Titanium-based plates used to repair facial fractures are sometimes removed despite their high biocompatibility. Local discomfort can lead to plate removal surgery. Local discomfort may differ according to patient characteristics, tissue properties and plate thickness; however, little is known about the relationship between these conditions and plate removal.
We performed a hospital-based, retrospective cohort study of patients who underwent internal fixation for facial or frontal bone fracture. To identify factors associated with plate removal, we used multivariate logistic regression models.
Data from 138 patients were analysed. All plates were made of commercially pure titanium, and all screws were made of titanium, 6% aluminium and 4% vanadium alloy. Plate thickness was 1.2 mm or 0.6 mm. Among plate locations, the frontozygomatic suture showed the highest percentage of complications (84%, 86 of 102 patients). The majority consisted of palpability and visibility. In patients who underwent plate removal (n = 96), all plates and screws were removed successfully. All plate-related complications were resolved after plate removal. No complications were introduced by plate removal. Plates 1.2 mm in thickness on the frontozygomatic suture had a relative risk of complications 2.48 times (95% confidence interval, 1.13–5.43) that of plates 0.6 mm in thickness. By multivariate analysis, the presence of plates on the frontozygomatic suture was a significant and independent risk factor for removal. Patients with plates on the frontozygomatic suture had a risk of plate removal 3.95 times (95% confidence interval, 1.55–10.07; P < 0.01) that of patients without plates on the frontozygomatic suture.
Plates on the frontozygomatic suture have a high rate of complications. Thick plates increase these risks. Patients with plates on the frontozygomatic suture are more likely to undergo plate removal surgery than patients without plates on the frontozygomatic suture.
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Published online: October 26, 2011
Accepted: September 27, 2011
Received: March 30, 2011
☆Part of this work was presented at the 26th Annual Meeting of the Japan Society of Cranio-Maxillo-Facial Surgery, Morioka, Japan, 17 October 2008.
© 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.