As titanium pins cause very tight bone ingrowth,9,10 the surface of titanium screws used for femoral neck fractures in children are smoothed to reduce turning force.1 The hexagonal sockets wore off rapidly and proved to be too weak to overcome the necessary torque for loosening the pin from the bone.
Lee and colleagues10 found that significantly more operative time was needed to remove titanium pins (vs steel pins) after 12 months or longer. When Asnis III pins (Howmedica, Rutherford, New Jersey) were used in the treatment of femoral neck fractures in aged patients, similar problems did not occur. One possible explanation is that bone density is higher in adolescents than in adults. In addition, more bone ingrowth and higher bone compression might occur in adolescent bones.1 Given the considerable disadvantages noted in their series, Ilchmann and Parsch1 concluded that use of cannulated titanium screws should be suspended and that stainless steel pins are safe to use in SCFE.
In our patient’s case, we also struggled to remove titanium screws. Subtrochanteric fractures can be complications after removal of screws for femoral neck fractures in children. If there are no specific screw-related symptoms, one should consider leaving the screw in place and avoiding screw removal.