Late Removal of Titanium Hardware from the Elbow Is Problematic

A retrospective review of 21 patients that underwent bone screw removal from the elbow was studied in relation to the type of metal, duration of implantation, and the location of the screws about the elbow. Screw failure during extraction was the dependent variable. Five of 21 patients experienced hardware failure during extraction. Fourteen patients had titanium alloy implants. In four cases, titanium screws broke during extraction. Compared to stainless steel, titanium screw failure during removal was not statistically significant (P = 0.61). Screw removal 12 months after surgery was more likely to result in broken, retained screws in general (P = 0.046) and specifically for titanium alloy (P = 0.003). Bone screws removed from the distal humerus or proximal ulna had an equal chance of fracturing (P = 0.28). There appears to be a time-related association of titanium alloy bone screw failure during hardware removal cases from the elbow. This may be explained by titanium's properties and osseointegration.