PMC

a Measurement of bone screw head diameter using a Mitutoyo digital micrometer with a range of (0–25) mm, b torque screwdriver with a 2.5 mm bit and angularly stable plate with locking bone screws (photos Čada)

Intraoperative picture of plating.
Open reduction and internal fixation of a Type 1 open fracture tibia with locking plate and screws. The tibia is being drilled with a quick coupling drill bit with appropriate sleeve.

We measured the time required to remove the screws and the size of metal debris through our technique. (A) The drill bits in a screw extractor set (IRWIN^®, Huntersville, NC, USA) are made of cobalt and not medical instruments. (B) A 6-mm diameter drill bit for the removal of 3.5 mm locking screws was held to a Jacobs Chuck of pneumatic-powered tool. (C) A plate was fixed in a wooden bar with the three locking screws whose heads were deliberately damaged. Further, we drilled the heads in a counterclockwise manner. (D) One head of the locking screw was then removed, which required less than a minute. (E) Next, 2 more heads removed, which required approximately 2 min to the separation of the plate and screws. (F) Upon observation of metal debris, the size of particles was found to be relatively large to remove.

Intraoperative testing of syndesmotic stability after distal fibular plating using a mounted drill bit for locking screws: The ankle joint shows relevant external rotational instability of the anterior tibiofibular ligament (B) indicating the need for surgical stabilization. Note opening (white arrow in B) of the star figure (black arrow in A) normally built by the tibiofibular, tibiotalar and talofibular joint lines by external rotation of the distal fibula (B).