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Objective: To determine the reasons for removing titanium hardware (mini plates, microplates, and titanium screws) in postoperative patients with maxillofacial trauma. Study Design: Prospective longitudinal study. Place and Duration of Study: Armed Forces Institute of Dentistry Rawalpindi, Pakistan from Mar to Dec 2023. Methodology: A total number of Fifty-one (n=51) patients reported to the Oral Surgery Department of the Armed Forces Institute of Dentistry for hardware removal previously treated with maxillofacial trauma. After following inclusion and exclusion criteria, consecutive sampling was performed. Reasons for hardware removal were evaluated and recorded. Results: Out of a total of fifty-one individuals, 41(80.3%) were male and 10(19.7%) were females. Of 51 patients, 18(35.2%) reported the complaint of pus discharge as their main reason for seeking expert opinion. In 24(47%) patients, elective hardware removal was performed due to the patient's demands. Meanwhile, 4(7.8%) patients reported the chief complaint of experiencing pain and unpleasant sensations. Hardware palpability was another factor reported by 5(9.8%) of the patients for hardware removal. Conclusion: The patient's request and infections were the leading causes of the plates and screws removal. The plate removal usually took place 6 to 12 months after initial surgery, and the mandible was the most often region from where these mini plates and screws were removed.

Background Hardware removals are among the most commonly performed surgical procedures worldwide. Current literature offers little data concerning postoperative patient satisfaction. The purpose of our study was to evaluate the patients’ point of view on implant removal. Methods We surveyed patients of a German level one trauma center, who underwent hardware removal in 2009 and 2010, with regard to their personal experiences on implant removal. Exclusively, data obtained out of the survey were analyzed. Results In 332 patients surveyed, most hardware removals were performed at the ankle joint (21 %) followed by the wrist (15 %). The most frequent indication was a doctor’s recommendation (68 %), followed by pain (31 %) and impaired function (31 %). Patient reported complication rate of implant removal was 10 %. Importantly, after implant removal because of pain or impaired function patients reported an improvement in function (72 %) as well as decreased pain (96 %). 96 % of all responding patients and 66 % of the patients who suffered from subsequent complications would opt for surgical implant removal again. Conclusion In summary, despite the challenging and frequently troublesome nature of surgical hardware removal our data contradicts the widely held view that implant removal is often without a positive effect on the patients. These findings may influence the surgeons’ attitude towards implant removal and their day-to-day routine in patient counseling.

Background Syndesmotic injuries can lead to ankle instability. They are treated with syndesmotic screws or suture device. The necessity for screw removal remains a topic of debate. When removal is performed, it usually occurs 2 to 3 months post-operation. In such cases, the screw is typically visualized flouroscopically before removal. We describe an ultrasound-guided procedure for screw removal that avoids radiation exposure and has minimal infrastructural requirements. Method In this prospective cohort study, Cohort 1 included 26 screws (18 patients) that were removed under both fluoroscopic and ultrasound guidance. This allowed for the assessment of the accuracy of ultrasound compared to fluoroscopic visualization. In Cohort 2, 22 screws (17 patients) were removed solely under ultrasound guidance to evaluate the practical applicability of the method. Results A total of 35 patients were included into our study, eighteen in the first and seventeen in the second cohort respectively. In Cohort 1, the mean distance between the fluoroscopic and ultrasound measurement points of the screw heads was 2.9 mm. The mean radiation dose was 1.4 cGy/cm², and the mean operation duration was 15.2 min. Cohort 2 had a mean operative duration of 10.3 min. There were no significant differences in baseline characteristics between the groups. Radiation exposure was not present in Cohort 2. In Cohort 1, the ultrasound-guided screw localization revealed high accuracy, with the threshold < 5 mm ( p  = 0.040). We did not identify any significant predictors for the screw localization accuracy. The duration of the surgical procedure was similar in both groups. In the entire pooled cohort, a longer distance from skin to screw was associated with a longer surgery duration (ρ = 0.419, p  = 0.012). Skin-to-screw distance was found to be the only independent predictor of surgery duration ( p  = 0.009). Conclusion Ultrasound-guided localisation and removal of syndesmotic screws demonstrate comparable accuracy compared to fluoroscopy, with the additional benefits of lower infrastructural requirements and associated costs. Furthermore, this method has a similar operative time to fluoroscopy and eliminates radiation exposure, supporting its feasibility as an efficient and safe alternative for syndesmotic screw removal. Trial registration In accordance with the Declaration of Helsinki the study protocol was approved by the Ethics Review Board of the University of Regensburg, Protocol number 21-2204-101.

Purpose Sacropelvic fixation plays a crucial role in complex spinal surgeries, particularly in adult spinal deformity (ASD) and other conditions requiring lumbosacral stabilization. This systematic review and meta-analysis aims to compare the rates of symptomatic screw prominence and screw removal between S2-alar-iliac (S2AI) and iliac screws, as well as those examining each screw type independently, to provide a comprehensive understanding and guide surgical decision-making and improve patient outcomes. Methods A systematic review following PRISMA guidelines was conducted using Medline, SPORTDiscus, Cochrane Library, and Scopus databases. Inclusion criteria encompassed studies evaluating screw prominence or removal rates for S2AI and iliac screws, individually or in comparison, involving adult patients with sacropelvic fixation. Data on demographics, comorbidities, surgical characteristics, and outcomes were extracted. Statistical analysis included relative risk difference (RR) calculations using a random effects model, with heterogeneity assessed via the I² statistic. Results Eighteen studies were included, comprising 1462 patients: 648 with S2AI screws and 814 with iliac screws. Symptomatic screw prominence was significantly lower for S2AI screws (1.9%, 12/648) compared to iliac screws (6.3%, 51/814), with a pooled RR difference of 0.08 (95% CI 0.04, p  < 0.001). Screw removal rates due to prominence were 0% (0/12) for S2AI screws versus 27.5% (14/51) for iliac screws. Low heterogeneity was observed for both outcomes (I² = 3.32% for prominence, I² = 0.0% for removal). Conclusion S2AI screws demonstrate significantly lower rates of symptomatic prominence and screw removal compared to iliac screws, supporting their clinical and economic advantages in sacropelvic fixation for ASD. Technological advancements and innovations in implant design further enhance the efficacy of S2AI screws. These findings advocate for their adoption as an effective fixation technique, reducing hardware complications and improving patient outcomes. Future studies will aim to explore factors influencing prominence risk and optimize surgical strategies in ASD treatment.

Background Clavicle hardware removal is a standard secondary procedure after fracture fixation, yet clinical decision-making regarding indications, timing, imaging, and postoperative recommendations remains highly variable. Despite the frequency of this intervention, no study to date has systematically assessed real-world practice patterns among shoulder and trauma surgeons in the German-speaking region. The purpose of this study was to evaluate current indications, preferred timing, imaging strategies, and postoperative recommendations related to clavicle hardware removal. Methods A cross-sectional, web-based survey was distributed to members of the German-speaking Shoulder and Elbow Society (DVSE). The questionnaire assessed surgeon demographics, surgical experience, annual volume of hardware removal, indications for removal (general and absolute), preferred timing, imaging modalities used for preoperative planning, the influence of fracture location, and recommendations for return to sports. Only complete responses were included in the final analysis. Results A total of 198 surgeons completed the survey. Irritation (90.9%) and patient preference (87.9%) were the most frequently selected indications for hardware removal, whereas infection (56.6%) was the predominant absolute indication for removal. Most surgeons favored delayed removal: 38.9% recommended hardware removal after more than 18 months, and 42.9% relied on radiographic consolidation as the primary determinant of when to remove the hardware. Radiographs were routinely obtained (99.0%), while CT scans were used selectively (37.4%), particularly for early elective procedures. Most respondents reported no fracture-location–specific differences in removal frequency, although lateral fractures were most cited among those indicating variation. Recommendations for return to sport varied widely, with most surgeons allowing resumption of athletic activity between 6 and 12 weeks postoperatively. Conclusion Despite the high volume of clavicle hardware removal procedures, management strategies remain heterogeneous, underscoring persistent uncertainty in indications, timing, imaging protocols, and return-to-sport advice.

Vascularized autologous bone transplantation combined with implant restoration is a preferred method for functional mandibular reconstruction. However, there is currently no consensus on whether internal fixation devices, such as titanium plates and screws, must be removed during the reconstruction process. This study aimed to assess the biomechanical and clinical necessity of removing these fixation devices. Eight patients who underwent mandibular reconstruction with fibula flaps and subsequent dental implantation were included. The study utilized finite element analysis to simulate and compare biomechanical stress distributions in models where fixation devices were either retained or removed. The clinical outcomes including peri-implant health, masticatory efficiency, and oral health-related quality of life were evaluated through follow-up examinations and standardized questionnaires. The biomechanical analysis indicated that the maximum stress on the grafted fibula surrounding the implants was significantly lower in the retention group (42.07 ± 12.06 MPa) compared to the removal group (44.892 ± 14.80 MPa, P = 0.017*). Furthermore, a positive correlation was identified between the simulated stress levels on the implants and the severity of gingival bleeding (coefficient: 0.82, P = 0.013*). Clinically, while there were no significant differences in marginal bone loss between the two approaches, patients who retained the internal fixation devices reported better quality of life scores regarding functional limitations and physical pain. In conclusion, retaining internal fixation devices appears to reduce mechanical stress on the peri-implant fibula graft and is associated with improved patient-reported outcomes. These findings suggest that the routine removal of reconstruction plates may not be necessary and that retention can favour peri-implant health and patient comfort.

Purpose To describe the indications, outcomes, and incidence of complications after hardware removal from anterior approaches following acetabular fractures. Materials Over ten years, 13 patients were included, complaining of pain due to late infection in nine (69.2%) and secondary osteoarthritis in four (30.8%). Fractures classification were T-type fracture (46.2%), both columns (38.5%), one transverse (7.7%), and one (7.7%) T-type with a posterior wall. The approaches utilized for hardware removal were modified Stoppa in 11 (84.6%) patients, ilioinguinal lateral (iliac) window in nine (69.2%), Pararectus in one (7.7%), ilioinguinal in one (7.7%), and Kocher-Langenbeck approach in one (7.7%)). Results The patients’ mean age was 37.1 ± 14.9 (21 to 65) years, and nine (69.2%) were males. Hardware removal was performed after the index surgery by a mean of 35.6 ± 20 months. The mean operative time was 143.8 ± 36 min, and the mean blood loss was 1573 ± 842 CC. The mean hospital stay was 3.2 ± 2.3 days, and all patients required blood transfusion. Four (30.8%) intraoperative complications, two (15.4%) vascular injuries, One (7.7%) urinary bladder injury, and in two (15.4%) broken screws could not be retrieved. Postoperative complications in five (38.5%): three (23.1%) had superficial wound infection, one (7.7%) had DVT, and one (7.7%) had L5 nerve root injury. After a mean follow up of 11.3 ± 4.4 (6 to 20) months, the VAS score decreased from a preoperative median of 6 (2 to 8) to a median score of 1 (0 to 6) at the last follow up. 11 (84.6%) patients described the pain as none or occasional, and eight (61.5%) were very satisfied with the results. Conclusion Hardware removal from the anterior approaches after acetabular fractures is demanding and carries a high complication risk. The surgeries should be performed when highly indicated, and the surgical team must be familiar with the anterior approaches.

Background: Recurrent anterior shoulder instability often requires surgical intervention, with 2 prominent approaches: anatomic (eg, Bankart) and nonanatomic (eg, Latarjet) procedures. While most surgeons favor arthroscopic Bankart, the open Latarjet procedure offers advantages such as quicker recovery and lower redislocation rates. On the other hand, complications include postoperative pain due to an impingement between hardware and soft tissue, resolved through screw removal. Purpose/Hypothesis: The purpose of this study was (1) to assess the Walch-Duplay score for functional outcomes and (2) to examine Subjective Shoulder Value (SSV), Single Assessment Numeric Evaluation (SANE), and visual analog scale (VAS) scores, as well as satisfaction and return-to-sports rate. It was hypothesized that screw removal does not significantly affect functional outcomes. Study Design: Cohort study; Level of evidence 3. Methods: Clinical data from a single-operator series of 692 shoulders treated for anterior instability with Latarjet technique between 2007 and 2021 were analyzed. Those who underwent revision surgery, previously underwent surgery on the shoulder, and had concomitant shoulder injuries were excluded. A total of 530 shoulders were eligible, and of these, 41 shoulders needed screw removal (7.7%). Propensity score matching yielded 41 pairs of shoulders split between the screw removal and no revision group. Results: At a mean follow-up of 85.0 months, the Walch-Duplay functional score was 76 ± 19 (median, 80; range, 15.0-100.0) and 81 ± 22 (median, 85; range, 0.0-100.0) ) in patients for no revision and screw removal, respectively (P = .15); SSV was 82 ± 15 (median, 85; range, 40.0-100) and 86 ± 14 (median, 90; range 40.0-100.0) (P = .14), respectively; SANE was 89 ± 19 (median, 100; range 0.0-100.0) and 89 ± 14 (median, 95; range 50.0-100) (P = .16), respectively; and VAS was 0.7 ± 1.3 (median, 0; range, 0-5) and 1.1 ± 1.5 (median, 1; range 0-5) (P = .06). Satisfaction and return-to-sport rates were statistically significantly lower in the screw removal group (P = .03 and P = .04, respectively). Conclusion: Our results confirm that screw removal after the open Latarjet procedure does not substantially affect functional outcomes. However, we acknowledge a lower return to sports and worse satisfaction scores in the screw removal group.

Background Locking plate fixation combined with coracoclavicular (CC) augmentation using a suspensory fixation system is a widely accepted technique for unstable lateral clavicle fractures. Elective hardware removal is commonly performed due to mechanical irritation or discomfort, yet data on radiographic and clinical outcomes following implant removal remain limited. The purpose of this study was to evaluate immediate radiographic loss of reduction and long-term clinical outcomes after removal of the locking plate and CC augmentation in patients with lateral clavicle fractures. It was hypothesized that a measurable loss of reduction occurs following hardware removal, and that clinical outcomes would nevertheless remain excellent, with no residual patient complaints. Methods A total of 41 patients with lateral clavicle fractures treated with locking plate fixation and CC augmentation underwent implant removal between 2013 and 2022. Coracoclavicular distance (CCD) was measured pre- and immediately post-removal. Clavicular drill tunnel (CDT) diameters were measured post-removal. Clinical outcomes were assessed using PROMs (CMS, DASH, SPADI, SSV, VAS), as well as return to work and sports, and re-operation rates. Results The mean CCD increased from 9.1 ± 3.2 mm to 10.0 ± 3.0 mm after implant removal ( p < .0001). A loss of reduction ≥ 10% was observed in 54% of cases, and a substantial loss (≥ 6 mm) in 12%. CDT measurements showed significant tunnel widening toward the inferior cortex compared to the superior and mid-clavicular cortex ( p < .0001). Clinically, 23 patients were included after a mean follow-up of 71 months. Patients achieved excellent outcomes with a mean CMS of 88.5 ± 10.5, DASH of 5.4 ± 7.6, SPADI of 93.4 ± 7.9, SSV of 95.4 ± 6.9, and VAS of 0.6 ± 1.1. PROMs did not differ between patients with or without radiographic loss of reduction. All patients returned to work and sports, with no reoperations required. Conclusions Although 54% of patients showed a measurable radiographic loss of reduction following implant removal, substantial displacement was uncommon (12%). Radiographic loss of reduction was not associated with inferior clinical outcomes. Patients demonstrated excellent long-term function, with a full return to work and sports.

Purpose To evaluate immediate loss of reduction in patients undergoing hardware removal after arthroscopically assisted acromioclavicular (AC) joint stabilization using a high-tensile suture tape suspensory fixation system and to identify risk factors associated with immediate loss of reduction. Materials and methods Twenty-two consecutive patients with a mean age of 36.4 ± 12.6 years (19–56), who underwent hardware removal 18.2 ± 15.0 months following arthroscopically assisted stabilization surgery using a suspensory fixation system for AC joint injury between 01/2012 and 01/2021 were enrolled in this retrospective monocentric study. The coracoclavicular distance (CCD) as well as the clavicular dislocation/acromial thickness (D/A) ratio were measured on anterior–posterior radiographs prior to hardware removal and immediately postoperatively by two independent raters. Loss of reduction, defined as 10% increase in the CCD, was deemed substantial if the CCD increased 6 mm compared to preoperatively. Constitutional and surgical characteristics were assessed in a subgroup analysis to detect risk factors associated with loss of reduction. Results Postoperatively, the CCD significantly increased from 12.6 ± 3.7 mm (4.8–19.0) to 14.5 ± 3.3 mm (8.7–20.6 mm) ( p  < 0.001) while the D/A ratio increased from 0.4 ± 0.3 (− 0.4–0.9) to 0.6 ± 0.3 (1.1–0.1) ( p  = 0.034) compared to preoperatively. In 10 cases (45%), loss of reduction was identified, while a substantial loss of reduction (> 6 mm) was only observed in one patient (4.5%). A shorter time interval between index stabilization surgery and hardware removal significantly corresponded to immediate loss of reduction (11.0 ± 5.6 vs. 30.0 ± 20.8 months; p  = 0.007), as hardware removal within one year following index stabilization was significantly associated with immediate loss of reduction ( p  = 0.027; relative risk 3.4; odds ratio 11.67). Conclusions Substantial loss of reduction after hardware removal of a high-tensile suture tape suspensory fixation system was rare, indicating that the postoperative result of AC stabilization is not categorically at risk when performing this procedure. Even though radiological assessment of the patients showed a statistically significant immediate superior clavicular displacement after this rarely required procedure, with an increased incidence in the first year following stabilization, this may not negatively influence the results of ACJ stabilization in a clinically relevant way. Level of evidence IV.