osteotomy is possible when posterior cortex bone union reaches osteotomy gap center even in incompletely filled gaps.

PURPOSE: The study aimed to evaluate the optimal timing for plate removal after open-wedge high tibial osteotomy (OWHTO) without loss of correction and to investigate risk factors for loss of correction after plate removal. The study presents the hypothesis that plate removal without loss of correction was possible when gap filling reached zone 2 (25-50%) on anteroposterior radiographs. METHODS: Ninety-one patients (101 knees) who underwent OWHTO using the TomoFix® plate were enrolled. Plate removal was performed at an average 16.4 ± 5.4 months after OWHTO. Clinical evaluation included plate-related symptoms, the Japanese Orthopedic Association Knee Score (JOA score), and Oxford Knee Score (OKS). Radiological outcomes, including the hip-knee-ankle angle (HKA), weight-bearing line ratio (WBLR), medial proximal tibial angle (MPTA), and posterior tibial slope (PTS), were evaluated preoperatively, at plate removal and at 1 year after plate removal. Computed tomography (CT) was performed at plate removal to evaluate the flange bone union, progression rates of gap filling, and posterior cortex bone union. In addition, the risk factors for loss of correction after plate removal were evaluated. RESULTS: At plate removal, 63 (62.4%) knees had plate-related symptoms (mild, 56 knees; moderate, 7 knees; severe, 0). After plate removal, the JOA score did not change, whereas OKS further improved; six knees developed loss of correction. On CT evaluation at plate removal, the flange bone union was achieved in all cases; the progression rates of gap filling and posterior cortex bone union were 47.0% ± 16.6% and 62.8% ± 16.5%, respectively. A posterior cortex union rate of < 43.3% was the only predictor for loss of correction after plate removal (odds ratio: 1.38, P < 0.01). CONCLUSIONS: Plate removal without loss of correction after OWHTO was possible when bone union of the posterior cortex reached the center of the osteotomy gap even in incompletely filled gaps. LEVEL OF EVIDENCE: Therapeutic case series, Level IV.

Impact of Soong grading on flexor tendon ruptures following palmar plating for distal radial fractures.

The purpose of this study was to evaluate flexor tendon injuries following palmar plating of distal radial fractures relative to the Soong grade. This retrospective cohort study included 113 patients who underwent palmar plate removal after a distal radial fracture between 2010 and 2016. In 13 patients, a greater than 50% injury of the flexor pollicis longus tendon was observed. Of these, nine patients were classified as Soong grade 2, four as Soong grade 1 and none as grade 0. The difference between the Soong groups was statistically significant (p = 0.006). Flexor tenosynovitis was present in eight patients (7%) and more likely in patients with a higher Soong grade (p = 0.026). We conclude that higher Soong grades are associated with significantly more flexor tendon complications. Therefore, elective removal of the palmar plate after union of the fracture should be considered in patients with Soong grades 1 and 2. Level of evidence: IV.

Titanium plate removal in orthognathic surgery: prevalence, causes and risk factors. A systematic literature review and meta-analysis.

The purpose of this review was to analyse the prevalence of titanium plate removal in orthognathic surgery, as well as the causes of plate removal, and to determine the associated risk factors. A thorough search of the PubMed, Scopus, Embase, and Web of Science databases was conducted. The inclusion criteria were studies of adult patients who underwent orthognathic surgery in which monocortical titanium plates and screws were placed. Of the 325 references identified, 19 were included in the qualitative synthesis and meta-analysis. Overall, 13.4% (95% confidence interval (CI) 9.6-18.3%) of the patients required the removal of at least one titanium plate; 9.7% (95% CI 6.3-14.6%) of the plates placed were removed. The main causes of removal were infection (6.6%), exposed plate (2.6%), thermal sensitivity (2.1%), palpable plate or screw (2.0%), and pain/tenderness (1.9%). Female sex, smoking, and plates placed in the lower jaw were the main risk factors, with odds ratios of 1.5 (95% CI 1.1-2.0), 2.5 (95% CI 1.4-4.2), and 1.8 (95% CI 1.0-3.2), respectively. In no case was a publication bias problem detected. Fixation using titanium plates has a relatively low prevalence of removal. Infection is the main reason for removal. Female sex and smoking, are the main risk factors for removal. Plates placed in the lower jaw is a non-significant risk factor.

Optimal effective-site concentration of remifentanil for sedation during plate removal of maxilla.

BACKGROUND: Removal of the plate following Le Fort I osteotomy and BSSO (bilateral sagittal split osteotomy) is a common procedure. However, patients who undergo plate removal experience intense pain and discomfort. This study investigated the half-maximal effective concentration (Ce50 ) of remifentanil in the prevention of plate removal pain under sedation using dexmedetomidine. METHODS: The study evaluated 18 patients, between 18 and 35 years of age, scheduled for elective surgery. Remifentanil infusion was initiated after sedation using dexmedetomidine, and started at a dose of 1.5 ng/mL on the first patient via target-controlled infusion (TCI). Patients received a loading dose of 1.0 µg/kg dexmedetomidine over 10 min, followed by a maintenance dose of 0.7 µg/kg/h. When the surgeon removed the plate, the patient Modified Observer's Assessment of Alertness/Sedation (MOAA/S) score was observed. RESULTS: The Ce of remifentanil ranged from 0.9 to 2.1 ng/mL for the patients evaluated. The estimated effect-site concentrations of remifentanil associated with a 50% and 95% probability of reaching MOAA/S score of 3 were 1.28 and 2.51 ng/mL, respectively. CONCLUSIONS: Plate removal of maxilla can be successfully performed without any pain or adverse effects by using the optimal remifentanil effect-site concentration (Ce50 , 1.28 ng/mL; Ce95 , 2.51 ng/mL) combined with sedation using dexmedetomidine.

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.

Benefits of hardware removal after plating.

Routine implant removal is frequently performed although evidence-based guidelines are lacking. But routinely planned implant removal has significant economic implications and shows considerable complication rates. In general, clinical outcome seems to improve but pain relief after operation is often unpredictable. Even in patients reporting implant-related pain, implant removal does not guarantee relief and may be associated with further complications. The intra- and postoperative complication rate remains very high. Implant removal demonstrates a significant learning curve and unsupervised junior surgeons tend to cause more complications. The need for implant removal may be questioned. Even with the implant in place, contact activities can be resumed. However, a new adequate trauma can create a new fracture independently if there is an implant in-situ or not. It is important to understand the complications and outcomes to be expected with hardware removal to carefully evaluate its indication.

Relationship between plate removal and Soong grading following surgery for fractured distal radius.

The aim of this study was to determine the relationship between volar plate removal and the Soong classification following fixation for fractured distal radius. In this retrospective cohort study, all consecutive patients who had volar plate fixation for a distal radius fracture in 2011-2015 were reviewed. Differences in Soong classification between patients who had plate removal and those who did not were analysed. The total incidence of plate removal was calculated and the indications analysed. A total of 323 patients were included. The incidence of plate removal in all patients was 17%. Soong classification was significantly higher in patients who had plate removal compared with those who did not. For patients with plate placement classified as Soong grade 2, the incidence of plate removal was almost six times higher than those classified as Soong grade 0. The relationship between volar plate removal and a higher Soong grading stresses the importance of accurate plate positioning. LEVEL OF EVIDENCE: IV.

Fracture of fusion mass following anterior cervical plate removal: Case report.

We present the case of a delayed pseudoarthrosis resulting from a fracture at the site of a radiographically confirmed anterior cervical fusion following plate removal. In this case, an anterior cervical plate was removed to allow for further surgery at a supra-adjacent level. A modicum of literature exists describing delayed fractures following hardware removal in thoracolumbar fusion constructs. The development of a fracture/pseudoarthrosis following hardware removal at the site of a radiographically confirmed anterior cervical fusion has not been previously reported. We describe the clinical presentation and operative management in the case of this rare and unexpected complication.