Investigating Surgical Removal of Plates and Screws in Patients with Maxillofacial Trauma

Abstract

BACKGROUND The removal of plates and screws in maxillofacial surgery following trauma has emerged as a significant concern. Understanding the primary reasons for hardware removal is crucial to enhance patient outcomes and reduce postoperative complications. METHODS This retrospective cohort study investigated 109 patients who underwent plate and screw fixation at Shahid Rahnemoun Hospital (Yazd, Iran) from 2011 to 2021. The study included 109 patients who met the inclusion criteria. The primary outcome was to identify and classify the causes necessitating plate and screw removal, which were categorized into four main groups: Pain, Complications, Procedural Problems, and Patient-Initiated Factors. Descriptive statistics were used to summarize the data. One-way analysis of variance and Chi-square or Fisher's exact tests were employed to analyze the associations between variables. RESULTS The study population was predominantly male (74.3%), with a mean age of 35.25 ±19.47 years. The time between plate and screw insertion and removal ranged from 14 days to 3 years, while this interval in most of the patients (51.4%) was between six months to one year. The primary reasons for hardware removal were patient-initiated factors (51.4%), followed by procedural problems (24.8%), complications (11.9%), and removals due to pain (11.9%). Except for age, other studied variables were not significantly associated with the removal cause. CONCLUSIONS The high prevalence of patient-initiated removals highlights the importance of considering individual preferences and psychological factors in surgical planning. The study emphasizes the need for age-specific considerations and a focus on preventative strategies to reduce infection-related complications.