Should orthopaedic plates and screws be removed?

 In the OR change-room was a younger surgeon who had taken over my emergency room work. I mentioned that I had just removed a forearm plate.

I don’t remove plates” he said.

“Why is that?”

I just don’t do it.”

“There might be some good reasons for taking them out…” I ventured.

“Like what?”

“Well there is always the risk of breaking the arm again, adjacent to the plate”

“When that happens I would remove the plate when I put the next on!”

“I don’t think that is quite the point – with a plate still in place even relatively minor trauma might cause the bone to break, which otherwise might not have happened if there had not been a plate.”

“How is that?”

“The plate, with a different distortion factor from the bone acts as a stress rider, and concentrates the stress at the sharp boundary at the end of the plate.”

“Well, I don’t know about that…”

“The screws through the bone also represent a weakness. Imagine fixing a plate on a bamboo by screws, and then bending it. Where will it break? Either through a screw hole or at the end of the plate.”

“But what are the chances of another fall onto the same limb?”

“Quite good. People tend to fall and injure themselves in particular patterns. Further with ageing, and loss of balance and sight and osteoporosis, the risks increase.”

“I can’t do much about that, can I?”

“A further problem is that the plate itself causes a weakening of the bone. The plate redirects the forces which would normally be transmitted through the bone, and the reduced stimulus to the bone and the strengthening mineral in the bone decreases, as per Wolf’s Law. This has been called stress shielding.”

“Anything else?”

“There is a micro movement between the plate and the screws, even when bone is healed, and this abrasion produces a fine dust from the alloy. This is easily seen, staining and permeating the adjacent tissues.”

“So what?”

“It may not matter, but conceptually the presence of this absorbable alloy may not be a good idea. Some years ago, I was able to demonstrate increased blood level of chromium, cobalt and beryllium in people subject to particles from implanted metal on metal abrasion.”

“Seems fanciful…”

“There are other reasons – as in this case, there was a danger of rupture to tendons overlying the screw heads because of abrasion. The movement at the adjacent joint was also reduced, because the plate had caused the muscles to glue down.   Then there was the discomfort of the ‘cold syndrome’ and pain on knocking against the plate through the skin. A relative reason might be future difficulties with MR imaging caused by residual metal. Some people are distressed by airport metal detector activation.

Implants represent “foreign material” which can act as a nidus for subsequent infection, perhaps years after insertion. Should that happen removal of the metal might become mandatory. This means that whenever metal is inserted a mode of removal must be designed into the initial procedure. This might not be as obvious as it seems. In the child exuberant bone can rapidly cover the metal, and grow make it even more inaccessible. Inserting a curved intermedullary rod into an unhealed fracture, or leaving in place a bent intermedullary rod, before healing is completed, might make extraction impossible, if substantial surgical damage is to be avoided.

Of course all these reasons remain relative to many factors, including cost, time off work and much more which needs be assessed individually, ideally by the surgeon who inserted them”

“Well, I don’t remove plates.”

The study referenced below demonstrate increased risk of breakage of a long bone at screw-holes and simulated “demineralisation” (osteoporosis). It is far from an exact simulation, but it demonstrates a danger. It must be remembered that whether a screw-hole is empty or contains a screw in the hole, the bone is weakened either way. Leaving the screw in place will cause the hole to persist. Following removal of screws the screw-hole may or may not close, but the surrounding bone seems to structurally compensate for the  previous weakening by screw holes. Breaks through screw holes do occur years after the screws have been removed, but usually with significant trauma. It is more common in my experience to have a break while the plate and screws are still in place. Said another way plates and screws have a temporary benefit, but once the bone is healed that benefit is replaced by the dangers of demineralisation and persisting screw holes. It is therefore frequently  policy to remove the plates once union of bone is assured.

This paper was designed to determine whether there would be a benefit if stabilising plates were flexible. However the key statement in this paper is “We have considered only the relative effects of atrophic changes under a plate and residual screw holes; in the clinical situation the transition zone between plated and unplated bone creates a further potential stress raiser”. It is this phenomenon which enhances the risk of breakage when a plate is left in situ after bone healing is complete.

http://www.jbjs.org.uk/cgi/content/abstract/73-B/2/283

Leave a Reply

813 Responses to “Should orthopaedic plates and screws be removed?”

  • Hey Dr. I had a bunion fixation on the 4th of April 2013 and was told my feet would be straight again. Was told i would be able to wear heels of any kind by 2014 January. My concern now is i am still not able to walk with heels because i cannot bend my big toe reason being the plate that was fixed on it. Can i remove the plate, and what are the pros and cons of doing so. Will appreciate to hear from you. Thank you

    • jp:

      It might be that the joint at the base of your big toe has been "fused". If that is the case then simple removal of the plate will not get you back to where you were before the surgery. This type of "fusion" at the base of the big toe is common, and regarded by some of my colleagues as the "gold standard". As you now know it is far from that, and is a procedure which (I believe) should seldom - if ever - be performed. It might be possible to "revise" a fusion at the base of the big toe, but that is not simple, and requires surgical expertise.

  • ankita:

    wat is the recovery period /admission period for rod removal from arm?

    • jp:

      That will depend on the position of the rod, the reason it was used, and the surgical expertise available. However, assuming that the rod is reasonably accessible, and the bone is fully healed, it can be done on a day-case basis, with use of the limb within hours or a few days.

  • Bell:

    Hello Sir, I sustained a broken humerus on September 20th 2014 and had an ORIF on September 21st. My biggest concern now is, I can't lift or contract the arm from a stationary point without any form of support. I can clench my fist, twist my wrist and move my fingers but I cant move the whole arm without the support of the right hand. This is the 3rd week and 3rd day post surgery.

    • jp:

      With your forearm supported, can you lift your wrist and straighten your fingers?

      • Bell:

        With the forearm on either my thigh or supported by my right hand, I can move the wrist and stretch the fingers. Infact, I can turn the hand upto the elbow level, just that I cannot raise the forearm up without any support. Any attempt to raise the arm only sees me raising my wrist instead.

        • jp:

          Is there any loss of feeling in the forearm? Can you turn your forearm "on its back" (palm facing up)? It might be that a nerve has been damaged (although there might simply be inhibition of a disturbed muscle.) You might like to look at http://en.wikipedia.org/wiki/Musculocutaneous_nerve

          • Bell:

            Thanks for the response thus far. Yes, I can turn my forearm with palm facing up. As regards loss of feeling in the forearm, I feel that slightly from the outer bone of my elbow (not the bone underneath the elbow) to a part of the forearm. Whenever I touch that area,it feels numb, though I could perceive I am touching it but the way it feels upon my touch isn't the way the rest of the arm feels.

          • jp:

            What you describe seems to be a result of muscle inhibition, perhaps not surprising. It is still very early, by orthopaedic standards. Please let me know the outcome at 6 weeks post-operative.

  • Rachel:

    My Mother broke her wrist 6 months ago and had a titanium plate inserted. They had to cut a nerve close to the thumb during the operation. The base of the thumb was numb for a few weeks but she has full feeling there now. If she bends her thumb she gets a sharp pain that runs down the top side of her thumb and wrist and she finds it difficult to pick up a kettle. The plate and break are in the centre of her wrist. She is wondering if ths is likely to be the onset of arthritus or after reading this article if it is related to the plate in some way and if she should ask for the plate to be removed. She will be 70 next year.

    • jp:

      You are generous when you say "They had to cut a nerve close to the thumb during the operation". The truth is that a nerve was cut unintentionally, perhaps negligently. From what you say it seems that there is an "adhesion", perhaps of the tendon, perhaps of an associated nerve. This should be correctable in expert hands. Ultrasound examination could give information as to where (and if) the tendon has been damaged. A microsurgical "neurolysis" might be the way to correct the discomfort. This is not "arthritis". Removing the plate alone will not necessarily correct matters, and it is suggested that the focus is on one of the long tendons to the thumb. The exact tendon should be identifiable by clinical examination.

  • well as of sept. 8, 2014 titan spine has implant hardware that is permanent and with a warranty and made out of titanium as the others do. To me this indicates the only reason these doctor who say maybe they should or not sure or yes I recommend it was to get to be paid for that 2nd surgery or as they say revision to remove broken or defective hardware. How do you see it if they are made out of the same material or metal.

    • jp:

      Do a web search and ask the manufacturer which metal is used in which implants... If you do not know the brand of the implant ask your surgeon, or check the account.

  • Heather:

    hello! I had a tri malleolar fracture in January of 2012...happy new year to me! haha All went well, and I had the pins removed the following May. All has been good since...except... 3 times now the scar area of the surgery and removal has gotten infected. I've gone to the doctor the last two times and been given antibiotics. It appears to be infected again, and I'm tired of antibiotics.I've asked the doctor (not the surgeon, I'm not able to see him without a new referral) if there's any chance perhaps there's a stitch or something in there still(it was infected right after the removal and additional stitching was found to be the cause) I can feel a lump in the area that hurts and I know it might just be scar tissue, but it really feels like I can move it around etc. I'm diabetic, so infection is not a great thing, but clearly antibiotics are not working and I'm frustrated that the doctor seems to just dismiss my concerns about what is causing the infection, rather than just treating it. I also wonder if perhaps the scar might be more susceptible to an ingrown hair, and maybe that's the problem? I asked my doctor and he laughed and said he didn't have a clue. I don't shave it,to worried I'll knick it, but I do use a hair removal cream, and I'm hoping that's not the issue...of course, if I knew it was, it sure would be an easy fix! Should I just go to a new doctor?

    • jp:

      Naturally I cannot say for certain why your wound continues to be infected, but persistant infection is unnatural, and some focal "nidus" may well be the problem. In the past this was an unabsorbed stitch, as you have said. Antibiotics alone will not resolve that problem. The nidus must be removed. One cause, often missed, is a "ring sequestrum", a ring of dead bone around the hole previously occupied by the screw (and often caused by a hot drill-bit at time of original surgery). It is probably not a hair (hairs absorb!). You surgeon must accept responsibility for your continued management. This would hardly be (or need) a "new referral"

  • Ram:

    Hi Doctor, I am very thankful to you for the article, I met with an accident almost two months back. One plate, about 7 screws was inserted in my right leg below the knee. Doctor suggesting, not to walk with full wait. Currently, I am doing physio therapy to make thigh stronger, walking using walker by toes wait. I would like to know will it take three months to walk with full weight? I need to go office ASAP. Please help, thanks in advance.

    • jp:

      Please see my letter to Emma. Your surgeon is the best person to answer your query.

    • jp:

      Thank you for the radiology which demonstrates a comminuted lateral tibial condyle depressed fracture. This has been adequately repositioned by a lateral buttress plate with sub-articular screws. You say that you are walking with light weight bearing via the toes (and presumably mobilising the knee joint under physiotherapy supervision). Your query is whether you need to wait three months before returning to full weight bearing. A factor is the need to return to employment promptly. You suffered a major injury to your knee joint. At this stage that joint needs to be protected emphatically. Weight bearing now could cause loss of position of the bone fragments, with resulting changes in the alignment of your limb, and ultimately incapacitating osteo-arthritis. My firm advice is to remain on crutches for (at very least) three months, whilst awaiting consolidation of the bone fragments.

      • Ram:

        Thank you very much Doctor for the response. Can I walk normally after three months post surgery. When can I start jogging?

        • jp:

          Have check X-rays at three monthe. If the bone has healed solidly you should be able to walk safely. You will then need another three months of "rehabilitation" while working up to extended jogging

  • nikki:

    hi im turning 21 now and i had a fracture on my right arm and i have a titanium plate on it .. and i am working as a production opertor now....my question is can i work abroad or is it possible to work abroad if i have this?

    • jp:

      Many people have migrated to different countries and different job oportunities despite having implanted metal (or even implanted joints) Provided you can fulfill your employment requirements I can see no problem.

  • Emma:

    Hi, I had a bimalleolar fracture on my right leg/ankle 3 weeks ago which required surgery with a plate and some screws. I have healed very quickly, and am already allowed by my doctor to put as much weight as I feel I can handle on the leg. However I do wonder about the metal, I do obstacle course running which includes drops and jumps, and I do NOT want to fracture this leg again unnecessarily. What risks are there, and should I be more vocal in my demands to have the metal removed? I do both horseback riding and these kinds of sports and I plan on returning to competing, which my doctors also think possible after rehabilitation.

    • jp:

      You are a long way from full recovery - your bones will take months, not weeks, to join firmly and safely. It might be advantage to have the metal removed, but think about a year ahead.

      • Emma:

        OK, how come then that my doctors tell me that I can put my entire weight on my leg already and have provided me with a different timeframe? Of course I understand that I cant go back to racing in a week or two, but I'm starting to get REALLY frustrated with the fact that leg fractures are given so incredibly different time frames depending on who you ask. Some canadian ice hockey players break their legs and are back on the ice in 4-5 months, a Swedish soccerplayer was back in the game considerably faster than "a year" - yet when I ask I get answers between "3 months" to "at least one year". This is very, VERY frustrating as a patient, especially for one like me for whom sports is everything and I am aiming VERY high in my sport, since it destroys what confidence and trust I have in doctors. This is not said to you specifically but as a reflection of my experience so far with it all. Because who do I trust? The doctor who says I can be back in sooner, or the one who says later? They're both doctors.

        • jp:

          You say that "leg fractures are given so incredibly different time frames depending on who you ask." What you must realize is that the difference in healing times is not because who is asked but because there is a great difference in the injuries. There is no such tick-box entity as a "leg fracture": The injury to bone might be a tiny flake, or a catastrophic mutilation of the bone into multiple fragments - the "Corn-flakes Crumble" injuries. Further, the damage to soft tissues varies considerably, which will vary healing time. Other variables are the degree to which the broken bones are contaminated by soil or bacteria, or whether the blood supply has been damaged - at times irreparably. My guess is that you have had a non-displaced fracture, perhaps of only part of one bone. You do not say how your injury has been immobilized - by a cast or a boot? (I know that there have been supportive plates and screws inserted). If this is the case it is possible to allow (guarded) body weight to be supported by the broken bones. But if you load the unhealed bone beyond a certain point it will break apart. Screws and plates are no substitute for the strength of the original bone. What can be said with certainty is that bone takes a known and slow time to heal. Many people have re-injured their fractures by their impatience, often inflicting permanent complications on themselves. You have said that you "healed rapidly". What you mean is that the skin has healed rapidly, because that is all you can see.

  • shikha agarwal:

    whats the best time to remove the screw and plate

    • jp:

      There is no "best time" to remove implants. There are multiple variables, as is the case in all surgery. Removal time would depend on age, life expectancy, symptoms, surgical care availability competence and safety, as well as many personal factors such as occupation, finances, available leave and family commitments. That is why the opinion of a trained surgeon is required - someone who can make a professional judgment encompassing these variables and arriving at a "best compromise".

  • Avnish Sethi:

    I met with an accident and broke my radius and ulna both.Then I have gone through a surgery where they put titanium plates with 13 screws (both bones).They did my surgery in july, 2014.Now it's been three months. I am able to normal work in my life. And I need to go for removal because I want to join forces. And I am not allowed with plates. So basically my questions are - 1. When should I go for removal of plates because , the more early it would be, the more fruitful for me. 2. And after removal of my plates when I can be fit completely means how long will it take to get the full strength in my arm. as I talked to my doctor who did the surgery, he told me that minimum time is One Year. Can we go for removal of plates less than one year. THanks & Regards Avnish Sethi

    • jp:

      Since your surgeon will be taking responsibility for removing the plates, and your welfare after that, your surgeon must make the decision about when to remove the implants. I suggest you put the (relative) urgency to him.

      • titan spine gives a warranty on their implant devices and they are permanent. It makes one wonder if the others didn't get together and say their devices must come out to get paid for another surgery to remove them. I would expect the FDA will need to make some changes because the others are not similar because they do not offer the patient a guarantee and titan spines implanted devices are permanent. It looks like a conspiracy if they use the same material to make these devices. I imagine V A and medicare will now require guarantees for their patients in the future.

        • jp:

          The manufacturers of implants have nothing to gain if the device is subsequently removed - only the surgical team and hospital will benefit financially. The need to remove implanted metal is complex and multifactorial - as I have tried to show over the years. Never say never in surgery - I bet Titian implants have been removed at times. All implants regulated by the FDA meet comprehensive standards, and Titian is unlikely to be any better or worse than the others.

  • LORI J:

    I am finding this article quite interesting. I broke both bones in my left ankle/leg around 6 years ago. They put in a plate, 7 screws and 3 pins. I was not allowed any weight bearing for nearly 8 months. Pins were removed after one snapped. Six years later the area is still tender to the touch, I have restricted movement in my ankle and pain. I have long thought that the plate and screws are causing damage and pain to my leg. I have had scans done as it felt as if the flesh or muscle "grabs" on something in my ankle. However I keep hearing that there is nothing wrong. I also have now an extremely enlarged and tight calf muscle on that leg. (I have also had scans to eliminate blood clots etc.) I'm not sure what is causing the troubles but all I know is that it restricts my movement and as a 28 year old female I don't want to spend the rest of my life limping around, in pain with restricted movement.

  • ARNAV PATTANAYK:

    should i remove them or not?

  • Luis:

    Dr. JP Driver-Jowitt, I've sent my xray to your email research at orthopaediciq dot org. Thanks a lot for your response. I really appreciate it. You're helping a lot of people from different parts of the world by using this website. You're such a good man and kind man. I know you are already busy with your profession but still you put your time to reply us on our questions. Again, thank you and may God bless you a thousand folds.

  • L Thomas Gaspar:

    Oh. With titanium, I have only ever seen the plus side (superior biocompatibility) mentioned, never any drawbacks. What are the advantages of stainless steel that are absent in titanium?

    • jp:

      Biocompatibility might not be as benign as has been touted. Significant sensitivities / allergies have been reported.(see this website) Expense can be a major disadvantage, both material costs and machining costs. Stainless can be easier for the surgeon to work with, easier to bend and shape, and easier to cut when necessary. Titanium has an extremely low modulus of elasticity and a low tensile strength. Implants, therefore, have to be bulkier than stainless steel in order to provide same rigidity Other drawbacks of using titanium include its poor resistance to wear as a bearing, notch sensitivity, and reports that it is more susceptible to abrasive wear by particles of debris. The latter can be extrapolated to the wear between plate and screw.

    • L Thomas Gaspar:

      Thank you very much for the extremely valuable information.

  • L Thomas Gaspar:

    About 6 weeks ago my 16 year old son suffered a distal radius fracture that was fixed by ORIF. He has recovered very well, he is not in any pain and he has regained movement in his wrist and hand almost completely. At his checkup the surgeon said that whether or not the plate and screws would be removed or left in permanently would be deciced at the six month checkup. He said if it wasn't for his young age, they would not even consider removing the plate. Looking at his surgery report I noticed that the plate and screws that were used for the fixation are made of stainless steel, not titanium. Does the choice of metal affect the decision whether the plates should be removed? (I am a bit surprised that stainless steel is still used as I assumed it had long been superseded by titanium.)

    • jp:

      "Stainless steel" is a variety of alloys, and has been the most widely used implant material, with advantages absent in titanium. The material should not influence the decision to remove the implants

  • Luis:

    Im 2 months post op. Had ORIF to fix radial head fracture with 2 screws. I still cannot bend and extend elbow past the right angle. Elbow is so stiff that I can feel tightness around it. I was in a sling for 3 weeks before starting PT. I had 8 sessions of VERY PAINFUL PT but didn't improve. Could it be that the screws are restricting my motion or the bone is not aligned back? According to xray, bones are aligned. Though when i try to compare it with the uninjured arm, it seems that they are not the same. I can feel the radial head when i tried to rotate my hands on the injured arm. But i cannot feel it on the other one unless i press my thumb. Will CT Scan help more to see if bones are aligned well? I believe i cannot be scan through MRI due to the screws. I can raise my hands but not without pain and i can hear popping sounds when i do it. I also hear popping sounds when i rotate my arm. I dont get any other answer from my OS aside from continuing PT. (Sorry for whining)

    • jp:

      The more information the better. CT would be reasonable, perhaps with CT of the good elbow for comparison. I would be happy to see, and assess, your current (post operative) x-rays. I do not consider that you are whining unnecessarily. You have a major, and disabling problem, in a joint which is very unforgiving.

    • jp:

      Your right elbow. The x-rays make matters much clearer. The initial injury seems to have been a break through the radial neck with displacement of the radial head. This was re-assembled by two screws. The pronation-supination movements (with which you will now be familiar, probably because of your physiotherapist), allows rotation of the proximal radius. This is permitted by "the annular ligament", a ring which surrounds the neck and head of the radius. In your case the screws protrude significantly and are almost certainly interfering with supination/pronation. They need to be removed. A word of caution - the interosseous branch of the radial nerve is close to the radial head, and expertise is warranted. The next problem is that the surface of the radial head is not as congruent as originally. That likely reflects the difficulty associated with this type of repair - perhaps with bone loss. The surgeon has performed a difficult task adequately. Even if the radial head is not perfectly congruous, acceptable function can be expected. However, the convalescence from this type of injury is often many months of difficult physiotherapy, and more patience is warranted.

      • Luis:

        Thank you very much for your information. I appreciate it. According to the surgeon, he buried the head of the screws beneath the radial head but I believe you're right that the screws are protruding that's why I can hear cracking sound every time I supinate and pronate. I'm going to seek a second opinion or request for a CT Scan for more details. Based from your experience and expertise, will you prefer to remove the screw or excise it and replace with a titanium radial head? I would really want to achieve a full function if possible. Are elbow splints effective? The surgeon offers a Manipulation Under Anesthesia and second surgery but he told me the risks of re-fracturing, damage of nerves and more stiffness. Should I trust this surgeon and let him perform surgery again?

  • Team Fitness:

    Two years ago I was injured in a MVA. I suffered fractures to my spine (t1-t-11) with several rib fractures and clavicle fracture. The clavicle was treated with surgery, in which a plate, pins, rod, and screws were placed. I am beginning to have some irritation over the screws and plate. I am not sure if I possibly aggravated it by working out or if the screws are backing out. But the last two days have been very painful. I am sure an x-ray would be the best definitive answer. But should there be anyone questions I should ask when I see my surgeon?

    • jp:

      Having undertaken to operate on you in the first instance, your surgeon has (at the very least) a moral obligation to see you come right. Why not simply tell the surgeon what you are experiencing? Radiology, as you say, should be the immediate route.

  • Terry:

    Hi. I had a tri malleolar fracture 11 years ago which was pinned and plated. My ankle is still painful and swollen and I have limited movement. Would you recommend removal of the metalwork? And if I did could I improve my range of movement? Thanks

    • jp:

      I am sorry that you have had these problems for so long. There could be a number of reasons why your ankle has not returned to full function. The position (or misposition) of the screws is only one. I will help you best if I could see your x-rays. These could be sent by JPG or (copies) by post.

  • I javed:

    Hi Doctor, I broke my Humerus in a snow boarding accident in January 2013. Got surgery and had to have it plated. The plate covers 3/4 of the length of my bone. My radial nerve was unharmed and my surgeon advised to not remove the plate. He said removal could cause nerve damage. I got movement back in my arm and very rarely I will get some pain, nothing unbearable. The bone has healed and I am in good shape. Recently, I started boxing at the gym and I wanted to know if this is safe or should I stop all contact sport. I wanted to ask - Do I risk re-fracturing my humerus due to pressure on the plate? Should I see another surgeon to get my plate removed or can I leave it in and resume with contact sports? Thanks!

    • jp:

      It is unlikely that boxing withe the humeral plate in position will cause problems. Most nations have a Boxing Board of Control, which requires a medical clearance prior to participating. I suggest that you check with the BBC medical examiner.

  • jessie:

    Hi doc,I broke my clavicle n elbow 16 mos ago and had surgery wherein the doc inserted metal plates n screws. 4 days ago I had them removed by another surgeon that was recommended by thr previous one coz not available at this time. Just a few hrs after surgery, my new doctor asked me to straighten my arm right away and I was actually stl in pain n worried my stitches on elbow n collarbone wld open or something. Anyways,I just want to ask u doc if ths is safe. I mean to move my arm normally rihht away just after surgery.coz I remember my first doc yelling me that after metal removal, I stl ti b careful n my arm on a steady position same as the first time I had metals inserted.

    • jp:

      If the bone has healed soundly, then you should be able to use that upper limb near normally. The surgery itself might give some pain, which should not last more than a few days (which you have probably already found)

  • Manny:

    Doc, thank you so much for doing this. When I was 20, I broke my right humorous, a spiral fracture. I got a plate and 7 screws to fix the bone. The plate sits close to the elbow joint. I do get pain in the elbow, but only when I move it or workout. I had nerve damage of my radial nerve from the first surgery (nerve was stretched) which resulted in wrist drop and it took about 6 months to regain the use of my hand. I went to a doctor about plate removal, who said the risk of the injuring the nerve is high since there is so much scar tissue there and because it was already injured once. I am more scared about the adverse effects you discussed here in regards to leaving the metal in the body and the risks of foreign material. I do get tingling all over my body and my legs are itchy but I don't know if that is because I have extreme anxiety (tingling) and dry skin (itching) but I am extremely worried. Please advice on what to do. I am only 24 and want to live a complication free life. Do you recommend plate and screw removal even with the risk of nerve damage?

    • jp:

      Addressing the itch and skin changes first: Should you have a sensitivity to the metal or components of the alloy (such as chromium, cobalt or molybdenum), or a sensitivity ("allergy") to titanium, then that can be accurately diagnosed by appropriate testing. Only if the implant is the cause should you consider removing the implant. The risks to the radial nerve by removing the implant vary directly with the skills of the surgeon. If your surgeon is scared, then you should also be.

      • Manny:

        Thanks for the reply doc. I should clear up that my implant was stainless steal and not titanium, if that makes any difference. Could you tell me the name of the tests I can get to rule out allergy? I know I can get blood tests but are there any specific allergy tests I can get?

  • Greeny:

    in 2007 I fled down with my left hand and got my radius and ulna broken .we went to a traditional bone setter who did what was wrong. after some time interval we went to a hospital and confirmed that she did the wrong thing. There at the hospital the doctor confirmed that an operation should be taken that is open reduction and internal fixation with plates and screws. this operation was made in 2008 when I was eighteen years. Since then till now I have been with the plate and screws. Though sometimes I experience pain and after sometime it stops. sometimes the veins in that region checks .Am so confused on what to do ,should I go for the removal or should I go for medication. and am now observing that the size of that hand is not of the same size with the other.

  • Gus Dahdul:

    I'm going to remove the metal plate on my arm can anyone tell me how to do it my self my insurance has not approved my doctor request to remove it I'm going crazy the pain

    • jp:

      Attempting to remove a plate yourself could be a route to catastrophy. Your insurer needs forceful motivation, ideally by your current surgeon. It is in the insurers interest to have it done correctly and safely, since medical salvage is expensive.

  • tamer omari:

    hi... i have 28 years old , i broke my right ulna 3 years ago " distal part in the external part on the ulna that the plate is situated subcutaneous" and i will remove the plate the next week , "the plate had been causing pain and bother".. so i would like to ask your advice about how can avoid refracture and how to behave after removal and how much i should be careful ,,, "what i must to do and not to do" ?? thanks

    • jp:

      Rehabilitation of the forearm after implant removal has been addressed several times in earlier correspondence on this site.

  • Rukmini:

    I just want to know if the left elbow is broken n made a surgery with titanium plates and Screw fitted inside n due to continues early mobilisation will the screws break

    • jp:

      A “normal” range of elbow movement should not have an effect on the screws. The elbow is a joint which requires early movement to prevent it becoming stiff.

  • margy:

    my 32 year old husband was involved in a road traffic accident on the 9th of may and broke his right humerus and was operated on the 10th and was inserted a plate and some screws.he has a wrist drop how long does it take to recover from the wrist drop and will it be necessary for him to have the plate removed in the near future

    • jp:

      It seems that your husband's radial nerve has been damaged. This can happen as part of the original injury. The wrist drop might not have been notice at the time of admission to hospital, with the distractions of pain and the immobility of pain. Recovery will depend on the degree of damage. I am sure your orthopaedic surgeon will be monitoring the recovery with electro-myography and nerve conduction testing. Your surgeon will therefore be in the best position to give your husband a prognosis.

  • Andrew:

    I had a surgery 10.5 months ago to excise a fragment of bone from a (nonunion) avulsion fracture of my fifth metatarsal. The surgeon cut some of my peroneus brevis tendon to reach the fragment, excised it, and then reattached the tendon to the fifth metatarsal via 1.5mm stainless steel bone anchor suture. At this point, 10.5 months post operation, the base of my fifth metatarsal is considerably more swollen than on the nonoperated foot. It is also much more sensitive, painful to pressure. The tendon has marked thickening, but I guess that is to be expected after a reattachment like that. Also, I have lost a lot of range of motion, especially when supinating the foot. my question is, would it be wise or unwise to have the bone anchor suture removed. My doctor said before that the recovery for removing the screw isn't that bad, but I'm not sure. Is 10.5 months too early to think about removing the screw. Does the bone fill out and heal back as good as it was before?

    • jp:

      You do not say which symptoms warranted the (relatively extensive) surgery to which you were subject. Have those symptoms recovered? My initial thoughts are that you should leave alone any thoughts of more (potentially damaging) surgery for at least another year. Please let me know.

      • Andrew:

        Also, may I ask why you say this is so extensive? Is this something that I should be prepared to live with? I'm 24 years old, I was 23 at the time of the surgery, and I was extremely active before. I initially got the injury through overuse, too many hill sprints and jump squats in a short period of time. The peroneal tendon pulled a chip of bone off of the base of the fifth metatarsal. This continued to bother me for a while, eventually leading to the surgery. Is this so extensive that I should be prepared to never regain full functionality? I used to do a lot of high-impact stuff (hill sprints, power cleans, heavy pressing, basketball, football). Do you think I can get back to that level of activity? Is there something specifically about the tendon-bone interface, or the peroneus brevis insertion in particular, that makes this extensive and not guaranteed for recovery?? I definitely regret the surgery at this point, but I'm still expecting that at some point I'll be back to 100%. I appreciate your help. My life has reached new lows this past 6 months after realizing how injured I truly was by the surgery. You have no idea how much you are helping me.

        • jp:

          My initial impression is that the surgery which you had was excessive in relation to you symptoms, and the underlying problem. Since the surgery cannot be undone now, it would be prudent to allow matters to settle maximally, before further interference. Recovery times in relation to damaged bones and tendons take far longer than for the “soft” tissues. This recovery period is, at times, made more protracted by using the structures (the foot, in your case). However, one has to continue with life, and so loading a convalescing foot is often unavoidable. Matters might take another six months to settle. I would not allow any more surgical interference in the interim, if it were my foot. Long-term you should be optomistic about returning to your previous activities.

          • Andrew:

            Thanks for the response. So I should try to load the foot as little as possible? Use orthotic inserts, don't do high impact activity, etc? I don't quite understand the balance between "rehab" and rest. Some say to walk barefoot to work all of that deconditioned musculature in the foot, ankle, and leg structures, whereas others recommend wearing orthotics and never going barefoot. Also, with regard to the screw, based on everything you said here, am I subject to those same risks? The screw is a 1.5mm bone anchor, so it's not extremely big. That said, I'm worried about susceptibility to refracture of the bone and all of that stuff.

          • jp:

            Because I know so little about you it is difficult to give you comprehensive advice. Suggesting that the foot is used minimally is often not practical advice: one needs to work, commute, shop, and more. As you describe your problem currently it seems wise that you do not run: however exercise is important, perhaps to you more than most. Substituting with swimming and cycling are often realistic. Orthotics are often offered as a “knee jerk” reaction for many (or all) foot problems. If offered I would ask exactly what achievement is intended – and do not accept jargon. At times orthotics are counterproductive. I favour barefooted walking as it allows the foot maximum range to adapt to any given load, at each step: these loads vary with surface, pace, avoidance and pain. If a foot is constrained by shoe or insole or other, that adaptation is prevented. Hence the barefoot is better able to protect itself from excessive loads (except, of course, striking the foot on external objects) Pain, as always, is the guide line – no pain = no damage. The screw is there: the risks of implanted screws, which I discuss elsewhere, vary with site and many other contexts. In your case I believe the risks or removing it (or other meddling) at present exceeds the disadvantages of leaving it in for a further period, allowing further healing. I do not understand how it can re-fracture – the bone fragment has been removed. Incidentally the original injury was almost certainly a twisting into supination as a single event.

  • Elaine:

    How long does it take to recover from the plate and screw removal of ankle?

    • jp:

      You do not say which type of ankle break you had (there are many, of varying complexity) or which type of repair (also many). The necessary message here is that surgery (and recovery) is highly complex and varies considerably. Your letter seems to regard surgery as a simple, unitary procedure with predictable outcomes - like having the engine changed in a motor vehicle. This simple, linea and binary view is widespread and unfortunately is leading to the destruction of health-care (or out-pricing healthcare) by the malpractice industry. Is your State now one of the many which now has no obstetricians, neurosurgeons, neurologists or anesthesiologists, because of these misperceptions?

  • Kevin07:

    hi. i am 23 years old and i had my left arm fracture having both ulna and radius fracture with dislocation.it happened 7 years ago and i went through the surgery with two plates and screw.by the end of one year i was trying to remove the plates but due to Jaundice disease it was not possible. But now i am all fine and I am thinking to remove it after 7 years. Could it be possible ? Thanks regards

    • jp:

      Time is not an important factor usually. However there might be other reasons about being caution about having the plates removed. Suggest you talk to the surgeon who put in the plates originally,

  • Rajesh..shr:

    Thank you . Your suggestion means a lot. I will be hoping good results.

  • Rajesh..shr:

    hii...good to see your help through this article... 6 years ago i got my left forearm fracture i,entirely broke my Ulna and Radius as i slipped while playing football... immediately i was diagonised with two screw plates...i followed up the surgeon and after 1 year of recovery he prescribed me not to remove the plates as it wont cause any problem... so i decided not to remove the plates... since then now it has not caused any problem ... (but it swells up when the operated part strikes harder ) Can it be removed or do i need to stay as it is. ?! and the worst part is I got my right arm fracture broking both the radius & ulna with same dislocation..that too caused due to slipping off while playing football.. seems to be less fortunate me to play football... but as i went through surgery last 25 days with two screw plates... my right thum doesnt bend in the way it used to..rest of fingers are normal... and my arm doesnt rotate as it used to... I too concerned with the doc..he told me that it is due to the incision of muscle & said it will recover over the time.. I doubted on it because the same didnt happen when i have my left arm surgery... please consult me...!! & will it be risky to join the football again since my both arms are plated..!!

    • jp:

      You do not say whether there has been any loss of skin-feeling. There are a number of possible reasons why your thumb does not bend: damage to the muscle would be one. If that is so then recovery with time is likely: it is only three weeks since your surgery, a relatively short time in orthopaedic recovery terms. The loss of rotation might be more complicated. Please see a recent post where this was considered. I suggest you reach maximal improvement before you begin to consider removal of the plates.

    • Rajesh..shr:

      appreciated your suggestion. Do me a favour.doc also told me that removing the plates of my right arm would me risky because it has been placed right beneath the nerve which might get damaged while removing the plates. should i consider the risk or just wait for 1 year to remove it ? and for the rotation of my arm is it due to short period after surgery ? because whenever i try to rotate it, i feel pain at the operated part .

      • jp:

        At a little over three weeks after surgery it is far too early to think of removing the plate(s) on your right forearm. The risk to the nerve bears an inverse relationship to the capabilities of the surgeon. If the surgeon is nervous about removing the plate you may have cause to be nervous also. It is early to expect full pronation and supination (twisting/rotating the forearm) - Full recovery might take up to one year!

  • Paul N:

    Hey so in December of 2005 I sustained what was somewhat a compound fracture in my right forearm,entirely breaking my Ulna and fracturing my radius but not to the point where it was disconnected (I apologize for the vague explaination) but for it to heal properly I had 2 metal plate with screws put in my forearm, the doctors that worked with me told me I should have it removed within 2 to 4 years. But because to financial problems and many other things I wasn't able to within that time frame and it's now over 8 years later, I'm a 24 year old male and the plates continue to bother me, I feel a slight pain from time to time and I also can't turn my arm nearly as much as the uninjured one which is an issue for me (and has been since the surgery) is it still safe to have it removed? Would the plates even be the cause of this problem?

    • jp:

      The difficulty in turning (twisting) your arm (pronation/supination) may not be helped by removing the plates if the two parts of the radius were not correctly rotationally aligned at surgery , or if there is some other block (such as partial cross union). If the plates themselves conflict, then removal might help restore movement. As you see this can be complex. I might be better able to help you if you sent (JPG) your X-rays.

  • avinash:

    I had broken both my bones in right hand in Feb 2011. Then the bones were fixed using 2 plates abd 12 screws. Now it is almost 3.5 yrs and they are still there inside. So far, I have not faced any problem, like irretation or severe pain. Do I need to remeove it now or I can leave it like that only permanently ?

    • jp:

      It is likely that you broke two metacarpals. Since you have had a good result, without problems over three years, I would leave well alone until, and if, you do have problems.

  • pa weaver:

    july 2012 I had my 6th surgery on same wrist injury which was a left wrist arthrodesis followed by a druj arthroplasty with a scheker device implant in January 2013. pain continued in forearm which was reflected on 2013 and latest xrays in 2014 of a stress risers and appears to be bony callus along length of hardware I am scheduled for removal of fusion plate in hopes of pain relief and if not successful further intervention may require a third plate insertion. My question is how difficult is screw removal after two years and what is required after surgery any immobilization?

    • jp:

      I must assume that you had a comminuted fracture of the distal radius. The degree and position of the callus will determine the surgical difficulty of removal, and ultimately dictate the convalescence. However, I am not clear whether the specific cause of the pain has been established. If not is this simply a surgeon's random walk flavoured by hope? Many techniques are available to try and get the most accurate possible diagnosis of the precise, anatomical cause of pain. These include selective or highly selective (nerve stimulator assisted) local anaesthetic blocks. Radioisotope scans can also contribute. Feel free to JPG your X-rays.

  • On 01 January 2014 I was bumped by a car on my left knee on the tibia bone near the knee cap , there was a fracture there so they put plates and screws to join the bone and the fractures . I'm a 17 year old boy I want to know what will happen to my bone in future as I grow up.?

    • jp:

      Depending upon the surgeon's expertise you should make a full and perfect recovery. However your "growth plate" needs to be watched by follow-up x-rays, if you are still growing.

  • Gosia:

    Hello. I am 31 year old female. Back in August 2012 I broke my left leg for the first time. I had open reduction and internal fixation of medial tibial plateau fracture. It left me with metal plate and pins screws supporting my bone. Then unfortunately at the end of January 2013 I broke the same leg again however this time i was diagnosed with av left femoral condyle fracture. Which followed by left distal femur open reduction and internal fixation. Since then I had bone density scan to make sure I have no issue with bones and I do not, it was just a bad luck. Doctors were advising not to remove metal work from the leg however I am do not feel comfortable with metal in my body. Moreover recently I developed pain in the are where tibial plateau is following a slight inflammation in the area. I would like to ask what do you think about removing metal work from both bones at the same time and how long could it take to recover from such surgery. Also I was told there need to be bigger cut through the muscle to get the plate and screws out. Does it mean it takes longer for the muscle to recover? Any advice would be helpful and much appreciated. Thank you

    • jp:

      The "slight inflammation" nearly two years after the insertion of the tibial screws is worrying enough to suggest that radiology is justified to exclude infection. You do not say why you do not feel comfortable with the metal. Is there a specific reason? Usually the incision to remove implanted metal (through the existing scar) is somewhat smaller than the original. If you are to have the metal removed I see no reason why both sets (femur and tibia) should not be removed simultaneously, and under the same anaesthetic. Recovery time should be weeks, rather than months, and full weight-bearing is usually immediate, although crutches might be necessitated by pain and balance security.

  • jackie:

    Hi, My son had a titanium plate and screws removed last Tuesday , he says his muscle feels tight on his forearm . is this normal or something to be concerned about ? thank you

    • jp:

      The trauma caused by the surgery (or a tourniquet) can cause swelling of the muscles, and so the sensation of “tightness". However excessive swelling could cause a serious problem (see "compartment syndromes" by web search). One quick check for safety is to see whether all the fingers can by pulled backwards (extended) comparable with the other side. Then check that the fingers can be fully closed without (much) forearm pain. If there is a restriction to these two movements, telephone your surgeon.

  • i was involved in a motorcycle accident on 4/8/2013 i broke the tibia fibula and dislocated and fractured my ankle (talius). i also torn ligaments in knee and broke 2 toes and 2 metatarsals. they operated imediatly and inserted 2 large bolts through the tibia into the talius which have apparently healed well, but the fibula with a 7in plate and 6 screws in it hasnt healed at all i still have an open wound which is not healing my 3 rd consultant now wants to take the 2 bolts out of tibia cause he thinks this is causing infected flesh which is why the fibula hasnt healed and the wound is still open 9 months later, my previous consultant specialized in leg and foot injuries and said that it needs bone grafting so who is right?

    • jp:

      The priority is to cure the infection in your fibula. This will be assisted by removing the metal. The fibula is supported by the tibia, and therefore it matters little at this stage whether the fibula bone has healed. At a later stage, once the infection is under control one could consider a bone graft to the fibula, but not now!

  • TS GARHA:

    Dear Doctor, My wife had an accident around 5 years ago and broke her right leg below knee both tibia and fibia. Doctor operated it with 2 plates and 12 screws. Now the bone has healed and joined properly that we can see through X-rays of last 2-3 years, my wife feels gentle paing during winter. My Doctor has advised to remove the plates. We have planned to remove the same in this month only in coming week of May 2014. How much time will take her to walk and what are the precautions and care to be taken by her? Thanking you.

    • jp:

      Depending upon where the plates are situated, and how much the surgery intrudes into the anatomy, most people walk immediately after the surgery. Some might need a crutch or cane for a few days. The stitches usually come out after a week or ten days: During this time the wound(s) should be kept dry,

  • carrie:

    on 5/5/2013 i was in a car accident and broke my ulna and radius, i have metal plates and screws ( 6 in each). i just went to my f/u and have 3 months to decide if i should get them removed. I am very thin, you can see the metal sticking out of my arm. I had a 2nd opinion and the dr stated that 1 screw is alittle to long and is causing irritation and inflammation. The dr told me if i was his daughter he would tell me to keep them in and deal with the pain. I am torn, i cant live with constant pain. If i move my arm wrong it swells up and hurts. This makes me want to have the surgery to remove them, but on the other hand i am nervous for a re-break due to the holes in my bones. I have a 4 yr old son and am very nervous if he wacks my arm or kick it, it can break. please help me with some advise. thank you

    • jp:

      If you have significant pain, and if it is caused by the implanted metal, you should have that metal removed. Your surgeon should decide the precise cause and source of the pain. With appropriate rehabilitation (described in earlier comment answers) there is little chance of re-breaking. The screw holes tend to close, and the adjacent bone buttresses the previously injured areas. If you are still worried then bone graft paste can be injected into each screw hole, allowing it to become solid.

  • Joyce Drake:

    On July 14, 2012 I tripped and fell over a garden hose. Had Ulnar styloid avulsion fracture, no fixation. Open reduction internal fixation of: Displaced humeral shaft fracture 1 plate 11 screws, Radial styloid fracture 1 plate 5 screws on July 15, 2012. 2 weeks later the Dr. realized he missed a fractured elbow and on Aug. 1, 2012 I had internal fixation for an intra-articular distal humerus fracture with Osteotomy of olecranon process 1 plate 3 screws, and Distal humerus fracture 1 plate 6 screws. On May 2, 2013 these 2 plates and screws in the elbow were removed and while the Dr. was manipulating my elbow he re-broke it. He then put 3 more screws in the elbow and closed it up. I have been unable to flex my elbow more than 105 degrees and 35-40 degrees of extension. I had a CT scan that shows step-off of the trochlea. There is not a significant trochlear recess. I have overgrowth of bone around the coronoid. Dr. says it is most likely ectopic. With the proximal displacement of the trochlea, there is not room for the elbow to really flex. On top of this, the trochlea is slightly extended and the lateral condyle flexed. This will create a mechanical block because the 2 axes of the elbow are out of alignment. The Dr. said he didn't believe it would allow me, from a mechanical standpoint, to flex in a significantly improved fashion, even if portion of the coronoid were resected. The Dr. suggested re-breaking the elbow and start all over from the beginning with all the recuperation and therapy repeated or an elbow replacement. Here is my question: Since there is a plate and 11 screws in the humerus, wouldn't they have to be removed in order to get the shaft of the prosthesis into the humerus bone? If so, would it have to be removed and then let to heal for a certain amount of time before attempting to do an elbow replacement? My Dr. didn't discuss this matter with me, it just makes common sence to me that this would have to be done. By the way, the Dr. who created this mess is Dr. Robert Baltera and Dr. Hill Hastings II gave the second opinion.

    • jp:

      Your descriptions are clear but, as is often the case, seeing the radiology is much more informative. Given the complexity and the profound implications of the injury on you future upper limb function, could you send me the x-rays (JPG is good)? If necessary I will convene a meeting with specialist elbow surgeons, and get that opinion.

  • Dan Fortier:

    Sir, I had two screws placed in my left ankle due to fracture of talus in 1973 (41 years ago next week) and they are still there. Can I assume that due to no pain etc. in the joint that they can stay there for the rest of my life, or are there potential problems that could arise in the future?

    • jp:

      At this stage, given the successful result of surgery 41 years ago, I would not tamper with matters. It is highly improbable that adverse sequelae will now occur.

  • Car:

    Hello. I got an HTO 3 years ago and have made the decision to remove the metal plate and screws in June of this year due to the metal plate causing some pain when I try to do certain exercises. I just wanted to know what recovery time I can expect. Will recovery take nearly as long as the actual HTO recovery? Can I expect the same kind of pain after removal surgery as when they first put in the metal plate and screws? Thank you.

    • jp:

      Removal of implanted metal is usually far less painful than following implantation. Similarly convalescence is much shorter, and functional return is usually almost immediate.

  • Dear sir, I am a 30 year old male, praveen k verma, from India. I came across to your page wwhile searching about orthopaedic operation for bones on google. I had an road traffic axcident on 02 Dec 2009 and broken my left humerous bone and forearm bone , I got operated on 5 Dec 2014 , doc inserted an itramedullary titanium rod with 5 nails ans one single ti rod in forearm,it has been 4 years 4 months since than, I got admitted in hospital for removal of those rods , I found your page really veey helpful and important.x rays shows complete bone union , please advice me on what should I follow poat operation, as I take dicorate er. 500 mg for the treatment of seizure disorder too.please guide

    • jp:

      The rods and plates, after four years (and now that the bones have healed) have done their job. I assume that you have been using the arm for some years. However the bones need to regain their original strength, since they have been protected somewhat from full loading by the metal. Swimming is a good rehabilitative method, since it is difficult to over-load, whilst at the same time getting the muscles back to full strength (and the underlying bone in parallel because the function of the two is inseparable).

      • Thank you Sir for your quick and kind response on my query,can I rejoin gym as I used to workout previous to bone brake as I dont know how to swim.what kind of exercise is advisable. Thanks & Regards

        • jp:

          This is difficult for me to answer. In general terms I suggest return to all your previous upper body exercises at about 50% of what you were doing before the injury, for a month. Then increase these to 75% for the following two months. Thereafter you should be able to return to previous (before injury) schedules.

  • Nancy:

    Hello doctor. I had a 2-level ACDF (C5-7) in 2/08 with a metal plate and 6 screws. Neck and arm pain was relieved for a short while, however I never felt "well" after that. I had rashes all over my body, chronic headaches and double/blurred vision in my left eye. I suffered immensely until 2013 when I convinced an ortho surgeon to do a MELISA blood test for metal allergies. I was positive for gold and chromium, and hyper-sensitive to nickel. My titanium plate was an alloy that contained traces of nickel. X-rays revealed a herniated C4/5 and a “PARTIAL BONY FUSION” at the C5/6-C6/7 levels (5 years after fusion). On 12/30/13 he performed an ACDF on my C4/5 and then removed the plate and screws at the C5-7 levels. He said the tissue and bone where the metal was had "significant titanium staining". Samples of the black-colored tissue were sent to pathology which showed severe inflammation. My biggest concern at this time is that I have worsening neck, shoulder and arm pain that continues despite massage and physical therapy. The surgeon does not seem to be concerned with the fact that I only had a "partial bony fusion" prior to removal of the hardware, despite the fact that current x-rays now show anterolisthesis, kyphosis and more. I feel as if my neck is very unstable and I am very concerned. The surgeon says that everything is fine and to continue wearing a soft collar as long as I “feel” instability. Am I worrying for no reason? Any advice is appreciated.

    • jp:

      Thank you for substantiating the “titanium” allergy, in reality a result of the alloy components. The term partial fusion can mean a number of things: In your case I will guess that there is a complete fusion but of only a part of the inter-discal space (hence “partial”) It should be no surprise that your neck feels “very unstable” because the surgery was performed relatively recently (thirtieth December 2013) Because this is a repeat (and third level) fusion it is likely that there has been some de-nervation of the para-spinal muscles, and hence some (likely temporary) loss of muscle control. This can produce the sensation of “instability”. Remember, your head weighs the equivalent of two bricks. See the post on "recovery from orthopaedic conditions".

  • Sue:

    Our 80 year old mother broke her femur May 26 2013 due to a fall. A stainless steel plate and screws were used to surgically repair this. She completed 14 weeks of rehab at a nursing home. On September 15th she was walking (with her walker) and the plate broke causing the femur to re break. A titanium plate and screws were then used to repair it. Once again she completed rehab at the nursing home. She had very little pain through out recovery from both of these surgeries. For the past month she has been having pain in her upper knee. X rays taken on Feb. 6th 2014 showed that the bone had healed nicely. This pain in her knee has increased in both intensity and frequency. She continues receiving physical therapy which appears to intensify the pain. Any suggestions as to what may be causing this pain?

    • jp:

      With the limited information I have it is not possible for me to contribute in a useful way. Can she isolate the position of the pain exactly? Is it worse on weight-bearing? Does she have pain at night or at rest? Does the pain throb? Can she produce the pain by pressing on the overlying skin?

  • asif:

    Hi doc.one year back i had an accident. Below my knee and doc had put plates and screws in that leg. Recently i was getting pain so my doc had removed the plates except one screw left in between the bone(no pain now). But he informed us later one month after we found that screw in an x ray. When we asked him doc said it was very difficult to remove and had to drill the bone deep and told there wont be any problem. Were we misinformed? Or there is no problem actually letting the screw in the bone for ever? Please clear the confusion. Eagerly waiting :)

    • jp:

      At times the potential damage of removing (particularly) broken screws exceeds the benefit. Therefore it is not uncommon to leave difficult-to-remove fragments in bone. There is seldom a resulting problem. Your surgeon will have known that a fragment remained, and informing you of this would have been proper.

    • jp:

      I feel that I can comment, given a background in hand surgery. The traditional approach to base of thumb arthrosis has been to excise the trapezium and tether the thumb with re-routed tendons. This gives a predictable, stable and enduring solution (perhaps depending on the surgeon) in the elderly - the most frequent recipients of this surgery. Conceptually I have reservations about tethering the thumb to the index metacarpal. The reason is that the thumb is not normally constrained against the metacarpal because it needs the unusual mobility which allows the thumb to circumduct, appose, flex and extend. This freedom characterizes thumb function and tethering it to the index metacarpal could cause a significant disability. It seems that the selling point for the “tight-rope” procedure (it appears to be a fairly standard anchor implant) is a shorter convalescence. However, you will need that thumb for the rest of your life. If you were to amortize the period of shortened convalescence into your life expectancy it is probably inconsequential. I suggest you ask this surgeon how many he has done, and his follow up period. Anything less than five years is probably invalid. Ask also if you can speak to his treated patients (he can arrange their permission) On first principles implants should be approached with caution, and “new ideas” equally so,

  • Charlene:

    What are complications of removing bladder off of pubic syngas is titanium plates

    • jp:

      I imagine that you had a pubic diastasis with a repair using a plate. It is usual to put the plate on the front of the pelvic bones, therefore some distance away from the bladder. If this is the case the risk to the bladder by removing the plates will be negligible.

  • Holly:

    I broke my right ankle back in 97 when I was 18 yrs old. I have a titanium plate with several screws. After removal of the cast back then I continuously stayed broken out between my toes. It itched like crazy & I was told that I could be having an allergic reaction to the metal by a dermatologist. Well I lived with my feet breaking out off & on for about 10 years. I had broken a toe & went to get it set by a podiatrist. I showed him the spots in between my toes and he gave me some cream that cleared my toes up. Shortly after getting over the broken toe I started itching from my knees down on both legs. It would it so bad that in my sleep I would scratch until I made sores and would bleed. Tried the same cream I used in the past that cleared up my toes. I did not get lucky this time. The itching persisted off and on for a few years. Then 2 1/2 yrs ago I started having tingling & burning pain in both feet. They became extremely hypersensitive to the touch, swelling in both feet, feelings of hot & cold in them. Could not sleep with my feet under anything including just a sheet. I've been told I had tarsal tunnel in both feet and had a tarsal tunnel release in the left foot with no relief. Been to see a rheumatologist and she gave me the diagnoses of fibromyalgia & ideopathic neuropathy b/c there's no reason that I have it due to not diabetic. Out of all the doctors I have been to nobody has tested me for the metals in my blood. Cranium, chromium, & copper. I just had some more blood work done this week by a well known internist. She seems to think it could be a reaction to the titanium in my foot from 97. I am now 35 yrs old and have my fingers crossed that this doc knows what she is doing. I hope and pray that it will be as simple as removing my hardware so that I can get my life back. Has anybody else had a allergy to there hardware? If so what were your symptoms? Thank you in advance for any words of wisdom. I should know for sure in about 2 weeks.

    • jp:

      Thank you for your useful post. Titanium allergy, once thought to be very rare, does occur. I have reports of it regularly. The definitive diagnosis can only be made by removing the metal (and any metal dust near the screws). For the sake of others please let me know if removing the plate cures your skin problems.

  • aru:

    hi doc its me agan the person who wanted to do contac sports with metal plates am olny 14 docters said there is ni problem of keeping them in and doing contact sport they olny said they will remove if it pains so do you approve of this i dnt really want to take them tell me wat to do your a grat person and if i was to get into profeshonal boxing will i beable to have a creer with my metal plates in my fore thank you for reading

  • Gursift Kaur:

    My brother had an accident 5 weeks back. Both the tibia and fibula bones are broken. One rod with screws have been inserted into the leg. He has been doing physiotherapy on a regular basis, but at times, he has extreme pain in the leg. This pan does not seen to go away. Also, would it be advantageous to have the rod removed? Can the removal of the rod lead to any complications?

  • Elizabeth:

    Hi! On Christmas 2013 I broke my radial head. The radial head fracture was impacted and compressed with offset at the articular surface. The surgeon said she needed to elevate fractured part with plate and screws so it is aligned with the capitellum of the humerus. After 8 weeks I have full flexion and extension but can only supinate to 65 degrees even after an hour of therapy. I was out of town for my surgery so my new doctor is very critical of my first surgeon. He believes that the plates and screws are obstructing my supination while my original surgeon insists she put the plate in the safe zone and that's not the problem. Do you think removal of the hardware would increase my motion? Should I continue to do physical therapy from now until the removal of the plate? What is the recovery time and therapy like after a second surgery? How early can I have it? Any advice you have is much appreciated!

    • jp:

      I cannot be sure from which base you are measuring your supination. If it is measured from the “neutral” (mid pronation/supination) then 65 degrees is what I would expect in the relatively short time since your injury. You may well improve further, and physiotherapy is to be encouraged. However if your supination is measured from full pronation, this becomes a real problem, and you should consider having the metal removed.

  • Berlie:

    hi doc, first of all, thanks for taking time to answer our queries. i am 35 yrs old, male. last nov 8, 2013, i fractured my left patella and had ORIF the same day. i had 2 pins and fig-8 tension band. i was in cast for 4 wks. i had pt sessions as soon as cast was taken out and been having pt until last wk. rom is poor, stuck at 70deg. not using crutches anymore for 4 weeks now but still limping. last feb 3, 2014, while walking, i felt deep pain on the upper part of the knee, right in the area of the pin loop. i checked with os and he said it might be the hw. he gave me meds. was fine for 2 wks until last monday, feb 17, i felt intense pain this time on the lower part of the knee. i suspect it is the other end of the pin. the os told me the pins might be poking the soft tissue. suggested to remove the hw. he said patella is fully healed based on x-ray last jan. is it safe to remove the hw or i am faced with more risk of re-injuring it? currently, i am on the 14th wk. post op. thanks again and hope to hear from u soon. berlie

    • jp:

      This form of tension band wiring (there are others) commonly has wire/pin failure. This failure should be demonstrable on x-ray. At 14 weeks post surgery, with a demonstrably healed patella, there should be no contra-indication to removing the metal now.

  • hariharan:

    sir, ive two plates on both of my bones in my fore arm.. it was implanted on 12/6/2009. im not getting any pain because of that now.. but i need to take out these plates for joining in any defense forces.. so is it advisable to take these out??? please tell me what r all the problems i will face after taking the plates out.. and also tell me will i able to go gym and lift a 25kg weight????

    • jp:

      The purpose of the plates is to position the bones accurately while healing. Once the bones are healed the plates are redundant. It is interesting that defense forces (might) require removal of plates. If this is an important career opportunity for you then you might have to have them removed. This could be done under regional anaesthesia as a day-case. You should be able to use your hand the same day, and the arm within a few days. There are some risks, such as infection, but these are rare.

  • aru:

    hello docter i broke my right forearm radius and ulna on 25th of February i had 2 metal plates and 11 screws i really like sports contact sports like boxing can i now use my forearm for these kind of things like blocking with my forearm is this alright or will my forearm brake can the metal plates take the forece or do i have to take them out thank u for reading plz tell me wat to do :)plz reply

    • jp:

      I assume that this injury was on 25 February 2013. Has the healing been checked by X-ray? If so and the bones show “union” then you will be able to continue rehabilitation, graded upper limb exercises plus swimming. Avoid contact sport for a full year, and only then think about removing the plates if you have recovered fully. In general terms it will probably be best to have the plates removed at some stage, since full-force contact will run the risk of the bone breaking at the end of the plate. Allow another six months rehabilitation after removal of the plates

  • daniel leo bailey:

    I have the matta pelvic system metal plates in both pelvis and these has giving me a lot problem I just a another surgery jan 23 2014 and now my feet are still burning I have chest pain sometime short breath and I was told after 4 year they take out what kind danger if I don't get these metal plates out

    • jp:

      Removing pelvic plates is a significant procedure, and most are left in place. You will not be any great danger by leaving them in place, which might be the best option.

  • Janet Pownall:

    In your last post to me on 8 December 2013, you said it might help if you could see a copy of the latest xray, but what address should I send it to, either by email or post? Many thanks for your help and advice so far.

  • My age is 41 now and at the age of 38 my Hip bone femoural fracture (Head of Femor right) happen accidentally in bathroom slipped the leg and fracture right hip.On the same day surgery has done three internal fixation of screws has done.After two months I started walking.As per the surgery report there is 2 cms shortening in leg. Two years back i contacted to Orthopaedic and requested him to remove the screws he agreed and started performing the surgery he tried for one hour and the head of the screws are plain it was very difficult to hold in grip. He tried and afraid of fracture of bone if he applies force.It was not successful and he said it is jammed inside do not try to remove the screws otherwise once again the bone will fracture. So kindily advice me wheather i should keep the screws inside my bone forever.Awaiting for your reply on my mail.If any Orthopaedic agrees to remove without any damage to bone send his Hospital address with mobile no.on my mail. With Warm Wishes Sajjan D

    • jp:

      Assuming the surgeon who tried to remove the screws is competent, then it is unlikely that any other will be more successful. Very many people spend much of their lives with screws remaining in the femoral head (in this case probably via the shaft)

  • Aisha:

    About 4 months ago my mom fell off our porch and broke her two big bones in her leg one bone actually protruded thru the skin she had surgery and had a plate and 9 screws. She was doing really well started walking using a cane well suddenly this weekend her foot started swelling really bad and she is in pain went to the doctor and he said she prob had a hairline fracture she is in major pain he put her back in a cast. I'm wondering if maybe we should get the metal plates taking out? Or even get a second opinion

    • jp:

      The diagnosis of a re-fracture might be correct. However a deep venous thrombosis must be excluded or treated. The diagnosis will be helped by ultrasound Doppler or venography, “Hairline” fractures do not kill. Deep venous thrombosis can kill.

  • rdp:

    What a great service you are offering us here. Thank you, jp. I have scrolled through the entire comment list and didn't find anything related to displaced or comminuted patella fxs. I tipped off an eroded curb in December 2012 and broke my right patella (female, age 60). Had ORIF and pt and have regained ROM with tightness/discomfort only at a point of extreme bending (sitting on my heels). However, I continue to have discomfort>pain along the top of my kneecap and on the side of my knee nearest my left leg whenever the injured knee is bent and under load. I could not do the seated knee extensions with a weight in pt without extreme pain and going up and down stairs continues to hurt. My OS says it might be the hardware (screws and wire) that is causing the problem, but is concerned that removing the hardware sets me up for an increased risk of re-fracture. I find conflicting info on whether removing the hardware or leaving it there leads to better quality of life. I am flexible and being able to move w/o discomfort is important to me. Would you kindly share your thoughts on removal?

    • jp:

      Eventually the strength of the healed patella, its periosteum and the retinaculum will be far more strength important than the “screws and wires”. From that description I believe that you have had “tension band wiring” used to repair the patella. I also interpret your letter to say that the main body of the patella was not broken through, and remains sound (and so safe). Tension band wires frequently break or loosen, and their screws are often uncomfortable. Best as I can judge the metal is likely to be the culprit. I usually take out this type of fixation after about a year. One reason is that there is little “flesh” to buffer the implants, and your type of problem has almost always been associated with metal (Occasionally it is associated with an improperly re-positioned bone fragment or a loose articular cartilage fragment)

      • rdp:

        You are correct about screws and tension band wiring. My OS never made it clear to me whether the patella had broken completely through --does that make a difference? He says my bone is at this point 95% of what it was at the time of the fx. Would I be correct in inferring from your comment that you don't believe the risk of re-fracture is higher after the hardware is removed?

  • Christina:

    Hi there, I'm a 22 year old female.. I broke my humerus in 4 places in Feb 2012 and had to have surgery to have a titanium plate w/ 12 screws put in.. I'm kind of stubborn and didn't baby myself at all (still dont..) I started driving 29 days after the surgery (I drive a stick) and was back to my normal life shortly after and recovered (or so I thought?) rather quickly.. But these days all I do is worry about my arm and my back (I also broke my back last year in April in an accident)... So I've been working out quite a bit since October (doing a lot of strength training mostly..) and have noticed more problems with my arm.. I can't really put it into words exactly how it feels but I'm just wondering, is it bad to work out and build a lot of muscle in my arm bc it might interfere with the plate possibly? It used to only bug me here and there with small sharp quick pains and when I'd hit my elbow or arm on something but now it seems to be gradually getting worse.. I can feel it like when I lower a weight or during pushups. I don't have insurance or anything and I just recently got charity to cover med expenses for mostly everything except for therapy visits, so I really don't want to go back to have them look at my arm and then get more bills.. So do you think my arm might be ok and that's just how it feels with building muscle by/around the plate? Or could it possibly be something more serious like something to do with the plate or screws or the bone itself? Please help I need piece of mind =/

    • jp:

      As often happens it is difficult for me to get a complete picture, and so be able to offer a firm and sound solution. But broadly speaking you seem to have the common features and the discomfort of rehabilitation. After the type of accident you had many of the muscles and other moving structures will have “glued” by “fibrosis”(adhesions) and these might be pulling and hurting as they gradually release and begin to move smoothly again. Suggest you read my post on “Recovery from Orthopaedic Injuries and Surgery”. As said often swimming is probably the best exercise –minimal loading, maximal muscle recruitment.

  • Khalid turki:

    Hiii i am a 16 year old male and i was recently involved in a motorcycle accident in which i fractured my upper part of the tibia under the knee in which the tibia was fractured as if it was a glass mirror were there were fractures all over a day after the crash i had surgery on my right leg and a plate and screws were inserted to hold my bone together and the fractured part of the tibia i was wondering as i am 16 would it be better for the plates to be removed or left in as i really dont think a boy as young as me should be having metal in his left in my body for the rest of my life as younger people genreally heal better than older i am also worried will i be able to run with metal plates as i plant to lose alot of weight

    • jp:

      As you say the injury is recent. The high probabilities are that you will be able to (and perhaps need to) have the screws removed once the bone has healed. This is unlikely to be earlier than six months from the injury. Meanwhile you should / must exercise within the limits suggested by your treating advisors: A stationary cycle is usually imperative, and swimming cannot be encouraged too greatly.

  • nathan:

    Hi, like a previous commentor I suffered a gunshot wound to the humerus of my right arm. It tore through artery which they fixed, and broke the bone, which they put a titanium plate on. The nerve was supposedly undamaged, I had full movement of hands, wrist, and fingers, along with feeling. It looked good and was healing fine, doc said I could do most anything except contact sports. I was passing a football and tried to throw one deep on my last pass when I heard (and felt) it pop. Broke it on the same bone above the plate where there were screw holes. Screw holes were from an external fixation they put on when they fixed the artery before putting on plate. Nobody paid attention to those and I was told I was fine to pass a ball. Anway thats besides the point. Today it is healed fine (they have another plate on it) and I have been going to the gym regulary. Recently I have felt a sharp pain when moving my arm in different ways. Simple stuff like brushing my teeth or lathering up soap, or when I nudge my elbow up to something. I went on a snowmobile ride and seems like thats when it started, no sudden impacts but it was a bumpy ride. I dont remember anytimes when I felt any sudden pain. Is it possible a screw came loose or backed out and is hitting/ rubbing a nerve? I had planned on going into the miltary. Recruiter said my arm wouldnt be a problem. I'm norvice about this new pain and do not want to get rejected from the military cause of this. Any thoughts?

    • jp:

      As always, diagnosis first. Pin-pointing the pain and the movements which produce it to your surgeon is the first (and most valuable) diagnostic step. Only thereafter is radiology useful. Bothe the surgeon and radiologists need firm pointers to the anatomical site of your pain. Next the management which depends entirely on diagnosis. External fixator screw holes are bigger than the screw holes from a plate application, and more often become infected. Greater care of these holes is required (as you found to your cost),

  • Lisa Billingsley:

    Thank you for your reply, Tammy! I am sorry that you aren't doing much better with all of the hardware out. I have heard that once the hardware is out you should be as good as new. My break did not affect my ankle joint and it sounds like yours did :( Take care!

  • Michele:

    Hi, I suffered a gunshot injury to the humerus in 2001, the radial nerve was 50% destroyed. After a plate and screw fixation, tendon transfer and lots of therapy I have a pretty functional hand wrist arm ability. After all these years with little of no problems I received a painful blow too the arm about 2 months ago when my child accidentally jumped on it. It has had an annoying pain coming and going since then. I went for an X-ray which didn't show anything much to worry about, no loose screws, plate seems fine etc. blood tests done for infection show nothing much, now on a course of anti inflammatory ford three weeks which doesn't seem to have helped at all for the three days I have been drinking it. Doc is very reluctant to operate as he says the injured nerve, scar tissue etc and unpredictability of what he would face on the inside make the risk of further disability to the hand and wrist very high and he cannot remove the plate without touching the nerve so we need to try everything else except operating. In addition I am allergic to anti convulsants meds which cause a Steven Johnson syndrome reaction so this limits meds that can be used to try and reduce the current pain if it is the nerve which is causing it. Do you have any suggestions why it would suddenly bother me now? And why the pain doesn't go away although the X-rays, bloods etc show no explanation?

    • jp:

      I am sorry to hear about what must have been an extensive and trying convalescence. X-rays and other tests do not show everything. That is the limitation of the diagnostic aspect of orthopaedic surgery. You likely had a small bleed or contusion associated with the radial nerve. Your surgeon’s reluctance to operate is wise. You have got away with an acceptable functional recovery which should not be jeopardized. Your own natural healing is on your side, and two months may not be long enough for spontaneous recovery. An anti-inflammatory gel or Arnica oil rubbed over the painful area could help you much. Physiotherapy, perhaps with ultrasound treatment, could be beneficial. If the tender spot is small and consistent in position, then injecting steroid into the area might also be of benefit.

  • tamer:

    hi. dr i am a 28 years old ,3 year before i had broken ulnar shaft on the distal part ..2 days after i did surgery plate and 6 screw in the external part,, the problem is about that i do sport in the gym and a workout sports ,, but the plate cause pain and bother .. i am so worry i cant do sport anymore "the sport is my life" .. so i wuold like to ask if i remove the plate can i turn to do sport or i cant do intensive and a professional sport for ever.. i will be glade if you tell me the benefit and the risk of the operation ...specially for an athletic person .. thank ....

    • jp:

      A single break of the ulna (with an intact radius and an intact inter-osseous ligament) should recover full function. It has to be asked why the plate is causing pain, and it should be ensured that the pain is associated with the plate. If it seems likely that the plate is the sole cause of the pain, and given the importance of sport to you, the plate could well be removed. The surgery, in my region, would be done as a per-cutaneous day-case, perhaps under local or regional anesthesia, with immediate return to upper limb function. The sutures/staples would be removed a week later (keep the wound dry until the removal). The risk is minimal.

      • tamer:

        thank you doctor ,, i wuold like to ask about the holes thats maybe will cause a refracture,, and abuot the post operation recover ,, ?? at lest i will be glad if you tell me your country .. ? thanks a lot for your helping .. "iam the same guy with the ulnar fracture " tamer 28 years old from bologna italaia."

        • jp:

          Screw holes in bone often fill spontaneously. But even if they do not, after the plate or screws are removed the total strength of bone recovers (after some months) to the original strength.

  • Danny:

    Hello. My mother, who is a type 2 diabetic, passed out and broke her right ankle in 2 places about 5 years ago. She had surgery a week later and had a plate and 2 screws installed in her ankle. Recently, her family doctor told her at the 5 year mark, the plate and 2 screws have to be removed. My mother is doesn't want the plate or screws to be removed and is wondering why at five years they have to be taken out. Thank you and waiting for your response.

    • jp:

      I assume that your mother is past mid-age. The information which you convey is not conventional. All and any surgery requires justification. At times that justification is to increase comfort; at other times it is to prevent worsening in the future. Although, as a type ii diabetic she (in theory) might have an increased risk of infection associated with the screws this is so incremental that this risk (in itself) would not justify surgery. Please ask your family doctor about his reasoning, and ensure there are no other factors which have prompted this advice.

  • A C SOLA:

    l. am 46 years. A female, had a car accident in November 2013. I had broken femoral shafts of the two legs a week after l did surgery plate and screw was fixed in my legs. Now l want to know when will l be able to walk, and how will l be able to walk coz after leaving the hospital l was using wheel chair for mobility. Thanks for your respond.

    • jp:

      Once the x-rays show that the thigh bones have healed (joined firmly) you should begin training to walk. That training should include a stationary bicycle, and ideally swimming in a pool. If you can find a swimming pool to use, make sure that you are accompanied by a good swimmwer when you are in the water.

  • Adio Adesola:

    l have broken femoral shafts on my two legs surgery was performed on the legs same day plate and screw was fixed within the first week of the accident. when.and how would l be able to walk. Thanks for your quick respond.

    • jp:

      Once the healing been checked by X-ray and the bones show “union” then you will be able to begin rehabilitation with graded upper and lower limb exercises plus stationary cycling and swimming. Avoid contact sport or “risk activity” (such as motor-cycling, skiing and contact sports) for a full year.

  • Soosaar:

    Hello, After bad calcneus fracture and 9 operations (due to complex Staphy aur and stretp infection) I have 2 screws holding femural condule vasclurised bone graft with my halved own calcaneus - now very good fusion prognostic under free flap and infection gone from blood samples - what impact will screws have in very long run (20-30 years on)dangers ex osteporosis/ reaccurance of infection?

    • jp:

      It seems that you have been salvaged from the Valley of (calcaneal) Death. This was a horrific injury, and I am glad that it has recovered this far. Do not concern yourself about screws in decades ahead. Leave it to your surgeon to treat any future infection (which might require removal of screws at the appropriate time).

  • Shawn:

    I broke my left hand the first football game of the season. I had to have surgery, and get little rods in my hand. My doctor gave me the choice to take them out or leave them in. He wasn't much help, only telling me that if it bothers me, get it out. However, he also said i can keep it in for life if I want. It's a hard choice because I'm constantly getting hit at the position I play. My hand also is sooo much bigger than the other! The plate can easily be felt with the slightest tap. I just don't want to risk anyone hitting this thing next year and re-injuring it.

  • Dan Brown:

    Hello. About four years ago I had surgery on my left pinky finger which result in a plate and screws to repair my finger. To this day I still have extreme pain trying to put gloves on or sometimes when I put my hands in my pocket. Of course I have the occasional aches and pains that are expected, but should I still have extreme pain when trying to put on gloves or making a fist? Should I consider having the hardware removed?

    • jp:

      You probably had a break of the fifth metacarpal neck. This was likely plated from the top (not the palm side). If so one of the "extensor tendons" could be adherent by scar, or intruded upon by the metal. You have a relatively common problem which is often cured by removal of the metal.

  • Lisa Billingsley:

    Hi, I am a 47 year-old female who broke her right tibia and fibula about 6 years ago. I slipped on black ice and my leg slipped to the side of me and I heard the bones break. I had surgery one week later (ORIF). I plate and six screws. I was non-weightbearing for 3 or more months. I am able to do most things but I have never been able to run at all without pain. I went to the doctor and he said if it was due to hardware pain it would be down near the end of my plate, not near the fracture site where it seems to be hurting. My leg has really been throbbing a lot more and I think I want to hardware removed which surgeon is willing to do. If I do have surgery, do you think I will probably be able to run again without pain? Thank you so much for your response.

    • jp:

      It is of concern that the pain is a throb at the fracture site. This might be associated with a non-union or with infection. You should be appropriately investigated, perhaps with a radio-isotope scan and signs of inflammation sought by blood testing.

    • Tammie McCown:

      Lisa hi. My name is Tammie I had a compound fracture. Same bones tibia and fibia right ankle. I had 19 screws 2 plates 1 on side.April 2009 and 1 year later(Feb. 2010) I had them removed, I had 2 broken screws I told them to leave them because they would of had to rebreak to get these out.Today 4.5 years later I can not bend my ankle and its starting to hurt more often and more painful.Something I was told to get use to. I just try and be careful, as I am 50 now. Good luck.

      • jp:

        Thanks Tammie for your support to Lisa. It can be lonely out there. It should not be difficult to remove broken screws by using a cylindrical drill bit which removes bone surrounding the broken screw. The screw-hole is, however, enlarged slightly.

  • Prateek Arora:

    I have a plate in my femur and the bone hasn't joined yet.it is 5 months ago that i had got the surgery done.The plate is continuously bending outwards nd the bone is also bending.The doctor has stoppede form bearing weight.What else can i do to prevent my femur plate from bending. Please help

    • jp:

      The plate will only bend if you are taking weight on the limb. Check whether the plate is broken by x-ray - at times a broken plate can be difficult to detect and several x-ray views might be necessary.

  • glen:

    i am having a screw removed from my knee and i was wondering how long i would be out of sport for

    • jp:

      This will depend upon the site of the screw and how elaborate is the surgery to remove it. You do not say the type or cause of your injury or the type of sport you wish to return to. Without that information I cannot offer sound advice.

  • lois baily:

    I have a metal plate on the outside of my leg and screws in the ankle on the inside of leg. about 8 or 9 screws all together. in the foot and leg. I fell broke both ankle bones and had nine breaks with the bone in leg broken also. this has been 17 months ago. The dr says the screws and plate stays. I do have osteprosis at 3.5 in the foot. But my problem is the top of the foot is numb but the foot burns like fire, I am now taking Neurotin 3 times a day and still have so much burning yet. I feel like theres no help for me but somewhere someone has got an answer .PLEASE help

    • jp:

      The nerve supplying the top of your foot has been damaged, possibly one of the branches of the peroneal nerve. If your orthopaedic surgeon cannot help, ask a neurologist to locate the site of damage to the nerve. Once you know where is the problem various methods could be used to abolish the pain.

  • ms B. Robertson:

    Due to severe pain on knee and lower leg 3years after rod put in. fibula,finding it hard to walk, and what todo for best.

    • jp:

      Knee pain after a lower limb injury is complex and requires expert analysis, which is not possible with the limited information you have supplied.

    • ms B. Robertson:

      After. I fractured my tibia + fibula 3 years ago in a fall i had a rod put in my fibula, thats causing me severe pain can it ne removed?

      • jp:

        Your assumption is that the rod is the cause of your pain. If the pain is below the knee-cap, related to the scar, if you can feel the rod through the skin and pressure on the rod causes your pain, then it is likely that the rod is the cause of your pain. Once the bone has been shown to have healed (by x-ray) there should be no reaon why the rod cannot be removed.

  • yojann:

    i underwent sergery on my broken right forearm on dec. 14 2013. i'm still in the healing process. my forearm has a slight cuveture to it. is this normal or is my arm permenantly curved/deformed.

    • jp:

      If your forearm bones were repositioned and held with internal fixation then the shape should be “normal”. (Apart, perhaps, from temporary swelling). It is possible that the internal fixation is incorrect. The radius is normally curved. If that is not maintained, or there is rotation, the outward appearance will be abnormal. Were post-operative performed? That would provide the definitive answer. Feel free to e-mail them.

  • Becky Christian:

    I fractured my left ulna and radius bones in September 2003 in a go cart accident. I had plates and screws in both bones by having surgery. In September 2004 I had surgery again on my left radius due to non healing so they put an artificial bone graft to help. Every few weeks, my arm swells near the ulna side and forms a large lump which is red and extremely painful. I've had numerous xrays and im told everything is fine. I have seen the surgeon to see how I can stop this from recurring and was told I need to live with it. I did ask if i could have the hardware removed but he didnt think that was a good idea. The pain seems to come from overuse and changes in weather patters and generally lasts between 6-7 days. What would you suggest? Thank you for all of your help!

    • jp:

      Has your surgeon seen the "lump" when it is prominent? Have any markers of inflammation been demonstrated in your blood? Have you had an ultrasound or MRI performed? It seems that the surgeon does not think that removal of the plate/s is a good idea from his point of view, not yours. Feel free to send your x-rays for an opinion.

  • Sarah:

    Hi my son who was 24 at the time fell and broke his elbow radial head and it was dislocated, he had ORIF full radial head replacement he also has a plate and screws on his forearm, this happened in August 2011, he is always in pain he describes it at a dull ache and when it is cold he is in more pain, he was going to have the plate and screws removed in September 2012 but he had a baby son to care for while his wife was at work and decided to wait, now he wants to have the plate removed along with the screws , is this possible after 2 years ? thanks

    • jp:

      The short answer is that there is no reason why the delay should make removal more difficult or contra-indicated. The longer answer is whether removing the plates will cure the discomfort. From your description of the type of pain I think that it is probable that the plates are causing the ache. However a synthetic radial head can also give discomfort.

      • Sarah:

        Thank you for the swift reply , is recovery time quicker than the first operation or the same please and will he have a full cast on again ?

        • jp:

          "my son who was 24 in August 2011 when fell and broke his elbow radial head and it was dislocated, he had ORIF full radial head replacement he also has a plate and screws on his forearm, this happened , he is always in pain he describes it at a dull ache and when it is cold he is in more pain, Now he wants to have the plate removed along with the screws , is this possible after 2 years" Mostly the plates are removed as a day-case, often under regional anaesthetic. The limb should be capable of some function immediately. It is unlikely that a cast will be necessary. The limb should be kept dry until the stitches are removed. Then six months of graduated rehabilitation before full loading.

  • Daniel:

    Hi doctor, I was in serious car accident (2003) broke tibia and fibula of both left and right ankle joints, and as the Left was much worse I was told coral was used as a bone growth substitute, additionally large plates and screws are in both ankles. My questions are if I should remove the plates and screws, and if possible somehow the coral implant? Over the last 10 years Occasionally I experience excruciating pain where the coral was implanted, such as a pulsing throbbing pain and usually occurs after I wear a boot which has a high side and creates pressure and friction near the coral implant site/metal plates. This is the second time I have severe inflammation in 10 years, and am currently taking Naproxen 250mg from doctor that told me it is due to inflammation at a site near the scars on ankle. Recently (August 2013) I have had a surgery on shortening the paroneal tendon as it was rolling over my ankle joint when flexing the tendon up the the left. I have also experienced minor swelling and redness near the sites of metal plates on my left ankle several times since 2003. What would you say my best option is to proceed in healing in the near future? Thank you kindly,

    • jp:

      Coral is sometimes used as a "substrate", that is a scaffold onto and into which bone will grow. The coral is gradually replaced by your own living bone. That is not to say that at times fragments might remain and perhaps become infected. Therefore have your reconstructed left ankle x-rayed, and if necessary a radio-isotope scan or MRI. That should clarify any possible problems.

  • Janet Pownall:

    Thank you for your recent reply. I didn't explain it very well but it wasn't a fractured neck of femur, it was what I think you would call a non-displaced extra capsular fracture. It was a clean break of the thigh bone. He has a plate on his upper thigh held in place with screws or nails. The pain he is in has a big impact on what he is able to do and how far he is able to walk. Is this normal? His GP referred him to the local orthopaedic surgeon, but he just said there was nothing wrong and didn't really want to know. Should we try to see somebody else do you think?

    • jp:

      If the break was “non-displaced” then the healed bone should be in its original anatomical state, and should function normally accordingly. Therefore the pain might well be caused by the implanted metal. Is there a pin/blade up the femoral neck? If do it is possible that this is extruding from the bone and impinging elsewhere. “Standard” X-rays might well not demonstrate this, and further views might be required. Does your husband have pain with particular movements or positions? Is the pain worse when weight-bearing on the injured limb? [I realize that he has pain when standing].

      • Janet Pownall:

        No he hasn't got a pin going through the femoral neck, just the nails holding the metal plate in place. He experiences a dull ache most of the time which turns into a pain when he stands up and puts weight onto the leg. He is of medium build and weight (not overweight). The longer he stands or walks the worse the pain gets. He has a good range of movement but avoids supporting his weight on that leg if he possibly can. For instance, he uses a walking stick to lean on when he walks and he will only do steps if there is a handrail.

        • jp:

          It is difficult for me to give a definitive comment. When was the last x-ray performed? It would help if you could send that to me, electronically or otherewise.

  • Zoe Grimston:

    Hi, I broke my tib and fib in April and have a plate around 20cm long and 9 screws in my fibula towards the outside. I seem to be healing well, dorsoflexion is improving but I suddenly have very localised swelling following my plate. The ankle itself is a little swollen as it often is. There is only a little stiffness and pain. My main concern is some tendon ot nerve involvement (I haven't been able to feel some of my foot since the surgery). Any advice would be very nuch appreciated. Thank you.

    • jp:

      My guess is that the loss of sensation is on the top of your foot, perhaps related to an injury to the peroneal nerve. This might well have happened at the time of the accident, particularly the fibula break. Whether it will recover spontaneously is difficult to predict. My practice is to use an elasticized stocking on all leg fractures, under the cast if necessary, and I would encourage you to do the same for some months until all swelling has gone.

  • Samantha9313:

    Hi I am a 44 yr old female had a bad fall in my bathroom with an outstretched arm and suffered a comminuted proximal humerus (5 piece break) right arm. I had surgery 4 days later and had ORIF plate and 15 screws fitted. I have a large scar too as a result which is healing well. I am nearly 4 weeks post op and attend Physio every week and improvements are experienced on a daily basis but it is very slow and I am still stiff. Full movement in fingers, wrist and elbow. I went for a review at the hospital last week and was told that I may not be able to reach above my head because the metalwork would impinge around my shoulder joint. I was distraught at this news. My physiotherapist was more optimistic but said it will take time. I have also suffered from all oover body itch since the surgery to present day, could it be the hardware, I don't want a titanium plate in my body. Could I request or pay privately to get it removed 1 year post op?

    • jp:

      It is very early to plan future moves (as I am sure your physiotherapist will agree). At least six months is required for this convalescence. Should you have problems reaching above your shoulder after that then the cause must be established. One way is to use an X-ray to watch the movement in real time, which could show if the metal implant is obstructing or making impact with your shoulder-blade. Another way will be to use MR scans (or arthroscopy or arthrography) to determine if there is any injury within the shoulder joint. There should be no need to have this done privately. A National Health Service has an obligation to cure you as best possible. It is improbable that the metal is causing the itch: more likely it is the medication you might be taking, perhaps for pain.

  • hello doctor, male 33. my left femur broke in 2009.surgery with rod and plate. now it is better i can walk&cycling even ruining i feel no problem. but problem is that rod is longer from hip to near to knee. it is teasing me in my muscles like a steel nail. i want to remove that.because now my bone is assembled. should it better to remove that all rod and plate? would it be danger or something other? because i want to live like previously (before broken)i have. kind regard,

    • jp:

      You speak of a rod. I will assume that this is an intra-medullary rod, down the marrow cavity. This is likely to be the main cause of pain, as it is probably intruding into the muscles of the buttock. Removal should be easy, via a two centimeter incision, with full weight-bearing walking the same day and stitches (if used) removed a week later. However occasionally calcification of the muscle, where damaged by the rod, might need removal and increase the dimension of the incision. A caveat: If the rod has bent a significant increase in the surgery might be necessary to remove it. The plate is likely to have been used to retain a separate fragment. Those screws might be impacting on the plate and occasionally require removal to allow the rod to be removed. Removing the plate usually needs a larger incision, perhaps comparable with the original incision. At times the screws can be removed “per cutaneous” via small incisions over each screw, and the plate also removed via a small incision. This needs a little more expertise, and is not often performed. Following plate removal more pain might occur, and removal of sutures might be delayed for ten or fourteen days. Full weight bearing walking the same day is usual.

  • Dennis L:

    I have an epidermal inclusion cyst on incision scar after ankle surgery. Can cyst be removed without also removing plates and screws? Background. I had surgery for bimalleor fracture of right ankle Dec 2012. Plate and 6 screws. During recovery nurses and pt's noted spot on incision line that wasn't healing normally. They believed there was a stray stitch that would come out on it's own. Couple of months went by, still not healed properly. In July 2013 Ortho referred me to dermatologist. Diagnosed epidermal inclusion cyst. Didn't want to excise herself because cyst goes all the way down to metal plate. Ortho gave me two choices: 1. he'd excise cyst but wanted to remove hardware at same time. Concerned I believe about infection risk and resulting complications; 2. leave cyst in place and monitor for signs of infection, at which time he would want to remove cyst & metal. I selected option 2. However, it's become a problem because shoes rub and press against cyst and it becomes inflamed if I walk any great distance.

    • jp:

      It seems that option 2 is not working out. Therefore go back to option one. From your description I doubt whether this is an inclusion dermoid “cyst”. More likely an infection probably associated with a stitch. My suggestion would be to have the line of the original incision excised, and remove the metal at the same time, to get it all past you. Please let me know the outcome.

      • Dennis L:

        Update to my Nov 18 post. There has been significant improvement over the last two weeks. "Cyst" stopped draining and a small scar formed. Scar tissue fell off about a week ago and remaining wound seems to be healing. Hope this continues, If so I think I will not require more surgery to remove cyst and metal. The metal itself doesn't bother me, just the wound.

        • jp:

          Thank you for the follow-up which is useful, always. In retrospect this was most likely a stitch abscess. The stitch was probably "dissolvable", and once this foreign material dispersed the associated inflammation faded. Implantation dermoids continue to grow. One lesson is that "dissolving" stitches can take many months or years to disappear, and are prone to both sensitivity reactions and as a nidus for infection. For those reasons plus cost and longer post-operative discomfort I do not use those sutures.

  • Janet Pownall:

    My husband broke his hip almost 3 years ago. It was the top of his femur that was broken just before it meets the hip joint. He was operated on and now has a plate along his thigh bone with nails holding it in place. He still gets a great deal of pain in the area of the surgery when he puts weight on his leg. He can walk quite well with a stick but because of the constant pain he can only manage short distances. We cannot understand why this is so painful after all this time. He has been back to the local hospital and had xrays but the doctor he saw said there was no problem with the metalwork and it looked "pefect". He would not discuss removing the metal. Is it normal that he should still be in such pain whenever he puts his weight on this leg? He thinks it must be the metal. Could it be anything else? He was told by the hospital doctor locally "this is as good as it gets, you will just have to live with it". I would really appreciate your views on this.

    • jp:

      From your description I will assume that your husband had a “sub-capital fracture” or said another way a “fractured neck of femur”. Such injuries can cause the death of the “ball” of the femur. This might not be demonstrated on conventional X-ray, but could cause significant pain. Possible ways of identifying this include radio-isotope studies, angiography, intra-medullary wash-out of radio-opaque dye and MR imaging. If the bone is alive and healed the metal should probably be removed in the management of the pain. This can usually be done as a day-case, with full weight bearing (and hopefully) pain free walking the same day. Because of the high risk of this dying of bone many surgeons perform a total hip replacement for this injury at the outset. It is unacceptable that your husband should be expected to have this continued pain, the precise cause of which requires illumination. Total hip replacement might be necessary.

  • Janet Pownall:

    My husband broke his hip in a fall almost 3 years ago. It was the top of his femur that was broken before it meets the hip joint. He was operated on in Southampton and he now has a plate along his thigh bone with nails holding it in place. He gets a great deal of pain in the area of the surgery whenever the leg is bearing any weight. He can walk quite well with a stick but because of the constant pain he can only manage short distances. We cannot understand why this is so painful after all this time. He has been back to the local hospital and had xrays but the doctor he saw said there was no problem with the metalwork and it all looked "pefect". He would not even discuss removing the metal. Is it normal that he should still be in such pain whenever he puts his weight on this leg? He thinks the metal nails and plate are causing the problem. Could it be anything else? He has been told that this is as good as it gets and he will have to live with the pain for the rest of his life. I would really appreciate your views on this.

  • Daina:

    Hi, I had a open complicated fracture ulna and radius. Had ORIF done 4 years ago,now i am having severe pain and swelling of my arm,x-ray and bloods done no infection.I have implant of stainless steel.Will it be rejecting by my body after so long.is it better to be removed. please reply Thanks

    • jp:

      Rejection is unlikely and a “missed infection” or a vein thrombosis must be considered and investigated (again). You might need “edema control” which is often offered by specialist physiotherapists. Find a cause for your symptoms before removing the metal.

  • Laurence Hanton:

    Hi ya, I had a sports accident back in December 2010 while in Spain which I broke my arm (radius/alna mid shaft) clean break, so I was operated on in Spain to reattach arm with plates and screws. After several months my radius bone didn't heal creating a non-union, but by mid July 2011 the surgeon here in England re-operated with a bone graft and replaced existing plate with a new plate with new screws and holes on radius. Now due to occasional aches and pain and plate rubbing and catching at times would it be good reason to remove plates now, but do worry about any weakness that this may bring and if this is a life time feeling or if I can get confidence and real strength as If their hadn't been a break there at all, if you can give me any advice please .thank you

    • jp:

      It is common to remove fore-arm plates once the bone has healed. If the plates are causing symptoms (I cannot be sure from your letter what you mean by “rubbing and catching”) there would be valid reason to remove these plates. After a year of graded increased loads and exercise the bones should be as strong as they were before the injury.

  • Janet Pownall:

    My husband broke his hip in a fall on some steps almost 3 years ago. We were on holiday in Greece and it was almost a week before we could fly back to the UK for an operation. It was the top of his femur that was broken before it meets the hip joint. He was operated on in Southampton and now has a plate along his thigh bone with nails holding it in place. He still gets a great deal of pain in the area of the surgery. He can walk quite well with a stick but because of the constant pain he can only manage short distances. We cannot understand why this is so painful after all this time. He has been back to the local hospital had xrays but the doctor he saw said there was no problem and the metal plate and it looked "pefect". He would not consider removing the metal. Is it normal that he should still be in such pain whenever he puts his weight on this leg? He thinks it must be the metal. Could it be anything else? I would really appreciate your views on this.

  • Nathifa:

    Hi, I would like to first say thank you in advance god this forum and your anticipated response. My son will be going into surgery to have about 1-3 screws place to help heal a metatarsal fracture. My questions is how soon after can he have the screws removed? And if not how long is the life expectancy of the screws?

    • jp:

      My guess from your phrase is that this fracture has not occurred in the immediate past and the screws are necessary to ensure union of bone. Is this the fifth metatarsal? That bone often takes longer to heal than others. The answer must be that when healing of bone is complete (and demonstrated by x-ray to be complete) then the screws will have fulfilled their function and could be removed. As an average, healing of a "delayed union" could take three months.

  • Fiona:

    Hello, Thanks for the interesting article. I'm a radiology typist :) I had bilateral tibial transfers in 2008, with fantastic results, my ROM and comfort have been hugely increased. However during surgery I developed bilateral DVT, even with prophylactic Clexane, tights, mobilisation (the works!) so my surgeon has said to me unless there is a problem the screws (2 each side) will be staying put to avoid further risk of DVT. Recently though I seem to have developed a very localised "itching" inside my knee over what I believe are the screw heads. It feels a bit like the "itchy" tendonitis feeling, but as I said it is extremely localised and recent. Could it be that the screws have fractured and/or are working there way out of the tibia? I realised that I would need x-ray to be certain, but I wonder what is the life expectancy of the hardware? Thanks Fiona

  • Joseph M.:

    Trauma: Car accident Late December 2010, Classified as a 'crush' injury closed fracture to my upper tibia and fibula. The fracture was located inferior to the knee joint. ORIF 1: Intermedullary rod with 4 screws total. 2 inferior to the knee and 2 superior to the ankle. Endured about 3-4 months of physical therapy and returned to work at a new job. ORIF 2: In early 2012, I go for a second opinion because I had still experienced a lot of pain, discomfort, and even slight swelling after working at a bank all day and then coming home to use my laptop at night. After the initial X-ray my new trauma surgeon/doctor could not see enough to warrant a new diagnosis until he had a CT scan. So after he saw the CT scan he told me that a plate would do the trick. In May 2012, he removed the I/M rod and 4 screws. Now I have a plate with 3 large screws affixed horizontally in a triangle right below the patellar and as well as another 8 screws or so evenly spaced up except for a diagonal screw perpendicular to the line of the fracture. POSTOP: About a week later he called me to say it was an emergency because the lab found a benign infection from the samples taken during the procedure. I had to have a PICC line inserted into a brachial vein travelling up my arm ending at my shoulder. I was at this point on antibiotic home infusions 30 mins a day-- Ceftriaxone, as well as an aggressive oral antibiotic, Rifampin. This way the antibiotic pumped directly into my heart flowing through my whole body, to render the infection as non-threatening after a few weeks. I had about 3 follow up xrays and as of May 2013 (4.5 months ago) my surgeon said this bone has healed 100%. He left the option to completely remove the hardware as a result of another infection occuring. It was at this May appointment that I had asked him what the pain and discomfort was that I had felt SUPERIOR to the ankle, on the MEDIAL side of my lower leg which is no where near the fracture site. I asked the doctor and he said that this is a result of the LOWER END CORNER of the plate bending against the smaller diametered portion of my tibia. So now lies the question, do I undergo this third and hopefully final procedure? I plan to do it in January right after the holidays are finished. He told me I would be about 2- 4 weeks non-weight bearing and another 2 weeks toe-touch bringing full recovery to 4-6 weeks. What are my risks, do the benefits outweigh the risks?

    • jp:

      I cannot say whether removing the plate will relieve the pain at its lower end because I cannot be sure that is the cause of the pain. Since the plate is likely close to the skin, injecting the painful site with a little local anaesthetic might substantiate the belief. Verification of the point of injection by radiology would be optimum counsel. Could your pain originate at the site vacated by one of the transfixation screws? The lowest screw will have gone through the tibia, and so through the medial cortex. There is little downside and downtime involved in removing the plate (as I have imagined the plate). The upside would be pain relief, along with more general benefits as listed elsewhere on this web-site.

  • Joseph:

    Trauma: Car accident Late December 2010, Classified as a 'crush' injury closed fracture to my upper tibia and fibula. The fracture was located inferior to the knee joint. ORIF 1: Intermedullary rod with 4 screws total. 2 inferior to the knee and 2 superior to the ankle. Endured about 3-4 months of physical therapy and returned to work at a new job. ORIF 2: In early 2012, I go for a second opinion because I had still experienced a lot of pain, discomfort, and even slight swelling after working at a bank all day and then coming home to use my laptop at night. After the initial X-ray my new trauma surgeon/doctor could not see enough to warrant a new diagnosis until he had a CT scan. So after he saw the CT scan he told me that a plate would do the trick. In May 2012, he removed the I/M rod and 4 screws. Now I have a plate with 3 large screws affixed horizontally in a triangle right below the patellar and as well as another 8 screws or so evenly spaced up except for a diagonal screw perpendicular to the line of the fracture. POSTOP: About a week later he called me to say it was an emergency because the lab found a benign infection from the samples taken during the procedure. I had to have a PICC line inserted into a brachial vein travelling up my arm ending at my shoulder. I was at this point on antibiotic home infusions 30 mins a day-- Ceftriaxone, as well as an aggressive oral antibiotic, Rifampin. This way the antibiotic pumped directly into my heart flowing through my whole body, to render the infection as non-threatening after a few weeks. I had about 3 follow up xrays and as of May 2013 (4.5 months ago) my surgeon said this bone has healed 100%. He left the option to completely remove the hardware as a result of another infection occuring. It was at this May appointment that I had asked him what the pain and discomfort was that I had felt SUPERIOR to the ankle, on the MEDIAL side of my lower leg which is no where near the fracture site. I asked the doctor and he said that this is a result of the LOWER END CORNER of the plate bending against the smaller diametered portion of my tibia. So now lies the question, do I undergo this third and hopefully final procedure? I plan to do it in January right after the holidays are finished. He told me I would be about 2-4 weeks non-weight bearing and another 2 weeks toe-touch bringing full recovery to 4-6 weeks. What are my risks, do the benefits outweigh the risks?

    • jp:

      It seems that low grade infection might be associated with the lowest of the fixation screws used originally with the inter-medullary rod. Since that screw will have gone right through the tibia then discomfort might be felt on the medial side. In the face of any type of infection it is standard practice to remove all metal, even if that metal is some distance away from the proven site of infection. The recovery period will likely be that suggested by your surgeon. Benefits include the reduction in pain and less risk of infection. Risks are the costs and additional convalescent period, but very little else

  • Lisa:

    Hi I broke my ankle in 3 places almost 6 months ago, I have 7 screws and 1 plate! In a couple of weeks I go in for my checkup and im hoping for good news that I can get all the hardware removed soon as I know it hinders my walking at times! My doctor told me when he first did the surgery that he would forsure remove the hardware but he also said he would inject the holes with bone marrow paste, I have never heard of this procedure and was wondering if you could please explain this to me and if you could give me an estimate of healing timeline for all this?? thanks alot!!

    • jp:

      The “life expectancy” of implanted metal varies with load. However for practical purposes for these screws it is indefinite. Backing out of screws is a different matter, which might be a matter of months (although they might never back-out). Infection, of course is unpredictable. Radiology would be justified if you have symptoms, and would be a wise precaution.

  • Teah:

    Hi, im 20 now and last year i had my knee surgery bcoz my ligament (im not sure the details) and i have kinda metal screws in my knee (bcoz i see the xray) What is the complication of not removing the metal screws? Bcoz the these day i feel kinda weird in my knee. Thank you.

    • jp:

      Implanted metal shows so well on x-ray that many feel that metal must be the most significant influencing factor after surgery.The weird feeling in your knee might be due to the original injury or the reconstruction method. You do not say where the screw is located, but consider other causes before attributing the sensations to the screw.

  • S:

    Hi just wanted to check if you have encountered a similar set of circumstances and have any thoughts or recommendations regarding: 13 year female in accident, Laforte 1 2 3 one side 2 3 other side, depressed skull fracture, extensive reconstruction surgery. One surgery for brain/skull fracture and only one other for face! The doctor worked morning to night...she took out bone fragments in the nose and eye floor, realigned the other bones and rebuilt beautifully my daughters lovely face. Because there was over one inch separations... An intricate configuration of surgical plates... Nine of them... And bone grafts to repair the occipital floor... Was used. Ideally, dissolving plates would have been used but they went with metal. There was an initial intention to remove them as it was expected a further surgery would have been required to fine tune the setting of the right eye's final placement (only the best guess could be used for placement because of the swelling) My daughter is now 24. When we fly she consistently lands with the appearance of a black eye and the pressure is very painful on descent. In extreme cold the place where the plates lie under becomes red and mottled and painful. She says that it feels like she is an electrical field magnet, and feels vibrations around charged concentrations.... Do metals attract electricity. Does toxicity build up from leaching of metals. We haven't been able to mend children for that long really in relative terms... Long term outcomes for taking out versus leaving in. Pain is starting to radiate to other joints... Might be related? Your thoughts wold be appreciated... The is a paucity of info and I was delighted to see your post. Thank you so much

    • jp:

      I am delighted that your daughter has recovered so well. The para-nasal sinuses are related to the orbit surrounding the eye. These are filled with air which will react to pressure changes during aircraft changes in altitude. I cannot offer definitive comment, but I suggest you discuss this with the maxillo-facial surgeon who reconstructed your daughter's face, and ask about possible significance, including air leaks from the sinuses. The changes in skin colour and pattern over the plates is not surprising. These plates are close to the skin surface and can act as "heat sinks" when exposed to changes in air temperature. One result is the effect on the "vaso-motor control" of the overlying skin. It is highly improbable that this is of significance. The "electric shock" feeling, which I think you are describing, is probably related to the highly innervated area which was treated surgically. I gather that your daughter has learned to tolerate this discomfort over the years. If there is one, very specifically identifiable, area of discomfort the injection of cortisone is likely to help. In the final measure one of the plates or screws might need removal. However, having gone through all that she has, probably the least intrusion the better.

  • Kiran:

    Hi, I had recently undergone ORIF for left forearm fracture. Due to the surgery i now can't fold my left thumb. Please advise me whether it is permanent or i can bring back my nerval activity on the thumb movements.

    • jp:

      You do not say when your surgery was performed, beyond "recently". Temporary loss of nerve function could be due to the original accident, or surgical factors such as the tourniquet or traction on the nerve during surgery. You should consult your surgeon promptly. If there is pressure on the nerves that should be reversed as soon as possible. That will now be the role of the original surgeon.

  • Kiran:

    Hi,first of all thanks for this site giving me opportunity to post this question here. I am 23 years old and i broke my forearm(both ulna and radius). Doctors fixed my fracture using ORIF procedure using two titanium plates, One with 6 screws and other with 7 screws. Surgery happened before a week. Already i am quite comfortable with my surgery without any pain now. Eventhough the plates helping my recovery i still dont wann that plate to be in my hand. Please advise when should i remove both my plates. What are the chances for refracture on removal of my plates. Whether i should consult same doctor for removal. Please advise.

    • jp:

      The plates could be removed once the bones have healed - as demonstrated on x-ray. The surgeon who put them in would be best placed to take them out.

  • kristy:

    I had a plate implanted after a car accident in 2005. it troubles me when I bump it against something. after streneous activity it becomes swollen and distorted, my arm, and feels bruised and hurts. it is currently in this shape. recommendations?

    • jp:

      If metal becomes symptomatic eight years after implantation it should be assumed that something is wrong. Radiology, at least, is warranted.

  • tom:

    a 12 foot fall, comminuted right ulnar with exterior 5 inch plate and screws at elbow and right wrist fracture with ulnar plate and radial head replacement. Subsequent (3yrs) development of aseptic vasculitis but not local, systemic even to the point of a small stroke in otherwise healthy 53 year old. Stainless steel and without other source of vasculitis seriously thinking about plate and screw removal. have not drawn metal levels nor done patch testing. Your recommendation?

    • jp:

      I think that you are asking whether a sensitivity to implanted metal or metal debris can cause a vasculitis. I do not know. However I will research the possibility.

  • irene:

    Hi I had a tiba fiba fracture and would like to have pins and plate out its been 8 months as having plain

  • danleonte:

    Hi, i have on 26 July a orif due to a bike accident with middle radius simple fracture. A totally incompetent surgeon put me a 1/3 semitubular plate with 7 screws and due improper bending of the plate he broke a triangular part of the bone, then he put a screw just in the fracture focal and moved about 6-7 mm the bone part. Now is almost 5 weeks, i have excruciating pain, how soon can i remove these plate? I can send you x-ray with initial fracture site, after 3 weeks if you could give me a email address. Thanks, Dan

    • jp:

      Thank you for the radiology. The triangular fragment might or might not have been cause by inappropriate screw placement. This type of "comminuting" is common with long bone fractures. It might not have shown on the initial x-rays: this is because minimally displaced fragments frequently do not show on conventional radiology. Undoubtedly it was moved out of original position by the imprudent screw which seems to be in the fracture site. If anything were to be removed it could be this screw. The rest of the metal is holding the radius well: the radial "bow" has been reconstructed appropriately, and a rotational deformity shown in the original films has been corrected. A counsel of perfection would have been to place three screws above and three screws below the break (not two above and four below as is the case). However, having said that, the metal is performing an important function at present, and a good result can be expected eventually. So leave the plate alone until the radius is healed in eight or so weeks - perhaps waiting as long as six or twelve months before thinking of removal. I cannot know the cause of the pain. This is probably in the soft tissues, likely in muscle, because of the mechanical nature when you use the hand and so activate the muscles. There are many possible causes which include inappropriately placed (buried) stitches. The triangular fragment might be hurting adjacent structures. Therefore accurate diagnosis of the cause of the pain might be needed. On the other hand your pain might slowly recede with time, and I would give it time. Do not expect anything like full function inside a month.

  • dharmesh:

    i had a fracture of upper end of tibia before 5 years, fixed with plate and screws, all went well, i was totally recovered, no pains or local symptoms except mild occasional pain to severe pain if i overused the same knee, and slight restriction of mobility of left knee, unable to flex completely, 5 yrs passed with plate inside, no problems, but since 1 month, my bp used to remain consistantly high, since few years my bp used to hike occasionally, otherwise i was healthy in every aspects, no diabetes, no other illness, no history of any major illness all my life, my weight is 65 kg, i met with the motorcycle accident in 2008, there was a fracture of the upper part of tibia, very close to knee joint, and surgery was performed with plate and screws fixation was done, all went well, and everything healed well, in 3 months time i was normal, the pain too was minimal, few years passed but since 1 month i am feeling heaviness in mind n body, sometimes vertigo, and blurring vission, weakness, fatigue, lithargy, aversion to physical work, my bp used to remain high regularly without apparent reasons, Now i need your guidence in regarding the side effects of the plates keeping in side for 5 yrs, do you think it may produces symptoms like these which i mentioned, are these the symptoms of systemic metalic poisoning? if i remove the hardware from the body , will it help relieve these symptoms, as such i have no problem of pain at the site of operation, but there is slight restriction in the mobility of the knee, i cant flex it 100%. kindly guide me, i m confused whether go get the hardware removed or to keep it as it is? whether its advisible to keep it in for 5 yrs to continue furthur or should get it out? pls help me to get rid of this worry so that i can decide better.

    • jp:

      It seems as though you are wondering whether the plates in your tibia could cause high blood pressure. That is exceedingly unlikely. There are many other causes of high blood pressure, and since high blood pressure is such a dangerous condition you should have all the other possible causes investigated in detail.

  • Md abu Rayhan:

    Helo sir. with due respect may humbly inform you all that I am caring a nail inside my ulna of right hand for last 18 years. so long it was ok. but now I feel pain in the elbow and dont get full strength. I wanted to remove the nail but Doctor failed to do so. any way I want to remove the nail. please advice me ............ with Thanks .. Rayhan.

    • jp:

      Provided the nail has not bent in the interim, it should be straight-forward to remove it. But please be sure that the nail is the cause of your symptoms first.

  • I as well as my pals came checking the best procedures on your web blog and immediately came up with a horrible feeling I never expressed respect to the blog owner for those strategies. These young men had been absolutely stimulated to learn them and have in effect truly been making the most of them. Many thanks for really being quite kind as well as for deciding on this form of terrific useful guides millions of individuals are really wanting to know about. My very own honest apologies for not expressing gratitude to sooner.

  • Darek:

    July 17th surgery for Big Cell Tumor removal at distal fibula. 3 screws and a plate to support bone graft. I am a competitive soccer player, 33, and I am worried about regaining original strength and range of motion because of the hardware. Is this a well founded worry, and enough consideration to remove hardware. Feeling lots of stiffness and aching still. Thank you.

    • jp:

      July 17 is very recent in orthopaedic terms. The bone graft needs to incorporate, and depending whether this was vascularised, or a free graft, that could take at least nine months to become functional. The long term outlook depends upon the successful removal of the tumor. I am afraid that you have to wait patiently for at least a year.

  • Lasika:

    Hi, My hip joint was broken due to an accident when I was 21years and had to undergo a lag screw operation ( with 2 Pins) and my doctor said that I can remove it after 1 1/2 or 2 years... But as I had to join my husband abroad, I could not go for the Pin removal operation and now its been almost 3 years... When I met the doctor last time, he mentioned that if screws are tighten with the muscles he's unable to remove the screws. Also he mentioned that he cannot give any decision until he open it and see the situation. However now I am in a situation where I have to decide whether to keep it or take a risk and open it and see if they can remove... I prefer to keep it if there is no after effects... Please explain me what is the best decision to make at this point... Also please advise me if there are any effects if i do not remove the screws... Thanks.

    • jp:

      A great many people have lag screws in the hip, following a breakage - just like you. The majority of adults leave the screws in place indefinitely.

  • Rolinda:

    I had a plate and 6 screws put in my wrist in February for distal radius fracture. I seemed to be healing and regaining movement, slower then I would like but doing exercises etc. I am bruised along the scar now and have a lot of pain. My surgeon is out of town and I go back on August 13. Could this be the metal plate causing bruising? It is very painful when I move a certain way.

    • jp:

      Six months is unusually long to have pain from this type of injury. The pain may well be cased by the plate, or protruding screws. Could you send copies of your x-rays? Thank you for sending these films. One screw appears to be wrongly inserted into the radio-ulnar joint. There is also the appearance of surface incongruity of the radial articular surface under the lunate. The more radial screw might be intruding into the wrist joint. Given your protracted symptoms the distal screws should be removed promptly.

  • ija:

    one more question....i hv another 3 weeks until time for me to xray my leg again...in the 3 weeks CAN I BENDING MY ANKLE UP N DOWN EVEN THOUGH ITS VERY LIMITED FOR MY ANKLE TO BEND NOW ?? SOMETIME WHEN I FORCE MY ANKLE TO MOVE TO 90 DEGREE I CAN FELT PAIN...IS IT OK TO ME TO DO IT EVERYDAY ?? u as a dr on this field, can u give me some advices that can help me to improving my ankle bend back to the normal ...

  • ija:

    I'm 20 now .I have a metal plate with 5 small screws on one side and 1 large screw on the madial malleoulus which is the actual broken part.... i broken my ankle about 1 month already and thinking to taking it out ASAP. is it possible for me to having surgery removal on this year ?? if so how long the recovery time ( walking without crutches, play p.pong, badminton , running etc.)..

    • jp:

      Once the bone is proved to be healed - by x-ray - the implanted metal can be removed. It is likely that after an isolated medial malleolar break that you will return to all previous activities.

  • geoff:

    I had ORIF surgery after triple fracturing my ankle in a motorcycle accident. The surgery was PAINFUL, so not sure I would want to go through that again in a million years! They'd seriously HAVE to keep putting local anesthetic into the foot and ankle for 3 days after the op for me to even consider it, and they just don't do that for some reason. Instead I took loads of morphine and other drugs, which still didnt manage to keep the pain level down. I would love to have the foreign body out of my body though, especially since I want to start running again in the coming months! I worry about the dynamics of the load bearing structure being altered and less efficient, due to plate and screw, of which I have 1 and 9 respectfully. I sometimes go for long walks and I think I can feel an indentation in my ankle that is near (but, not on) the plate. And I sometimes get pain in there too.

    • jp:

      It is very unusual for removal of metal to be as painful as the first implanting operation. Most walk immediately after removal, without crutches, and minimal discomfort.

  • AnnaLois:

    I am the one who posted before , asking a ? I had fell and broke both ankle bones.which came thru to the outside .Everythig in the foot went to the left and the foot itself went to the right , nine breaks , 3 fractures, I am now back in rehab I am now in a permanent brace cause the foot wont pick up. The PT seems to think that I may be able to get out of the brace, I have asked my dr about removing the 8 screws and the metal plate . theres screws thru both sides of the ankles. I don't think Pt will help cause the foot will not bend with screws and metal plate . I can feel those screws in the one ankle. I asked the dr about removing them and she has told me NO. Is it because of the osteprosis and arthritis that I NOW have in the foot. I would give anything if they could and would take these screws and plate out..but my dr refuses too.

    • jp:

      There might be other reasons why your ankle is not recovering as you would like. I suggest that you ask your surgeon for an explanation as to why you still have problems

  • Katherine Hall:

    I am a 46 year woman that was assaulted and my wrist was broken in several places. I had surgery and a plate and 6 screws were inserted into my wrist. The screws were too long and cut my muscle, ligaments and a nerve. I went to the Dr. several days after the surgery complaining of terrible pain and knew something was wrong. He ignored me and claimed it was all in my head and claimed I was just after more pills. When I went to get another opinion he became angry and wrote out on a prescription pad and gave it to my knew Dr. demanding that the screws not be taken out, they were and now I have lost the complete use of two fingers, my wrist and the strength in my hand.

    • jp:

      Can you send me copies of your X-rays to djadmin@telkomsa.net?

      • jp:

        Thank you for these images. The broken bone has been corrected adequately and should serve you well in the future. It is correct that the screws are a little long, but this would generally be accepted. What I cannot tell is whether the drill went beyond the bone and into the tendons, or alternatively caused a bleed which has interfered with tendon function. I am not surprised that the incision wound became infected as the stitches were far too tight, and will have interfered with the blood supply and healing. That infection might also have involved the tendons. If your fingers are not functioning well then physiotherapy could help much, although that might take several weeks. Removal of the plate should be delayed until healing of the bone is proved by x-ray, and all infection is controlled. I do hope all comes right. Let me know if I can help further.

  • misty:

    i broke my left tibia and fibula in 2010. The fibula was broke up higher, and the tibia was broke down low closer to the ankle, spiral fracture. I have a plate with 11+ screws, and i have had some redness and swelling in the area of the screw placement. I've learned to live with it and about a year ago, my OS prescribed some ketoprofen cream to apply during these "flare-ups", my problem now is i am suddenly experiencing, sometimes excruciating, knee pain, but always constant left knee pain that cannot be explained. Could the plate have some type of affect on this? i have absolutely no problem with my right knee. i work as a bartender so im on my feet 8+ hours a day. my OS is no longer practicing, as he has retired.. Do i just gamble and have the plate/screws removed to alleviate the knee pain?

    • jp:

      I am sorry but I know so little about your injury that I cannot give solid advice. Is the tibia now correctly aligned? You need a professional opinion, since there is a risk that there might be a low-grade infection where you have the redness. That redness is abnormal at this time after your surgery.

  • Maneesh Kumar:

    My sister fractured her thigh and surgeonjfixed steel plate with screws on 14 .10 2010 now can the plate removed their us no problem with it

  • I am so glad I found your site. I really found you by accident, while I was browsing on Yahoo for something else. Anyways I am here now and would just like to say thank you for a great post and an all round enjoyable blog. (I also like the theme/design), I don't have time to read through it all at the moment, but I have added your website to my favorites, so when I have time I will be back to read more. Please do keep up the awesome job!

  • raff:

    I broke my hip 8years ago they put pin and screw,a year later they asked me if i wanted them out i said no,in the meantime with this fall it effected my left,i was born with a clubfoot, and i was fine upto my accident,now i walk side ways and im about 3inches short on my left leg,to cut the story short,my angle of my femur is 135degrees(the shaft neck)what they want to do is take out my pin and screw and see how my leg falls,im so confused i dont know what to do,im scared stiff being cut opened again,it took me over a year to walk when i shattered my hip,please help i have to give a decision,thank you.

    • jp:

      I am so sorry to hear of your accident, and the outcome. Could you send me your x-ray as a jpg or similar. That will allow me to make a better informed comment.

  • Cosmo jones:

    Hi im a 17 year old student who broke my ulna and radius on my left arm clean in half in a rugby game about 14 months ago. I had 2 plates and 12 screws put in but now I'm wondering if I should get them out. There's a few factors that are making me think this: 1 it is quite painful whenever I go the the gym and exert force on it, 2 I'm slightly worried about the distortion factor making my bone more vulnerable to breaking at the ends of the plates, this is quite a risk considering I still play rugby union at a fairly high school grade and it gets bashed around a bit (my doctor didnt advise against me playing but he said its at my own risk), 3 It does get targeted alot during games because I wear an arm guard to protect it, opponents often stomp/punch my forearm which is quite painful. 4 I want to keep playing rugby and remain generally active I'm the future and I see the plates as a constant burden (vulnerability). I understand that taking plates out is often not done and I also understand te risk involved (having holes where the screws were). What do you think???

    • jp:

      One misconception is that "taking out the screws causes there to be holes in the bone". The hole is there whether the screw is in or out. Think of a bamboo, with a screw through it, being bent. It will break where the screw (hole) is. There is a good possibility that once a screw is out the hole will close. Should you have the metal out see my earlier posts about a graded return to contact sport. It would be wise to not play rugby for a season after removing the metal, but to work the limb at gym during that time.

  • Orif ankle 3 months ,2 large screws inside ankle ,plate 6 screws outside,2screws on the bottom of my plate are popping out ant when I rub something on them or touch then I get an electrical shock in my toes ,I also recovered from infection in ankle ,If I suggest hardware removal and dr. Says no what options should I follow for pain relief?Ankle still swollen pain ans purple at sight.

    • jp:

      Perhaps you should not assume your surgeon will not remove the screws, which would seem the practical solution. All my patients use a below knee elastic stocking for at least six months after ankle orif. That is likely to reduce the swelling and discolouration. The sensation you feel is almost certainly the screw irritating an overlying nerve. Point this out to your surgeon and request particular care in removing that screw.

  • S Libuna:

    Hi! I have a friend who had a motorcycle accident 10years ago. She broke her tibia and had a titanium implants to support her leg and since then it wasn't remove. But now she develop an ankle swelling,redness,hematoma,pain and skin bruises on the screw site of the affected leg.I am so worried what is the cause of this?.What she is going to do? I hope you could you could help us.

    • jp:

      You list features which are suspicious of infection. Professional advise, perhaps from the surgeon who treated her previously, is required.

  • anna:

    I fell one year ago and broke both ankle bones which come thru to outside on the right leg.bones of the foot and leg were broken in nine places. and 3 fractures. I have a metal plate on one side and 8 screws on the inside of ankle and leg. I cannot walk the way I should and am wondering if these are taking out if I could walk better. I also tore the tendon down the back of the leg and it was very severed . the dr says I need a permanent brace. I have osteorposis now at the point of 3.5 and arthritis already in the foot. I am 66 years old .my foot goes numb when I lay down and it still aches and hurts

    • jp:

      It is difficult for me to get a full picture of your injuries from the description. However the numbness in a foot when you lie is characteristic of a tarsal tunnel syndrome (similar to the more frequently recognised carpal tunnel syndrome). This is realitively easy to correct (by a well trained and experienced foot surgeon). I suggest you consider a surgical solution if it troubles you sufficiently.

    • Anna:

      thanks. With the osteoporosis and arthritis already in the foot I was wondering if it would be possible to remove the screws and plate all together. I was told that I almost lost the entire foot completely.. and wondering how suffiecent the AFC brace will be in walking normal again.? I thank you for your response .

      • jp:

        The bones in your foot are held together by their own healing. Once that occurs the metal is redundant. Removing the plates might counter the osteopaenia (Wolfe's Law). I am unhappywith the concept "arthritis set in". Should you have an arthritis (and how do you know?) removing the plates can only increase your joint mobility.

  • rocky:

    hi i am rocky and i have steel in my hand for five years and still not taken out .i am not sure wether i could remove those or is it not possible .i want to see that i can remove it .but theres no pain but sometime it gives a fraction pain in my hand what must i do ?

    • jp:

      Thank you for the enquiry Rocky. You do not say where in your hand is the steel, and the reason it was implanted. If it is troubling you seldom, and if there are no other reasons to remove you might leave well alone. However for a definitive opinion why not ask the surgeon who put it in? (If you think that he is taking it out only to generate his income, and unable to supply convincing reasons for the removal - walk away).

  • Alfiz:

    Hi, i broke my left humerus bone in clean half about a month ago in badminton(sad case). So two weeks ago, i went for surgery and doctor placed a metal plate with 10 screws into my bone covering almost 3/4 of my upper left arm. Surgery is good, no radial injury, ongoing PT. But to me, i find it uncomfortable having a metal plate on my arm and is slightly heavy to me. I need advice if i need to remove the metal plates, what are the risks of doing it ? Timeframe to remove the plate ? In 1 year max ? Please seek your kind expert advice, i've been thinking alot on this. Thanks.

    • jp:

      The strange feeling is probably related to the minor changes in muscle. Having been displaced there are likely to be adhesions between some muscles which normally work independently of one and other. These sensations tend to correct over the years. The feeling of "heaviness" is probably the same, since muscles less strong perceive the loads carried by them to be greater than the opposite side. Removal of a long plate on the humerus has a significant risk of damaging the radial nerve. This is because the previously exposed parts of the nerve will be disguised by scar. A top orthopaedic surgeon should have no difficulty in removing such a plate. However it might be prudent to consider leaving it in place if it is not troublesome.

      • Alfiz:

        Dear Doctor, Thank you for the kind reply. Is it an SOP for surgeons to record where the radial nerve lies on the hole no. of the plate in case of future removal so as to avoid radial nerve damage ? Secondly, from your experience, what are the chances of radial nerve injury if i proceed to remove it once my bones healed up? Sorry to bother you,sir.

        • jp:

          The normal anatomy of the radial nerve is consistent, and using the plate as a marker is not particularly helpful. If the radial nerve had been found to be abnormal it is likely that it would have been marked. There are several ways to do this. The problem is that the normal anatomy is replaced or overlain by obscuring scar following surgery. One reason for my suggested caution is that in some health services removing a plate is often delegated to a trainee or other surgeon of lesser experience. Even when all factors seem optimal radial nerve damage to the radial nerve occurres periodically with plate removal. Therefore, unless imperative, leaving humerus plates in situ might be prudent.

  • Cindy Montoya:

    My 9 year old granddaughter has a plate and 4 screws on her ulna bone, when she is out in the sun her arm gets really red and she says it feels hot on the inside. Is this plate heating her arm up from the inside out, and now possible causing damage to the surrounding tissues?

    • jp:

      Surely this is a response to the sun’s heating? I cannot think that the plate is “heating the arm”. I would concentrate on allowing the bone to heal correctly, keeping watch for possible infection. See other postings about removing plates from growing children.

  • Kathy:

    I had a level 4 tibial plateau fracture in March 2010 from a skiing accident. I have a plate along my tibia and at least 9 pins/screws. I have become accustomed to the pain from weather changes, walking too far and standing too long assuming it was just what I had to endure. I recently started a "boot camp" with lots of squats and lunges. My knee has really been bothering me so I went to the Dr. to see what was up. He was very surprised that I was doing that type of exercise and strongly advised against it stating I would wear my knee down in no time. He recommended swimming, bicycling and elliptical. He also recommended that I have my plate and pins/screws removed that it may make me feel better and he would be able to clean up some of the cartilage in my knee. The Dr. that put the hardware in said I could leave it there. I really don't know what to do. Will removing the hardware really make for a better quality of life? Will the aches go away that I experience when I over use my knee? Just not sure if the risk of another surgery is worth it or not?

    • jp:

      I think you must accept that the injury to your knee will leave a permanent residue to a greater or lesser degree. It is rather like dropping a tea cup, which is then glued into an approximation of the original, but the sequelae will remain. The discomfort you get with weather changes may well be associated with the implanted metal, and there may be a benefit to arthroscopic inspection of your knee and if necessary debridement. Your decision might be assisted by the suggestion that the risk of surgery to remove the metal would be minimal. Ultimately you will only know if removing the hardware makes for a better quality of life once it has been done.

  • ivana:

    good afternoon - my husband had a 14months ago a hockey injury and broke his leg on two places - 17 screws and a plate was put in - he assured full complience -not to play hockey past winter - but now some friends recomended that he has the plate removed !!!???? would any doctor recmend -to do so ??? thank You

    • jp:

      You give the impression that your husband would like to turn to active sport, perhaps (ice?) hockey. I know little of the type of break which he suffered and the type of subsequent reconstruction. However, in broad terms, there are many situations in which removal of implanted metal can have substantial benefit.

  • I have a pin in the marrow cavity of my right tibia to correct for a break in the lower part of the bone. (A typical show from a skiing accident though mine was due to being kicked by a horse). This all happened in 2006 and I am now planning for removal of the pin as I am in increasing discomfort from the leg affecting my ability to walk - my foot goes numb after a short time and I get pain behind the knee and then traversing to the groin. My main worry though is the discomfort when at rest with feelings of heat along the bone. I am cobalt allergic and in recent weeks have been diagnosed with COPD and thyroid problems. Is there much evidence of toxicity from these implants for people already allergic to cobalt?

    • jp:

      The cobalt-chrome-molybdenum alloys used for implants in the past are rarely (if ever) used now. In 2006 the probabilities are that your implant was stainless steel or perhaps titanium. What needs to be assured is that the discomfort is related to your intermedullary nail. A foot which “goes numb” and pain behind the knee and into the groin are not consistent with the symptoms of an intermedullary nail. Discomfort at rest and feeling of heat along the bone, may portend infection. I believe that you need an accurate diagnosis before assuming that your symptoms are caused by this nail.

  • Tammy:

    Its been a long and grewling 3 years since I fractured my arm. I broke the ulna and radius and both were plated. when I got the casts off I had contractures in the fingers. the pip joints have beed swollen and inflamed for 3 years now x-rays show some formof casifications forming. I have been seeing physio and OT for 3 years with slight improvement. could the plates be interfering or have you ever heard of this sort of thing? Thanks Tammy

    • jp:

      I cannot be certain, but some of your features point towards a period of blood deprivation, following the injury, with subsequent damage to the muscles. Did you have severe pain in the post injury period? If this is the case, the primary cause of your symptoms needs to be addressed. I think it is unlikely that the plates are contributing to the symptoms that you describe.

  • TED:

    i had a bone plating operation on my right arm below the elbow last march 7,2013.the doctor told me that it will be 3 to 6 months before they will remove the plate.is this possible to this short period of time? Thanks.

    • jp:

      Implants used to align long bone fractures are often removed between 3 and 6 months, providing there is radiological evidence of union. Injuries to the bone near the elbow often prompt relatively rapid removal of implanted metal in order to assist the recovery of movement in the elbow.

  • Jay:

    I had to have surgery at the Mayo Clinic in Rochester, MN in 2007 to remove an Enchondroma bone tumor which they initially thought was Osteosarcoma or Osteoblastoma. Luckily, it wasn't EITHER of these, but an actually and Enchondroma. Anyway...I had the surgery to removed the tumor on my left femoral head in the "ball and socket joint" of my left hip. A YEAR post-op, I HAD to have the screws and hardware removed as they were "reacting" with my body....Seems my bod doesn't like ANYTHING FOREIGN and I was SUFFERING TERRIBLY with UNGODLY PAIN! Now, here in 2013, My hip is acting the SAME WAY it was in :07......having the SAME PAIN, the SAME JOINT "POPPING"....just can't deal with it anymore. I just don't know where to go from here!

    • jp:

      Given the reputation of the Mayo Clinic there are persuasive reasons for you to return to the original surgeon for further investigation – which might require hip arthroscopy and various imaging studies.

  • krystle:

    December 20, 2002, when i was 17, i broke my tibia in half, broke my fibula nearly in half, and shattered the little anklee bone (?) into three pieces. My ankle area on the left leg, if that makes sense. I had a plate and seven screws put on the outside, and three screws on the inner part of my ankle. 3 months later, the dr removed the middle outer screw because it went through both bones. The leg hurts when the weather turns cold, and with any amount of decent exercise. I've learned to deal with the pain that comes and goes. Yesterday, however, it started hurting along the plate. Not just on the outside, but deep on the inside too. It hurts to touch, it hurts to move it or to walk. It literally hurts about as bad as it did when i first broke it. There's not much swelling at all, and the area isn't hot and red like I would think an infection would look. There has been no trauma at all, it actually started while i was driving. Sorry to post so long, but I want to avoid a trip to the ER if possible. TIA!!

    • jp:

      This may well be an irritative tenovitis, with the tendon having rubbed against the plate (or uneven bone) whilst you were driving. The sudden onset and severity of the pain sound less likely to be an infection and more likely to be a mechanical entity. I would watch it for some days perhaps rubbing an anti-inflammatory gel onto the skin over the painful area. Please let me know the outcome.

  • Beth:

    My right humerus was broken nearly in half in a car accident 10 years ago this last February. Following my initial hospital stay (I suffered a large scalp laceration as well), I was advised to try to allow the bone to heal on its own. Not knowing anything about such things, I did as was directed - wearing a large sling with side pillow and sleeping upright in a chair. I never had horrible pain, which seems odd. I went back to the hospital for checkups regularly and was given new directions each time. I was told to use a bone stimulator. My last straw was when they asked me to walk with a cane. This was a highly reputable trauma 1 center, and obviously they saved my life, but after FOUR months with a broken arm I was done. I went to a surgeon who took one look and said I should have had surgery day one. Within two weeks, I had surgery. He went in through an incision on the back of my arm - he told me he could try going between my collarbone, but risk of nerve damage was higher. Afterwards he told me that he never wanted to see my arm ever again, because there was so much scar tissue. Since then, I have had most mobility. If I lift too much or if the weather takes a quick turn (not too often), I can have a dull but sore pain at the break site. At this point, 10 years later, is it worth it to have it checked out to be sure ht the plate and screws are all still good? Are these metal parts truly good for life? I avoid push-ups and lifting too much weight in order to avoid pain. The pain never lasts more than a day, probably once every couple of months. Thanks for your help- and sorry for the ramble! :)

    • jp:

      Since you have no symptoms my emphatic suggestion is to leave well alone. The metal parts do not need to be “good for life”, as their structural benefit has been taken over by the healing of the bones. The purpose of implanted metal is almost always to retain the bones in alignment, anticipating their healing, which is likely to have happened in your arm.

  • Brianna:

    I had a radial shortening done April 23, 2012 for Kienbock's disease, from this I had a rod and I believe 7 screws in my radius. My wrist hurts off and on and so I am used to that, but lately I have been getting some stabbing pains in my radius if I hold something too heavy or bend my wrist a certain way. After reading this, I didn't know if it could possibly be due to the metal plate.

    • jp:

      It is natural to attribute pains in a limb which has had an injury or an implant in the past to that event. However other causes of pain must be considered. Amongst these is de Quervain's tenovitis. Research this on the Web. Please let me know if the description resembles your symptoms.

  • Thank you so much for your reply. I did go to the ER and they did ultrasound, X-ray and CT scan but it was not at the same hospital where I had the surgery, so they did not compare to my post tests from after surgery. Unfortunately, since it is a county hospital where I had my initial surgery, I have no choice but to wait. I appreciate your response.

  • I had surgery for a shattered humurous (actually the very upper portion of my shoulder)9 months. Everything seemed to be going well and I was regaining almost full range of motion. I have osteoporasis and have had severl breaks and surgeries using tinanium rods and plates. This one however, just overnight started giving me pain and reduced ROM. I did not reinjure it in any way that I am aware of and I am very concerned that the plate and/or screws have moved in some way. I do not have insurance and had to have this surgery at the public hospital in Miami. I cannot get an appointment to go back to the clinic until the end of April. Any thoughts as to what may have occurred? Thank you so much.

    • jp:

      From what I can deduce you had an intermedullary rod (down the marrow canal). It is not uncommon to have these "migrate" which could cause pain. This would be easily verified by x-ray. It is likely that if you explained to the hospital that you have sudden pain you would get seen more promptly. Alternatively invite yourself to the emergency room. Please let me know what happens...

  • Kay:

    I am worried about the steel plate that I have. I was told due to the nature of the break they cannot be removed. It is now seven months later and my physiotherapist thinks that there could be some ligament or muscle damage. I have swelling and pain. Could this really be possible?

    • jp:

      I do not understand the comment "due to the nature of the break they (the plates) cannot be removed." With few and rare exceptions metal implants are designed to hold fragments in place only until the bone heals. Once the bone has healed the implants are redundant. If your surgeon had said that "due to the position of the plates it would be technically hazardous to remove them" that would make more sense. You do not say where the plates are positioned and what are your symptoms. Common sites where the plate causes symptoms are where the tendons and bones run over or are adjacent to the metal, and abrade against the implant. If this is the case there is a more compelling reason to remove the metal, since abrasion against the moving structures can cause damage, including rupture.

  • Nick Zois:

    thank you for your help. Where are you located?. sincerelly Nick Zois

    • jp:

      I would rather not give my geographical area, as I am reluctant to treat people who come from afar. The best place to be treated surgically is near home.

  • Louise hales:

    About 5 years ago I sustained an open fracture of the distal third of my tibia and fibula following a horse kick. After initial stabilisation with an external fixator plates were put on both bones. I feel I have made a good recovery but I do experience some low grade intermittent pain which corresponds with the position of the tibial plate along the front of my shin. It is most noticeable if I jump or run but some days I am aware of this discomfort even when just walking or standing. Other days I hardly notice it at all. On most days the pain is enough to prevent me from wanting to run for more than a short distance especially on hard ground. It feels like a " shin splint dullish aching feeling". I wonder whether removal of the plate will alleviate this? I have spoken to 2 surgeons who say they cannot explain the reason for the pain and they are not sure if removing the plates will help though they think it might be worth a try but it's my decision. Xrays taken a few months post-op had shown that the fracture had healed well but none have been taken recently. I'm really not sure what to do. I certainly could "live with" the level of discomfort that I experience but would be willing to go for surgery to remove the metal work if it might improve things. I'd be grateful for your advice.

    • jp:

      The symptoms are characteristic of "plate pain". Only you know how much the discomfort reduces the quality of your life. If it is significant I believe that there is a high chance that removing the plate will help or abolish the discomfort. It might help you to make a decision to read some other comments about the same dilemma, and the benefit of removal of implanted metal. Please let me know how it goes....

    • sally:

      very fascinating article. Years ago i too had a radial shortening due to kienbocks disease. The procedure seemed to have stop the pain & progression, but my wrist still does not bend. The 6" plate was left in, no problems. Then a couple years later, I flipped my four wheeler and the same arm broke right at the end of that plate. Just exactly as you describe in this article. Another surgery included a 9" plate, to be left in, unless it starts to cause me problems. Its been 2 years since my last surgery and im having some pain & slight swelling at the plate sight. Its an aching pain, feels like a big bruise. Do you think it could be starting to give me problems?

      • jp:

        The plate may well be giving you discomfort. Discuss having it removed with the surgeon who implanted the metal. This may well be an irritative tinovitis, with the tendon having rubbed against the plate (or uneven bone) whilst you were driving. The sudden onset and severity of the pain sound less likely to be an infection and more likely to be a mechanical entity. I would watch it for some days perhaps rubbing an anti-inflammatory gel onto the skin over the painful area. Please let me know the outcome.

  • In lay terms on Nov 8th 2012 I had subgery to reset the heal in my rt foot along with removal of screws from previous surgery that caused bones to be too close the screws on the upperportion of my heal has done well but i have a large break in down the center of my calcaneus (Heal) where a screw was placed when the heal was straightened and reset. Could the screw have caused the break. The physician said he does not no what caused it and wants to use a very espensive magnet bone growth stimulator

    • jp:

      Was the calcaneum broken by a fall? Various forms of bone stimulation, chemical and physical are used where there is "non-union" which seems to be the problem in your heel. They vary in efficacy, but none produces certainly predictable results.

  • patty:

    wrist fusion 6 months ago druj arthroplasty with scheker prosthesis 6 weeks ago pain and pressure at fusion plate. orthopedic surgeon suggesting bone stimulator and vitamin d and protein bloodworm? would plate removal relieve pain since fusion appears healed

    • jp:

      You do not say what the reason for the fusion and prosthesis are. Was it Madelung’s deformity or post injury? Which type of (wrist?) fusion plate? It is difficult for me to give advice without a clear mental picture of the background. Perhaps you could send an x-ray?

      • patty:

        wrist fusion plate was a 3.0 synthes compression plate fusion was done after a failed 4 corner fusion due to complications from injury,that was surgery number 6' yhen surgery number 7 was scheker prosthesis dr. notes from last clinic visit state stress reaction due to stress riser as the end of scheker plate and the end of wrist fusion plate are close to one another and pain is localized in that area. has ordered a bone stimulator and said as worse case would remove fusion plate. my pain is intense so, would plate removal be the best chance for relief? fusion is healed was done 8 months ago. dr. ordered blood work that showed vitamin d level is 12, would raising that level with script of vitamin d along with bone stimulator help resolve issues

        • jp:

          The management of pain, like the management of all illness requires a specific diagnosis. It can never be a random walk along the lines of “let's try this, or let's try that”. This is where the quality of the surgeon demonstrates itself. From the information I have, I cannot come close to a diagnosis. There is no downside to calcium (and magnesium) supplementation if you have delayed union of bone. The vitamin D should be acquired by exposing yourself to sunshine daily (even in winter)

  • Thank you, I will call my surgeon first thing in the morning!

  • I had a Anterior Cervical Fusion 5 yrs ago. I started about 2yrs ago having problems on and off feeling like I was choking like I had tried to swallow a huge pill that wouldn't go down. I had x-ray 2yrs ago that showed one of the screws had come out but not enough to have it removed. It is getting worse when I lay down it is really bad. Has anyone had this problem and it so was surgery the only option? I'm really nervous about this but the constant choking feeling is starting to really bother me.

    • jp:

      There are no absolute time scales for removal of metal and other implants. If the implant is causing discomfort, or causing danger (such as seems to be the case with you) removal is justified. To measure the degree of intrusion of the implant a radiological study (such as a “barium swallow”) will help. The danger you face is potential erosion through the esophagus. Seek help promptly

  • Liz:

    Hi I am 55 and have osteoporosis ( taking bisphosphonates for two years) I am also very fit,rowing regularly and training with weights and CV daily. I fractured my radius ( compound,intra articulate ) after a fall nine monthe ago and had an ORIF. I got back to rowing regularly after three months but I get pain and swelling around the plate and pins during and after. My hand surgeon feels the metal work coming out would help as the soft tissue/tendons etc are inflamed. I am a little anxious about having this done because of the osteoporosis and getting fractures where holes would be. I guess if I want to row I have to take this risk and try to avoid any trauma that could cause another fracture. Will I be at the same risk of fracture as I was before or will it be higher? Thanks!

    • jp:

      After removal of the plate, and after about a year of progressive increase in loading, the risks of re-fracture will be no higher than before the accident and lower than leaving the plate in place. A further benefit is that if the tendons are “inflamed” (probably by abrasion on the metal) these structures are at risk of tearing or breaking. This alone would be a sound reason to have the metal implants removed.

    • jp:

      With swimming you are very much on the right track. However have you checked that your legs are the same length? Measuring leg length is (surprisingly) difficult and requires skills. Even attempts to measure radiologically are difficult and often misleading. I will not pursue this problem now, but if you still have doubts I could post a full article on leg-length disparity.

  • Nick Zois:

    Hello and thanks for the informative site. My 20 year old son had a motorcycle accident two years ago (he was 18 then). He broke the femoral shaft. The surgeon placed a intermedullar titanium rod, one screw at the top of the femur and two screws at the bottom. The operation took place in Athens , Greece and it was successful. Now, two years later, he is serving in the army doing plenty of tiring work as a cook. My son feels some pain from the lower screws. He also limps in the morning. I talked recently with the surgeon and he said not to do an operation unless my son hurts. Also he said that we should wait for one more year (a total of 3). My questions are, should we have the operation? should we only remove the screws that are bothering him? is it safe to remove the inermedullary rod or is it now part of the bone structure? does the femur grow, if he is to get taller, accepting that some men grow in height up to the age of 25? how can he protect his leg after a new surgery? I appreciate you help in solving our issue.

    • jp:

      After a break of the femur in a youth over-growing of the femur can occur. Should this be the case (see my posts on measuring leg length) an easy way to correct would be to use a higher heel on the uninjured limb.

      • Nick Zois:

        thanks for the reply, do you think that we should take out the metal rod or not?

        • jp:

          Only your son knows how much discomfort he has, to justify removal. However as the discomfort is so focal to the screw and to the top of the nail, my inclination would be to remove the metal. This should be relatively easy, perhaps a day in hospital. It is unlikely that crutches will be required and he should return to all his activities after two weeks.

          • Nick Zois:

            hello it has been 2 years since the operation. When should we take the rod and nails out, two or three years must pass? thank you, Nick

          • jp:

            If the radiology indicates complete healing, removal of internal fixitives is usually safe.

  • Philip:

    I had a compound fracture in my left humorous 2 and a half years ago. I have a titanium plate from my shoulder to my elbow. The bone is fully healed now and I want to get the plate removed because a screw in my elbow joint is extremely painful when I lift anything with my left arm such as weights or pushups even. I want to get it removed but I heard the screws could potentially break and be stuck in the arm, or the pain may never go away. I am 24 yrs old. Should I just live with the plate in my arm or go for it and get it removed?

    • jp:

      It seems that you need relief from your pain. Assuming that the pain is from the plate and/ or screws, the way ahead is to remove the implants. It is true that occasionally screws break or cannot be removed. This is rare, and becomes your surgeon’s technical problem. It is usually not difficult to remove such a plate, but ask the original or an experienced surgeon to do this, as frequently there is a danger to the radial nerve. Intra-operative electromyography to localize the nerve/s is the counsel of perfection

  • Daina:

    Hello! I had a compund radial/ulnar fracture about 10 years ago repaired with plates and pins. Since a pregnancy one year ago I have had occasional 'attacks' as I call them where I feel extreme stabbing pain in my arm sometimes with swelling of the hand. Often after the fact I have a few days of aching and throbbing pain. This seems to go thru cycles now and often with weather changes. I am 30 but I am concerned as I get older the frequency of the pain will increase. Im wondering if plate/pin removal would be a good option for me at this point or is 10 years too long of a wait and will I have to deal with this pain for a lifetime? Btw i do get excellent relief from regular acupuncture treatment by my Chinese medicine doctor but if removal could eliminate this pain I would be willing to consider it. Thanks for your advice

    • jp:

      It is difficult to be sure that the pain is caused by the implanted metal. A good orthopedist would be able to give you a much more accurate opinion as to cause, by a detailed history and clinical examination. Is the pain precipitated if you press over the plates, or by particular movements of the hand? Do you have limitation of movement or pain when “twisting” the forearm? It might be that the (progressively increasing) loads of lifting and carrying a baby has precipitated your pain. This type of metal can usually be readily removed after ten years, particularly as you were an adult when it was inserted.

  • weishaar.m:

    I fractured my humerus above the elbow on April 29, 2012. I had a bad experience with a doctor who told me I didn't need surgery for my displaced fracture. Due to it being from a car accident I couldn't get a second opinion because of the insurance claim. My doctor then decided to put my arm in a temporary splint running along the outside of my arm for 2 weeks. The splint lost all shape in those 2 weeks and my bone continued to move around in my arm. At the next appointment my doctor realized this and decided to MAKE a splint out of casting material. He literally dipped the casting material, pushed it on my arm, and held it until it hardened. This "splint" went from my mid humerus to the top of my ulna/radius. He then left me in this "splint" for 7 more weeks with weekly check-ups when he finally decided to do surgery. 10 weeks after the initial break, I was still feeling my bone move in my arm and I went to surgery. I had a 6" plate inserted with 10 screws. All seemed to go well. He saw me one time after my surgery and then sent me on my way saying that physical therapy wasn't necessary and I could do all of it at home on my own. A month went by and my strength and range of motion was still poor and I felt something moving right above my elbow on the inside of my arm every time I bent my arm. I called the insurance company and they approved for me to go to a therapist on my own. After 6 weeks of therapy and the therapists telling me to get a 2nd opinion after the felt the "whatever it was" moving in my arm, the insurance too approved me to get a 2nd opinion. So now I am 7 months from the day that I broke my arm and my new doctor has done an x-ray and cat scan to discover that my first doctor didn't put the screws in properly or far enough. I have 2 screws that are straight through my bone and aren't even attached to the plate. Along with that I have 2 screws, located where I had the feeling, that are so far out of the plate that my medial nerve is catching on them every time I bend my arm. So I am going into surgery exactly 7 months to the day from when I originally broke my arm and I feel like i'm starting over. SOOO my true question is, what is the recovery for this going to be like. I am 21, don't smoke, and am generally healthy but I obviously have a bad history of recovery. Will I have any immobility again? Pain? More problems down the road? I am a High School cheer coach so anything that will give me an idea as to how coaching will go over for the next couples of weeks/months would be nice.

  • Joey:

    Hi i suffered a pilon fracture a year and 4 months ago, i have 3 plates and 16 screws in....i have decent range of motion but thin ankle cartilage.I still cannot stand for very long or walk very far without pain.Do you think hard wear removal may help ?

    • jp:

      Metal, especially much metal, as you have, can cause pain in a variety of ways and presentations. At times the metal impacts on the tendons and other moving parts, giving pain on movement. Metal often causes an ache with weather change, or when exposed to cold. Usually removal of hardware put in for this injury is relatively easy, and full weight bearing the same day is usual. I hope that this helps you to make up your mind.

  • Ashley S:

    Thank you, this article has been very helpful in reassuring us that it is best to have our daughter's plate and screws removed from her ulna. She was involved in a car accident and had a very serius compund fracture requireing 2 plates and 11 screws. They have been causing such pain and inflammation on the outside of her arm where the plate ends. I was very nervous about weakness in the holes left by the screws but i feel very reassured now. We will be leaving the smaller plate on her radius for now however as it is not causing any issue.

    • jp:

      There is usually a greater incentive to remove implants from children. Plates are sometimes covered by bone (unusual in adults, common in children), and in a child growing rapidly plates and screws can impede growth and cause shortening and deformities which are irreversible. Why have you decided to leave the other plate in? Please let me know the outcome.

  • Mike S:

    Hello, On Sept 4th, I had two screws removed from my tibia and screws/plate from the fibula. Had absorbable sutures with steri strips and wrapped in an ace bandage. This past monday, I went back to have the bandages removed. The first thing the doctor asked me, was if I was allergic to iodine. Both incision cites were extremely bright red in the same pattern he swabbed the iodine during surgery. He told me to take Benadryl and sent me home. Later that night, I noticed a large blister (with clear liquid) on the fibula side, just below the incision. I have two more very small blisters on the tibia side, I noticed this evening. I'm not sure if they were there during the doctor's visit or not. Any idea on what's going on here? Do I need something more than Benadryl. Thanks.

    • jp:

      An allergy is a possibility – perhaps to iodine, but other possibilities are the glue which is often used to make the Steri-strips adherent and the buried sutures can produce an allergic response. Infection should be kept in mind. The blisters might be a response to allergy, but – with clear fluid – could be “fracture blisters” an expression of oedema fluid migrating towards the surface. Diagnosis, as always, must determine treatment. Allergy to iodine, at this stage, is an assumption.

  • on December 1,2010 on fell backwards from the top of my garage onto the driveway. I suffered a compound fracture of the left tibia and fracture of the fibia. I was rushed to the hospital and the OS performed surgery to put a plate and screws on the fibia side. I had to wait about two weeks for the rest of the swelling to go down so that the OS could finish putting the rest of the 3 plates and screws on the tibia side. So, I had an ORIF pilon fracture of the left ankle with a total of 4 plates and 21 screws. After follow-up visits to the OS, he told me that i developed arthritis and that the cartlidge is wearing away. I work outside and climb ladders. I am 46 years old a non-smoker and healthy. He suggested that down the road i should consider having an ankle fusion if the pain gets intolerable. My concern is not so much the pain but the way I walk. I don't have much range of motion in my ankle but more than my OS thought I would have. When I walk, my left knee points outward and my foot is pidgeon toed. It looks like i am bowlegged. My OS said that the bone healed perfectly and everthing lined up accordingly. I also compensate a lot on my right leg. My question is by having all that hardware in my ankle is that affecting range of motion and the way i walk? I don't limp. Should i have the hardware removed? Also, i've been reading about INBONE ankle replacement as an alternative to ankle fusion. Which would you recommend? I used to run five times a week and i would like to do some form of activity in my life again. I can't do that right know.

    • jp:

      There are many causes of ankle pain after this type of injury –“arthritis” is only one (The pain of arthritis develops slowly, over years rather than months). Other causes of your pain should be sought – these could include pain from adherent or abrading tendons (perhaps the commonest cause) and the implanted metal. If, in fact, the bones have been correctly re-aligned by the surgery, a problem outside the ankle joint (and this mean a non-arthritic problem) would be much more likely. The change in alignment and the way you walk is a concern. Is it possible to send copies of your x-rays? The problem might be one which is easily corrected without the need for complex surgery. Ankle fusion is a disabling procedure, and ankle replacements have many potential problems, and are b=not to be undertaken lightly. Remember the popular term “joint replacement” is a misleading misnomer. The correct term is “joint substitution”, since the original joint can never be replaced and all the qualities and performance or the original (natural) joint are never replicated.

  • Paul:

    6 months ago I suffered a distal radius fracture of my right arm playing rugby so had a plate and 8 screws inserted. this has caused me no pain whatsoever and within a few weeks was able to return to the gym to do weight training (albeit very light weights). After 6 months I am back to nearly full strength with no pain at all in the arm. Would a return to playing rugby this season(starts next month) be out of the question? If i did return I would switch position from flanker to winger to stay out of the action as much! Thanks

    • jp:

      The problem is that rugby is all about getting action ! This type of break heals well and soundly. Have it checked by x-ray, and if there is sound bone union, then there should be no good reason not to go back to rugby after this time lapse.

  • Rob:

    Hello, I had an olecranon plate fixed after a good break. It healed well but kept causing pain at full extention and also when resting my elbow on desks, tables etc.. I had it removed a couple weeks ago due to this discomfort. My surgeon said it would help the superficial pain of resting my elbow as the plate would no longer be there, but that the extention issue would unlikely be caused by the plate. As it turns out, my extention is now better by degrees and painless. I have the plate as a souvenir and notice that the bent bit at one end, which would "poke" my tendon at full extention, is VERY sharp and jagged. Almost as if it had been broke off a rack like a model airplane piece. In my "googling" I notice that many plates have a second screw hole in this position, maybe they bent that off? Either way, the finish of the entire plate is a beautiful polished titanium, chrome in appearence. But that end is not. It would tear your skin if you slid it across the back of your hand. Can this be normal? If I had seen it before hand I would have fully anticipated the resulting pain that I had at extention. I am seeing my surgeon in a couple of days and will discuss, but was curious of your view. Regards, Rob

  • Mike:

    Hello, I fractured my tibia/fibula in April of 2011 and had the hardwae removed today. No boot needed and I'm able to weight bear as tolerated with crutches. The incisions were closed with a combination of disposable sutures and Steri Strips. My ankle was wrapped with an ace bandage. Post OP check is 7-10 days. The nurse instructed me to not remove the ace bandage or change the dressing for 7 days. Is this the usual procedure? I've always thought, that surgical bandages were supposed to be changed more frequently. Also, I was given antibiotics via IV right before surgery, but didn't need a perscription. Was it most likely a large dose that will last awhile? Thanks

    • jp:

      Your surgeons approach is very much as I would have done. It is often undesirable to change dressings, unless heavily stained with blood. In that case the blood (or other fluids) act as a medium for transport and growth of infecting bacteria. A single prophylactic antibiotic is the recommended policy. Give your surgeon credit for his spot-on approach. p.s. Keep the wound dry. Do not try the trick of a plastic bag and rubber band, a dangerous wheel re-invented continually. Plastic, soap, water, and bathroom tiles are a disastrous combination – which doesn’t keep the water away from the wound either.

    • jp:

      The plate might have been cut intra-operatively. Let us know what your surgeon said !

  • Sandy:

    I had an ulnar shortening almost 3 years ago along with arthroscopic TFCC repair. Unfortunately I developed causalgia and have decreased hand/arm strength. In X-ray, the ulna still has a line at the site of the osteotomy. I used a bone stimulator for 6 months to aid healing. I've had pain in my forearm for well over a year. My surgeon is concerned about taking out the plate; he is worried about the ulna coming apart, especially with the delayed healing of the osteotomy. However, another hand surgeon said it was healed a year ago, to remove the plate and then work on strengthening. Recently I started riding my bike for exercise and also taking low dose antibiotics (for another condition), and the pain in my forearm at the site of the plate has increased significantly. When I broke my toe earlier this year it healed within 6 months. So not sure why my arm has such pain and issues healing. Could it be a chronic infection? Should I have the plate removed? What is the risk or developing causalgia again? I'm an active 54 year old and would like to be able to garden, exercise, and work with my hands without so much pain.

    • jp:

      Causalgia is often, if not always, related to damage to, or entrapment of, a peripheral nerve. In your case it might have been the ulnar nerve – possibly in Guyon’s canal. You do not say what was the cause of your original wrist pain, assuming a diagnosis has been reached. This also has pertinence. The opinion of a neurologist, perhaps with electromyography would be useful. Whether the ulna has healed at the osteotomy site or not should be unequivocal. It is a radiological diagnosis which should be clear-cut. Therefore your concern about removing the plate (because of your fear that union of the osteotomy has not occurred) should be easily resolved. Whether removal is necessary (for relief of pain) is another question entirely. To resolve this the view of an experienced orthopaedic surgeon is required. From what you say it seems unlikely that there is an infection. More likely the continued pain is a mechanical, perhaps caused by abrasion of tendons over the plate and screws. If this is the case (and good quality ultrasound imaging will assist in this diagnosis) then removal of the plate is merited.

  • Mandy:

    I broke my ankle five years ago, I had a plate and seven screws put in..after five years the pins have gradually moved, one piercing through the skin! Four days ago I've had all the metal work removed, so far so good? I will update this message over the coming weeks.

  • Cathy:

    I had a plate put in my neck at the c/3 c/4 level in 2000, I developed a severe body rash and started getting ear infections. All of the bone fused, I have continued for years like this, Depuy sent me a plate to get tested and said I had a slight allergy to it. Recently they sent me for a MRI, I started coughing and after the MRI my throat started swelling and my voice box became inflamed and my neck has a burning sensation all the time. There is no doctor that will touch me because they said they didn't put the plate in. My plate has a small .06% FE in it. Even my PCM does not seemed concerned. Can you help me to get going in the right direction without making my doctors mad. It always feels like someone is choking me.

    • jp:

      Cathy. Whether the rash is related to the plate is difficult to know. How did you test the plate which de PUY sent? The sensation of choking could well be caused by the plate (which I assume is in the front of the cervical vertebrae). At times some types of screws back out, and intrude on the gullet. Have you had an x-ray to check this? There is no reason why the plates cannot be removed by another surgeon. You might have to hunt one out, or contact the supplier of the plate and ask who else inserts these plates.

  • Paul:

    6 months ago I suffered a distal radius fracture of my right arm playing rugby so had a plate and 8 screws inserted. this has caused me no pain whatsoever and within a few weeks was able to return to the gym to do weight training (albeit very light weights). After 6 months I am back to nearly full strength with no pain at all in the arm. Would a return to playing rugby this season(starts next month) be out of the question? If i did return I would switch position from flanker to winger to stay out of the action as much! Thanks

  • Grillo:

    Hi! I broke my fibula very close to my ankle a few years ago (2007 i think) and i have 7 screws and a plate there. Until a few weeks ago every think was alright but then i hit my leg where the plate is and started to hurt a lot. I took some ibuprofen and the pain went way. But this week came back when i was driving my car and after 2 really bad nites of sleep i gave up on the ibuprofen and took 2 vicodins and got better. I want to remove the plate and the screws but i cant afford to be on crutches for too long. How long do you think i will be able to walk (so i can work) and how long until i can surf or skateboard. I am a non-smoker, don't drink and 37 years old.

    • jp:

      Grillo. Supposing that it was only the fibula which was broken originally, removal of the plate should not prevent you from weight-bearing immediately after the surgery, without the need for crutches. Depending on the caliber of the surgeon you should have no post operative pain.

  • Aaron:

    In 2005, I suffered a compound fracture in my fibula about 4 inches from the bottom, and have a plate on the bone now. At the same time, I suffered a communited fracture at the joint portion of my tibia in the same leg and it has two pins in it. Additionally, during the accident the Tibia and Fibula were pulled apart from each other damaging the membrane between the two bones, and there was a pin placed all the way through both bones at the ankle. About a year ago I suffered a severe sprain in which this ankle swelled to the size of a large grapefruit. I received physio care for it, however since then, whenever I run, I experience a throbbing pain specifially where the plate is located and my ankle swells considerably, is tender to the touch, and developes redness. Would it be ideal to request having the hardware removed even though it's been close to 7 years? As running is a job requirement of mine, I can't just "not run".

    • jp:

      The pain, tenderness and throbbing are ominous signs of infection. Infection associated with implants can occur despite the seven year lapse. It could also be speculated that the more recent sprain could have caused internal bleeding about the plate, and this blood could have acted as a medium for the infection to develop. Incidentally, has the screw between the tibia and fibula been removed? This type of fixation often (perhaps usually) breaks with repetitive loading, perhaps after many weeks or months. Should this be so, that might also add to the pain of running. Radiology and orthopaedic attention is needed. Please let me know what happens.

  • Matt:

    Very interesting article. Last year I broke my ankle in 3 places. It was pinned and a plate put in down the outside of my ankle/lower leg. On Monday I had the metalwork removed after 18 months since it was inserted. This was due to an irritation occurring as the pins protruded, rubbing on footwear and aching when ever they were bumped. I was wondering what the sort of time frame is before I can start running on it? , then moving onto contact sports? Currently I'm walking on it without crutches. Obviously I will have lots of holes in my bones where the pins used to be so I'm wondering how long before my bones adjust to this and become strong enough to use fully. Many Thanks

    • jp:

      Matt. I am glad that your recovery has been so successful .There should be no limitation on walking. However cycling is superb rehabilitation. The ankle can be put through a large range, without the loading. Rehabilitation to running can be helped by a biokineticist or physiotherapist. But you could manage it yourself by alternate walking -15 minutes to begin and get it “warm” followed by a short jog of fifty to a hundred yards as a beginning. The increase the distance and time progressively. A year is a prudent time to wait before high load sports, but in the interim get fully fit as above, interspersed with swimming (but be careful about using flippers – only when you become confident via the rehabilitation described above.

  • mary:

    It will be one year since I broke ulna and radius. It has caused me pain everyday. The post-op pain was off the charts for weeks. It went into neuropathy. Nights of tears on the couch and trying to live one handed. But I would like to have the hardware removed now. I saw the surgeon a few months ago and he said "it can come out." But he did not e-ray? How would he know how much bone has grown over the plate? or the screws? Is this just an unknown factor for all this type of surgery? I want this out-but who wants to be cut open again. I would like to hear from another Dr or someone who has walked through this themselves.

  • Leighb:

    Hi! Curious to know is hardware removal would benefit me. Twenty yr old female and suffered a bimalleolar jan 2011, tin and fib both broken quite severely. Was fitted with a two inch plate on inside and outside of ankle with 7 screws in total. Now after a year the plate on the outside causes me pain that I can only liken to severe cramp with swelling and numbness. When I flex my foot onwards you can see a screw and edge of plate sticking out underneath skin, and if I catch it or knock it I suffer severe pain, or if I'm working long shifts (student who works full tone as a waitress and shop worker so always on my feet). I was told earlier this year I can have the outer plate and screws that stick out removed while the inner hardware must remain due to the fact the bones haven't fused together correctly. I turned down the removal due to the fear of s long recovery period. Should I get the hardware on the outside removed and will it ease the pain? I'm exercise 5 times a week and have combination of uni work and 2 jobs, so don't really want a long time spent recovering! Any advice will be much appreciated thanks.

  • Walter:

    1 1/2 year ago I fractured my fibula and tore my deltoid ligament causing medial displacement of my tibia and fibula. ORIF was performed on my distal fibula. 7 screws and 1 plate were placed in my ankle. One of the screws was for syndesmotic fixation. That screw was removed after 8 weeks from the initial surgery. Just a week ago I had the 5 inch plate and remaining 6 screws removed from my distal fibula. Doc said he wants me in walking cast FWB for at least 4 weeks. I am 25 y/o male and was wondering if this is on par. I am a very healthy and active individual and hate this slowing me down. Thanks.

    • jp:

      Walter. My personal preference is to get the joint moving immediately the metal is removed, using cycling swimming and walking. Please see other comments.

  • Tyson:

    Approximately 2 years ago I fractured my humerus while snow boarding. Come to find out I had an enchondroma that was discovered during surgery and removed. A Plate and eight screws were used to secure the bone, which was fractured at about the mid shaft. At this current point in time I experience a fair amount pain with lifting, as well as when I resist against medial or lateral rotation of the shoulder joint. The pain originates in the shaft and radiates distally toward the elbow joint. The plate is also felt fairly superficially, which in turn causes a fair amount of pain when bumped or hit it any way. The surgeon stated that if discomfort from the plate and screws was a problem that I may have it removed, but I am not sure if what I experience is something normal under my circumstances or not. I also feel like when lifting something heavy the bone is not able to "disperse" the weight appropriately under forces of a compressive nature. Tensile forces do not seem to be much of a problem. Please let me know what you think of my situation, and I appreciate your time.

    • jp:

      Tyson. Can I assume that there has been a change for the worse recently? If so the humerus should be reassessed with regard to the enchondroma (which may have been the cause of the original break). You do not say how the enchondroma was treated. Was it curetted out, and was the area bone-grafted? The integrity of the humerus needs to be assessed radiologically, initially with standard X-rays, but perhaps including a CT scan if needs be.

  • Robert Taylor:

    In June of 2007 I was involved in a head on collision which resulted in a tibial plafond fracture of my right leg. From the joint of my ankle, the tibia broke vertically in 3 directions. The surgeon told me that my only chance of avoiding severe discomfort was to have plates and screws internally fixated. I work in the construction feild and I've been coping with severe pain since the procedure. The top of my foot has a constant tingling sensation, when I move my ankle i feel the tendons sliding over something which causes a pain that i would describe as a shock through my foot followed by a warm, squeezing sensation in my big toe. I have gone to the emergency room in the past when the pain hits a climax where I have been told numerous times that my ankle is sprained. I've also shared this with an orthapedic specialist while I was being seen for a wrist injury. It seemed to fall on deaf ears. In the past year I have developed new problems. In 3 very distinct locations I have had sores forming on the skin along the incision site. They appear to be perfectly cicular. 2 of them are right on the edge of my ankle, one at the very top of the larger of the two plates. They happen frequently, a couple times a month. I witnessed the formation of one along with my wife. I had my ankle elevated and I was rolling it after swimming when I felt a pop along with a spike in pain. Over the course of a minute we watched a deep red spot the size of the tip of a ball point pen grow to the size of a pencil eraser. A lump formed and the next morning the skin was broken and bleeding which is the point that they would usually come to my attention. It happened again yesterday and everytime they seem to get a little worse. When lightly grazing the surface with my fingers it causes my big toe to throb. Thankyou

    • jp:

      Robert Taylor. You seem to have the “anterior retinacular syndrome” which I described many years ago, along with the treatment technique. This can cause the “shock” and the discomfort of the tendons seeming to slide over a protuberance. If this seems mysterious to your surgeon, suggest (and yourself do) a web search. If necessary your surgeon can write to me. The sores in the incision scar. Did you have buried, “absorbable” sutures? What you describe is very like a reaction to that type of repair.

  • geraldene:

    i suffered a bimolar fracture back at the end of december i have 11 screws and a couple of plates in, it was a pretty bad break. It is now 7 months on nearly and i am having problems, i cant lay on either side of my ankle it keeps me awake, no amount of painkillers help at night like they do in the day. I still have a hard job walking i do not use any support as i have been told not to and get on with it! i had an xray at the 6 month mark and everything seems to be fine and there where a couple of cracks still showing, i am considering having the metalwork removed which my surgeon informed me it was safe after 10 months to do so. I really want to get them removed as its so uncomfortable which i dont think i csn live with,i dont want to live on painkillers for the rest of my life! just like to know how would the procedure be? would i be non weight bearing like i was for 7 weeks?

  • My niece has caudal regression syndrome. Her knees are locked in a bent. they put screw in her knees in January. chk up appt. wasn't until 3 mths later. They noticed the screw came off of her rt knee. she just had her second surgery to fix it. she heeled quicker than last time but her rt. knee is the one that still bothers her. I asked a chriropractor if there was anything they can do for her knees. We are suposed to make a consultantion appt. do you think it would a good idea? would it do more harm since she already has the screws in? My niece is 3 she will be 4 in October. thanks

    • jp:

      Juanita. The caudal regression syndrome affects different people in different ways, some with very minor (or no) problems. Others suffer severe disability. Unfortunately, from what you tell me I cannot judge the effect on your niece and consequently the reason for (and the aim of) the surgery.

    • jp:

      Juana. The caudal regression syndrome affects different people in different ways, some with very minor (or no) problems. Others suffer severe disability. Unfortunately, from what you tell me I cannot judge the effect on your niece and consequently the reason for (and the aim of) the surgery.

  • Liam:

    Two years ago I had an ORIF on 4th and 5th metacarpal. Slowly, numbness progressed and spread in the tips of my fingers. The screws and plates were removed and full feeling was restored. Today I still have a large lump on my hand that is uncomfortable (6 months post op of removal). What is it? Will it go away? The last thing I want is more surgery but daily discomfort is irritating, if it can be fixed with surgery, I guess that is something I would have to do, again.

  • Liam:

    Dr. Henley, Two and a half years ago I had an ORIF with 2 plates and 8 screws of the 4th and 5th metacarpals. Slowly, I started to lose feeling in my fingers. Finally, I went back to my physician and complained of the possible nerve damage. The hand surgeon removed all of the plates and screws with full recovery of feeling in my hand. Today, there is still a large lump on my hand, 6 months post-op. What could it possibly be and what should I do? Are they cysts, new bone growth in the holes, scar tissue? I really do not want more surgery, but it is uncomfortable.

    • jp:

      Liam. I assume that the swelling is on the back of the hand and related to the scar? I assume also that the loss of feeling was in the ring and little fingers. What explanation did the surgeon give for the progressive loss of feeling (which is unusual)? You do not say where was the break in the metacarpals. Was the injury associate with a heavy object falling on the hand, or with a punch (different types of injury are produced by these different mechanisms) The most likely cause (and this has to be an informed guess) is that the metacarpal was not fully healed, and broke and angled again after removal of the plate.

  • Janet:

    Quite a while ago I underwent an operation in which my left jaw broke and plates and screws were inserted. Is there any way with medical advances that a bone graft could grow on a steel plate? I was getting an implant and there wasn't enough bone to support the implant so after two absess surgeries the jaw bone became unstable and broke. I now have 5 missing teeth in that area and desperately need the teeth so I can chew normally crunchy food and live a normal life. My partial does not fit and floats so eating is miserable.

    • jp:

      Janet. I claim no expertise in the area of maxilla facial surgery. However, on general principles there are techniques or re-establishing bone. In the institution in which I work free, vascularised fibular transplants have often solved this problem, often after large loss of bone following cancer surgery to the mandible. I do hope that you can be helped, as the technology is available.

    • jp:

      Janet. I claim no expertise in the area of maxilla facial surgery. However, on general principles there are techniques for re-establishing bone. In the institution in which I work free, vascularised fibular transplants have often solved this problem, often after large loss of bone following cancer surgery to the mandible. I do hope that you can be helped, as the technology is available.

  • Johna:

    Ten months ago, I had surgery for a distal radius fracture in which I had a plate and eleven screws implanted. My doctor instructed me to let him know if my wrist ever hurt on the opposite side of my plate or if I ever lost feeling in one of my fingers. He said that this would indicate that the plate was rubbing against my tendons. Otherwise, he said that my plate and screws need not be removed. For about a month now, I have had pain in my elbow whenever I pick up something. It seems to be getting worse. Should I consult my orthopedic doctor? Is this related to my surgery? Or should I just see my family doctor? Thank you for your time.

    • jp:

      His concern that you might have pain on the opposite side was probably because the screws were too long and protruding through the bone with a risk to the tendons, and as important the nerves (hence ht concern about numbness). Does this show on x-ray? If there is even a possible threat to these structures any screws which are too long should be removed prophylactically, I cannot comment on the elbow pain (you do not tell me enough about it). I would ask an orthopaedic surgeon to check you.

  • Sandy Nelson:

    I had a spiral fracture of my tibia and fibula seven years ago. I was 48 years old. My orthopaedic surgeon installed a plate and 5 pins. I have had mild but chronic inflammation (redness) over the years, but lately it became worse – sharp pain when going down stairs, and throbbing at night. After several visits to my GP, he sent me for a bone scan. When the results came in, they showed local indications of localized osteomyelitis, and I was referred very quickly to an osteopathic surgeon. I went yesterday, and he said he had never seen an "uptake" like mine before, that it indicated infection on the plate itself, and that antibiotics would not help. He also said it was entirely up to me whether or not to have the plate removed, so he obviously does not think that it is life threatening. I am now 55, and although I don't relish the thought of surgery, I think that it is better to have it now rather than later when my body might not be so healthy. My questions are: how could infection just be on the hardware, and how would it have gotten there? Can they test to see what kind of infection it is? If I don't get the hardware removed, is there more chance of complications later, e.g. spread of the infection or cellulitis? He told me that my leg would be weak from the holes of the pins and that he would put pellets of antibiotics in the holes to prevent infection. What are the risks that the antibiotics won't work? Thank you!

    • jp:

      There can be little doubt that you have an infection. It is not up to you to make a decision as to whether to have the plate out - That surgeon has an imperative obligation to make that decision for you, and in my mind he (and I) would be remiss not to advise prompt removal. The infection will be at the interface between the metal and the living tissue under the metal. Metal alone cannot support infection, because the organisms require the nutrition supplied by living tissue. The infection is at the interface because this is an area of relatively low oxygen supply (the metal cannot supply oxygen or other nutritional ingredients). This is a common phenomenon. Therefore removing the metal alone might be sufficient for your inherent anti-bacterial immune mechanisms to combat and perhaps cure the infection. Antibiotics alone will be insufficient, not the least because the metal, with no blood supply will not allow sufficient dose of the medication to reach that area. How the infection developed (i.e. how the bacteria arrived at a vulnerable host area) is of academic importance now. It might have been blood borne, perhaps from a tooth or infections in the mouth. The bacteria should be obtained and cultured at the time of removal of the plate. There is a significant risk to allowing this infection to remain unattended. I am astonished that you were not told, and warned, of this.

  • Gail:

    5 years ago I broke my talus, left maleolus, tib and fib in a car accident in my left leg. I have one plate 4 pins and a screw in my ankle and it was a very long recovery. For the most part now it doesn't bother me, but sometimes I limp, and if my foot swells my foot really hurts and I can't put pressure on it. My fiance has suggested to have the metal removed from my foot, but when my orthopedist put the metal in my foot he said it would be there for life. Would there be a benefit to have it taken out?

    • jp:

      It might be that the pain is from your ankle or a degeneration of the talus. Further, the tendons around the ankle can give pain (often when loaded by standing), or if they are abraded by a malleolar screw-head. Please assure yourself where the pain comed from, before assuming that it is from the plate.

  • Bird:

    12 yrs ago I fractured my tib-fib in 3 spiral fractures plus required a bone fusion at the top of my Tib-Fib. The orthopedic surgeon put in a plate & 11 screws & bone fusion. 3 months no weight bearing for the bone fusion to take. When I started walking a muscle herniated in the front of my leg. I've been in pain for 12 years. The surgeon says he can take out the hardware. The bone has grown onto the plate so some work to get the plate off the bone. Everything has healed. He will try to repair the herniated muscle when he removes the hardware What is your opinion about removing the hardware? What options are there for repairing the herniated muscle?

    • jp:

      You need to know exactly the cause and site of the pain. This is often difficult and requires an expert orthopaedic diagnosis. To remove the plate (if one can be reasonably assured that it is causing the pain) should not be difficult - even with some overgrowth of bone. I assume the hernia is through the surgical scar. It is unusual for such a hernia to produce severe pain (although it is possible). Local anaesthetic infiltration of the hernia might assist in deciding whether it is the cause of the pain. Perhaps, and more likely, scar in the muscle from the original accident, or the subsequent surgery, might have cause shortening of muscle and hence pain on standing / walking. Finally assure yourself that there has been no damage to the blood vessels - perhaps by Doppler ultrasound.

  • Hello, Last year I was involved in a motorcycle vs car accident...let's just say I was the loser. I suffered a bad pilon fracture of my left leg, an open book fracture of my pelvis, multiple fractures to my sacrum, and a dislocation fracture of my left arm where the radial head broke off and was displaced. Thanks to an outstanding surgical team I was put back together in some semblance of myself. However, I suffered from pain that I could only describe as mechanical. I pushed harder than most sane people and got my arm to work somewhat, but HO and what I felt were the screws kept it from functioning correctly. I finally convinced my surgeon to remove the screws, and some of the interfering HO. After the surgery, the first comment from the dr was that I was right, and one of the screw heads limited rotation of my wrist. Second problem was in my pelvis, and I could feel the plate moving and adding pressure to the screws when it flexed. X rays showed the screws had backed out about 2 mm. Once removed, the pain stopped completely. The last removal was the hardest to convince the Dr to do. I actually had to go to a different surgeon to get it done. The plate that ran up the medial side of my shin was causing extreme pain with every step I took. To me it was a simple lever type of mechanical for e issue, with the top of the brace acting as the tip of the lever and increasing the impact forces in just the one spot at the end of the brace. My question, how long should it take for all the holes to fill in?There were 12 screws in a distance of about 3 inches. One week out, the shin pain is completely gone. However, the medial side where most of the screws were is just throbbing with pain. Could this be caused by the "Swiss cheese" holes in the leg? And how long should it take for the pain to subside?

    • jp:

      Thank you for this letter which demonstrates the importance of removing screws in some circumstance. However the throbbing pain which remains would be of concern to me, as there might be infection at the site of the erstwhile screw. You need to return to (one of) your surgeons for investigation – including radiology – of the possibility of infection. Please let me know the outcome….

  • Ben Townsend:

    I broke my collar bone whilst playing rugby and had to have it repaired with metal plates and 9 pins. Also for my troubles I had to have a bone graft as a fragment chipped off too. At the time I swore I'd never play again as it was a long time out and I had a lot of pain. This was 3 years ago and I'm now starting to get the itch to want to play again. I used to love playing so much. What's your advice? Am I able to play? What do I need to do to be able to play again? Have the plate removed?

    • jp:

      Many return to rugby (and other high contact sport) after-collar bone breaks. My personal preference has always been to use an intramedullary nail instead because rehabilitation is rapid, and the surgery relatively (by comparison to plating) painless. But most important is that intramedullary nailing avoids the screw holes which are very prone (particularly in the collar-bone) to re-breaks. The same applies to the plate, which has an important stress riser effect in the collar-bone. Other benefits of intramedullary nailing of the collar-bone are that stripping of the periosteum is minimalised, risk to the infra-clavicular nerve is reduced and aesthetically tiny scars (often placed quite high in the neck) are possible – important in young women. Much of this does not apply to you, but I have used your enquiry to express more general information. In your case I would have the plate removed, check the degree of healing by X-ray and, if that is sound, wait a year for the screw holes to minimise, using the time to gradually increase the loads (see another recent reply re rehabilitation)

  • Parise:

    Hello, I am 50, alittle overweight, smoker. I shattered (bits and pieces) both lower leg bones in a skying accident in 2003. It took 7 months for me to walk on my leg without the help of cruches or cane. I had a plate put in to replace my bigger bone - shattered bones came together, the smaller bone came back together also by itself (quite a miracle!). I had a screw removed at one point because it was unscrewing just below the knee. My surgeon had said back then that if the plate ever bothered me that he would remove it. Well, for the past few years my ankle swells and if I walk more than a few hours (I like to walk alot) I have pain about 4 inches above ankle -in front of leg. This is not where the screw is, or the surgery...that's way near my ankle. My ankle was not broken only my two bones were shattered. I have contacted my surgeon and we should be meeting soon for x-ray etc. My question - does the bone grow around the plate? Like I said, the complete length of the bones were shattered, there was nothing holding up my leg. I'm a little scared having this plate removed, but I know it would take care of the swelling - which happens if I'm standing or walking for long periods at a time. Thanks for your response.

    • jp:

      The fear of removing the plate can be allayed if the bone is checked radiologically and seen to be sound. The cause of the swelling some distance from the breaks will require some consideration. One possibility is that the thinner leg bone (the fibula) might have shortened by overlap of the fragments, or might be relatively too long if the tibia has shortened. The importance of this is that both bones contribute to the ankle joint, and if these become –indirectly- out of position that might change the loading in the ankle with swelling of that joint. You should have the veins of the limb checked by Doppler-ultrasound – clots or other damage to the veins could have this effect, with swelling on standing. Please let me know the outcome.

  • James Gety:

    Hi. In January 2012, I broke my left radius that required internal fixation with a metal plate with 6 screws. In April 2012, I broke the same bone again at the end of the last screw due to a fall on that arm. That required another surgery to unscrew the last screw where it broke, and attach a smaller metal plate on the underside of the radius bone. Since I am actively competing as a professional athlete in martial arts, I was wondering when should I return back to training? And when should the plates be removed. Is it more advisable to remove the plates first before training again? Thanks for your reply.

    • jp:

      Training is a loose term. A better concept is rehabilitation which implies a progressive and staged demand upon your limb. Ideally this should be under the professionalism of a (sports) physiotherapist or biokineticist. But In any event you should be using that limb from the moment pain allows – hesitation will permit muscle and bone atrophy. But common sense is necessary – high contact sports inside a year would not be prudent. On the other hand swimming should begin immediately, and keeping up your general fitness by cycling, running and swimming is imperative. As you are a professional in martial arts it would be wise to get expert opinion from your treating surgeon as to whether the plates should be removed before you return to high contact activities. I do not know enough about you, your type of injury and much other to offer sufficiently highly tuned advice.

  • Terry:

    I find this VERY interesting. I had surgery on my ankle due to a terriable break in three places. A plate nine screws were placed. I had constant pain and stiffness. I finially conviced the Dr. to take an x-ray. Sure enough a screw broke. This wasn't even 6mos. after the surgery. Now I need to have another surgery, which I can't afford and don't qualify for medical assisantance. So is the Dr. responsible or what? Perhaps it was a defect screw or placed wrong I don't know. I just don't know why I need to pay for a surgery again when it has been less than a year that this has happened. Please give me any advice you have. Thank You! Terry Leiske tlleiske@yahoo.com

    • jp:

      The loads on the foot are extremely high. Ever had anyone stand on your foot? Therefore many factors might have caused the screw to break, including too-early weight bearing. It happens. It is unlikely that anyone is to “blame”. Rather be thankful that you will recover eventually.

  • Mike K:

    I have plate I believe hammered in the bone above my knee along with plate going up the side of my leg with 4 screws. I need knee replacement now. These plates and screws have been in leg for 40 yrs. I am 61 yrs old. Doctors tell me they need to remove plate above my knee in order to do knee replacement. Any thoughts?

    • jp:

      What you seem to have is common. A break of the proximal tibia or tibial plateau followed by arthritic changes requiring knee replacement. It is unlikely that the knee replacement could be performed without removal of this (blade) plate.

  • Jon J.:

    Hey! I had 2 major reconstructive surgeries on both my feet 4 years ago. Now i have pins in my feet and a stabalizer bar in each ankle. My right foots fine but in the left, the stabalizer bar seems to rise to the surface of my foot and then my ankle feels week and ill walk with it curving in untill(usually a day or two later) It seems to go back into my ankle and feels better :p Its really frustrating and bothersome. Im trying to start skating again(the surgery was because my feet werent growing straight, not from skating) But this seems to happen. Is there anyway to give it extra support or should i try and get it removed? Its just obnoxious . Thanks!

  • JBR:

    I had sliding-calcaneal-osteotomy on both feet-- separately, one at age 15, the other at 16. (Each heal has a large-- I'd say at least 2 inch screw in it.) I'm now 25, and my left heal often hurts. They both hurt a bit when weather changes (like arthritis, I suppose) but this one is a lingering pain and even touching the base of my heal where the head of the screw is, it's tender. Could this be a sign they need to be removed? Thanks! I don't ever recall my doctor saying a thing about this happening, but I'm certain anything can happen!

    • jp:

      It is common to place a screw into the "tip" of the calcaneum (postero-inferior extreme) with many osteotomies of this bone. Unfortunately this is the very point where heel-strike occurs, and subsequent pain is not uncommon, if my understanding of the surgery is correct you should have this screw removed, ideally under a local anaesthetic block, on a day case basis. You might need crutches for a week.

  • Kim B.:

    I am second guessing my decision to remove the pin in my foot. Two years ago I was in a head-on collision. I was very fortunate, but broke my foot. It was a lisfrancs injury (not sure of the spelling), so they pinned it. The head of the pin was on the side of my foot and rubbed on my shoes. I had it removed a month ago and now I have an even larger hard lump on the side of my foot which is very uncomfortable.

    • jp:

      That is unfortunate - It is likely to be a collection of (firm) blood, which might absorb. An outside possibility is that it might require surgical removal. What this illustrates is the unpredictability of some surgery

  • Emily:

    I just had two small pins removed from my distal fibula that had been in there for 2 1/2 years. My OS told me that despite the small holes in the bones, that my bone is structurally sound and my only recovery is the wound from the removal, that I can do any exercise I want. I'm nervous to go out running and cross-training for fear that the bone isn't actually totally stable or strong yet until the holes grow in. I broke it running the first time, so I'm very hesitant. He assures me it's fine, but at only a week out I'm so nervous to break it again. Any suggestions?

    • jp:

      After two and a half years, and your having used the ankle for most of that time, you can assume that the bone is sound and stable. The pins will not be contributing to the stability any longer. Removal should be as you describe it - small incisions, perhaps under local or regional anaesthetic, and your leaving hospital full weight-bearing the same day.

  • Anusha:

    hello!!I met with an accident 1 month back and I broke my both the humoures bones at shaft and an ulnar bone at proximal 1/3 and got my surgery done in which bones are fixed with.... plate and screw method internal fixation... and I'm going to op for removal of stitches so plz let me know how long the plates should be kept and what is the correct procedure .... if plates have to be removed will there be surgery again ..... plzzzz let me know

    • jp:

      Bones take months and, at times, many months to fully heal. Therefore the plates need to be left in place until that healing occurs. After that it is often a matter of convenience when they could be removed. At times it is undesirable to remove some metal - please discuss this with your orthopaedic surgeon who will have much greater information about your particular injury than I have.

  • Telisha Marie:

    Hello Dr. I have an issue concerning a surgery that my son has to have again. He just turned 13 and last year he was diagnosed with having bow legs due to Blounts Disease. Well in April he had a surgery on his legs where they inserted screws and plates into his bones to correct the legs they grow. I will say in the first 6 months we saw a tremendous difference, but when we went back for one of his check ups in December the x-rays showed that the screws had broken in the to part of his left leg, so he went back in for surgery. My concern for this was great, I wondered had the dr's made a mistake? How could the screws break they insured it was normal. Now, here we are back to the same position we went to dr yesterday for a follow up and the x-rays show now that the screws have cracked and bent on both the to and bottom part of his right leg. I am devastated and of course he is fearing having yet another surgery. The dr says this time hr will not use hollow screws even though he used these because they are easier to remove, this time he will use more sturdy ones that are solid. I fear this happening over and over, and my son having so many unnecessary surgeries. Everytime he is taken back to the surgery room my heart stops until I know he's ok and in recovery. Dr I ask you is this normal for screws to break like this? Should I have a second opinion done? Is my son safe having this many surgeries and incisions in the same spot in so little time? If this continues to happen should we continue have surgery after surgery? Please help!! I am currently pregnant and don't want the steed of this situation to hurt my unborn child. It seems as if you give great advice and I do hope that you can do the same for us?

    • jp:

      The object of the surgery in Blount' Disease is to arrest (or slow) a growth plate - or part of that plate. The screws would go across the growth plate and so prevent or slow its growth. The more tardy growth plate can therefore "catch-up". It is not unusual for orthopaedic screws to break. In your son’s case that demonstrates that the screws are taking a load, as they are expected to do. It is disappointing and worrying if repeat surgery is necessary - but often, particularly in Pediatric surgery, that happens. Anaesthesia in this era is remarkably safe. One needs to accept these things, and most important to know is that there is little likelihood of long term harm, despite the repeat surgery.

  • Morpheth:

    Hi. I'm 17 yo male and 1 week ago I fractured my left forearm. Radius to be exact. I've had surgery and have a plate and 6 screws. I have a half cast past elbow for 2/3 weeks. I've decided to remove plate and screws because I'm sure by bones will heal back when I remove them. I'm healthy and fit. Question is, is it common to have cast removed after just 2/3 weeks? How long till my arm is completely healed?(plates in) After 6 months I'll remove the plate and screws, is this a good decision? After taking plate and screws out, how long till the screw holes are healed and replaced by bone? By 4th week, can I do athletic activities? (how much can I use it?) Thank you very much !

    • jp:

      The cast is likely an extra precaution – belt and braces to the plate which is the main stabilizer of the break. That is why it can be removed relatively early. One intension of the early removal would be to get the joints in the arm moving as quickly as possible. While some use of the arm is to be encouraged, it would be unwise to fully “test” the arm with athletic activities inside six months. Even when the bone is “united” it will still be vulnerable for several weeks or months because of the osteoporosis (loss of mineral) which is always associated with both the surgery and the recovery from the injury. Some would argue that it would be best to wait for the removal of the plate, and then some before returning to sport.

  • janice edwards:

    I fell and broke my 4th and 5th metartasuls on my left foot at the begining of March.For 3 weeks I have had a plaster cast from below my knee to my toes but after a recent xray the orthopedic surgeon said that the bones are not consolidating and he has scheduled me for an operation to insert a plate on the base of my foot on Thursday. I am 57 years old and it is likely that I have osteoporosis, I live in France but I am English and discussing an operation in French is difficult for me. I am concerned that there maybe other alternatives other than inserting a plate. Is it normally the case that after just 3 weeks the bones should have consolidated and why a base plate Your thoughts would be appreciated.

    • jp:

      While it is not usual for bone to unite as early as three weeks, at times it can be predicted that union is unlikely without surgical intervention. This is particularly so where the fracture fragments are displaced. The surgery in that situation would have two purposes – first to ensure the bones heal in correct alignment and second to ensure that optimum healing occurs (for example by removing intervening soft tissue). Some breaks of the fifth metatarsal (the “Jones fractures”) are notorious for their slow healing, and it is often policy to fix with a screw early. Having said that, provided the bones are not significantly displaced, there is unlikely to be any urgency to operate. I often wait many weeks for the swelling to abate, even when surgery is strongly indicated. You would likely be safe to leave matters until you return to England, where you might be more comfortable with the language.

  • Stacy:

    I fractured my tibial plateau 4 years ago and also dislocated my patella. My orthopedic surgeon did a tibial tuberosity cutting the bone where my patella tendon connected and shifting it over to the right then screwing the cut bone back in place. recently I started experiencing sharp pain that is very localized to where the screws are placed with about an inch on either vertical side along the bone, it started out occasionally but now it is constant. When I put pressure on the leg it feels as though my shin is going to snap in half. My question is could my body be attacking the screws thinking they are a foreign object and damaging the bone? Possibly degenerating it? Should I go back to the surgeon, I'd rather not pay the copay if I don't have to. Thanks.

    • jp:

      Following tibial tuberosity re-insertion the screw heads are covered by little soft tissue. Therefore it is easy to knock these heads, particularly when kneeling, with some bleeding under the skin or other irritation. It is common to remove these screws (which is usually straightforward, sometimes under local anaesthesia as a day-case). Only you know how much the pain is intruding into your comfort, and that would be the only reason to remove the screws.

  • Felicia:

    Hello i am a 32 year female, I got hit in my arm with a cane in 98 and it broke my elbow in half, I had to have a screw put in there. My question is that it's always been painful for me to get all my motion and stuff back into my arm, but here in the last few years it gets painful when i lift something like weights on that arm, i can feel pain, or when i am doing a push up. Is there something wrong now? I was told i would have the hardware in there for life and nothing was talked about having any problems on down the road, so what should i do? I hate the word surgery and i know that the therapy i went through was tough, i can't imagine going through that all over again especially me being in my adult years. Please help!!

    • jp:

      Things do change with time, for example screws can migrate years after implanting. If your symptoms are a major intrusion into your function you should be investigated, starting with a capable orthopaedic examination and, likely, an x-ray. The good news is that now the bones are healed, should the screws need removal, the post surgery convalescence ought to be rapid and easy. It is unlikely that you will need physiotherapy.

  • Letesha Boner:

    I had surgery on my right heal 9 yrs ago. I broke it completely off and crushed my arch. They reattached my heal with titanium screws and plates and rebuilt my arch with coral. I have constant pain and sometimes my foot will "lock up" on me. Sometimes I feel like I have lost circulation in it. I also feel a pinching/stinging in my ankle. I have dark spots on it as well. My ankle is always swollen. I am in tears a lot of times because of it. I have gone to a podiatrist over it and he gave me cortisone shots in the top of my foot...PAINFUL and DID NOT help! He refused to take the hardware out because he wasn't the surgeon who put it in, I had a bad falling out with the surgeon who did the surgery, I haven't spoke to him since. I feel this is my choice because I'm paying for it and he doesn't have to deal with the pain I feel everyday. Do you think removing the plates and screws with help relieve the pain? Please help. Thank you

  • Letesha Boner:

    I can email you the pictures from my x-rays. What is the email adress I need to send them to. Thank you, Letesha

  • I had surgery on my right heal 9 yrs ago. I broke it completely off and crushed my arch. They reattached my heal with titanium screws and plates and rebuilt my arch with coral. I have constant pain and sometimes my foot will "lock up" on me. Sometimes I feel like I have lost circulation in it. I also feel a pinching/stinging in my ankle. I have dark spots on it as well. My ankle is always swollen. I am in tears a lot of times because of it. I have gone to a podiatrist over it and he gave me cortisone shots in the top of my foot...PAINFUL and DID NOT help! He refused to take the hardware out because he wasn't the surgeon who put it in, I had a bad falling out with the surgeon who did the surgery, I haven't spoke to him since. I feel this is my choice because I'm paying for it and he doesn't have to deal with the pain I feel everyday. Do you think removing the plates and screws with help relieve the pain? Please help. Thank you

    • jp:

      I am very sorry that you have had these miserable nine years. It is difficult for me to visualize the type of injury you had (there are many types and variants of injury in the complexities of the foot. I interpret “heel bone” to mean the calcaneum. If that is the case the management of its injuries is complex and the outcome often unfavourable. The feeling that your foot has “lost circulation” might be a sign that you have the “tarsal tunnel syndrome” which is not uncommon with damage to the calcaneum. This is a compression of the (plantar nerve/s) and the vessels. It can be relieved by surgical enlargement of the tunnel, although I suggest first wearing elasticised stockings for a few weeks, which (paradoxically) might give significant relief. Removing the plates helps at times. I would need to see your x-rays to give more specific, and perhaps more helpful advice. Can you e-mail, or mail to me?

    • jp:

      Please see comment and reply, Lynette Coleman

  • tami Jacobs:

    My mother had a fusion in her neck along with a plate. Her esophagus is slightly over to one side and she has a problem swallowing. Also she had an endoscopy in which the doctor stretched her esophagus. This should never have been done by the GI Dr. This was done 3 times through the 5 yrs. Now she had a swallow barium test that showed when she drinks the fluid spays in all diff. directions and the plate is now pushing into her esophagus. She gets chocked eating and drinking. No Dr. will touch this or say any correction could be done. Only dangerous.. She is 78 yrs. old and the problem is only getting worse. We were suggested to take her to another area away from the hospital and Dr. that did the surgery. They said no one in the area would touch it and we needed a second opinion. I can't bare to think this is something she will have to live with or could possible wind up with a feeding tube. She can sometimes get chocked on her own saliva.

    • jp:

      Cervical plates do produce difficulty with swallowing at times, and it is also possible to damage the esophagus during the implanting of these plates, or by abrasion against the plate. However, at your mother's age it is possible that she has an unrelated problem of motility of the esophagus, one of the expressions of achalasia, or perhaps one of the esophageal reflux problems.. But she needs urgent attention. She runs a significant risk of inhalation pneumonia. A starting point could be an ENT opinion, a general surgeon with a particular interest in the esophagus, or a gastroenterologist. Radiological motility studies by an expert in the field might be needed. If the plates are proved to be the problem it is straightforward technique to remove them.

  • tami Jacobs:

    My mother had a fusion in her neck along with a plate. Her esophagus is slightly over to one side and she has a problem swallowing. Also she had an endoscopy in which the doctor stretched her esophagus. This should never have been done by the GI Dr. This was done 3 times through the 5 yrs. Now she had a swallow barium test that showed when she drinks the fluid spays in all diff. directions and the plate is now pushing into her esophagus. She gets chocked eating and drinking. No Dr. will touch this or say any correction could be done. Only dangerous.. She is 78 yrs. old and the problem is only getting worse. We were suggested to take her to another area away from the hospital and Dr. that did the surgery. They said no one in the area would touch it and we needed a second opinion. I can't bare to think this is something she will have to live with or could possible wind up with a feeding tube. She can sometimes get chocked on her own saliva.

  • Angela Bednar:

    I am 58yrs and 6 years ago I sustained a closed # radius/ulna lower end. A year later I had an osteotomy of radius with bone graft, plate and screws because the bones out of position. The surgeon explained that one of the screws was longer than the rest and may or not cause a problem. The metalwork has now been in place two and a half years. I am not experienceing any significant problems to date. However, the longer screw has resulted in a raised bump,slight deformity, on my forearm above the wrist. The surgeon initially post-op said the metal would be removed. Later he said it would stay in place. My question: would it be possible to remove just the one screw?

    • jp:

      It is usually easy to remove a single screw, particularly as it is prominent, and easily found because it has raised the skin. I would usually not need to use more than local anesthetic in an office procedure.

  • Kathy:

    Thank you very much for your time and response. I had the arthrodesis because the pain in the joint which was badly damaged by osteoarthritis and gout was so painful. I also had developed a very painful Tailor's bunion on the foot from the way I had to compensate walking with the painful big toe. There was some infection in the arthrodesis incision that was successfully treated with antibiotics. I am not active since I've been ill with Chronic Fatigue Syndrome for many years. After reading your response I'm more inclined to leave the metal plate left alone. I am wearing shoes that do not rub the plate and it seems like risking infection again may be the bigger consideration. Kathy

  • jp:

    Thank you for your contribution. Your history demonstrates some of the disadvantages of the arthrodesis of the great toe. Convalescence is often long (in your case after four months you might need some more months before the fusion is "solid"). Then there is the inconvenience of the boot (which is very awkward) and now the nuisance of a bone stimulator. A solid fusion is imperative because the loads on that fusion are extraordinarily high, measured in hundreds of pounds. I have come across fractures of the arthrodesis, several years after the procedure and also fatigue fractures of the adjacent metatarsal. If you get a solid fusion, and the plate does not trouble you I would leave well alone. By that time you will be thoroughly tired of surgeons and surgery. Unfortunately I have had to take many of these plates out (even though I do not put them in) because the edges of the plate often rub against footwear.

  • lm:

    I'm in an interesting position. I have a titanium plate, R fibula,placed approx 2 years ago.Injury was fibular fracture immediately superior of malleous, plus multiple soft tissue repair (ATFL, CFL, Deltiod/ both peroneal/ both malleous all torn or ruptured), . Previous Hx of modified Brostrom's procedure on ATFL (repair did not hold in injury). Plate is now rubbing through peroneals. Remove, right? Not so easy. I also have agammaglobulinemia, and MRSA+ 10 years +/-. Plus more stuff. Immuno and ID are adamant plate stays.... risk of seeding bone with MRSA high due to the fact that it took 15 months for me to walk relatively unsupported when it was placed, largely from slow bone growth. Due to constant antibiotics, even with Ig infusions, also am at constant risk of add'l soft tissue injury. Ortho wants plate out... even with repair, will eventually cut through, plus the above mentioned stress factor etc. Feeling like a no-win, so am open to ANY insights. Im in my 40's and active to the best of my ability. (Yes, I know full Hx isnt here. And yes, I have good working medical knowledge for multiple reasons.

    • jp:

      Your dilemma can be resolved into two pivotal aspects. First: The danger to the peroneii. You cannot sit an watch it happen. You have lost enough of your ankle supporting structures, and if the peroneii rupture you will have an almost insurmountable problem. Second: Managing the infection. If you have low grade infection somewhere there is a risk that it will seed to the precincts of the plate even if you leave it in place. The relative avascularity of the tissues adjacent to the plate make for that vulnerability. Further, if the plate is really abrading through the soft tissues, those also run the (small) risk of infection. Supposing you remove the plate - you will be creating a far less susceptible field for future infection. If the surgery is to be performed my regime would be: The skin incision must be a single cut, no "sawing" ( which produces a ragged incision). Ideally optical enlargement should be used to minimise soft tissue trauma. Practically no use of scalpel once skin incision is complete. The tissues should be separated with an opening of the scissors (not a cutting by the scissors). This will prevent or reduce damage to the blood vessels, even "micro" vessels. Fat should never be cut, only separated and spread. Periosteum might need sharp cutting or forceful elevation off the plate, but only over the plate. Gentle tissue handling. No toothed forceps, no toothed rake retractors, no tugging, no levering, no McDonald's behind the fibula. No tourniquet. The operative field must be lavaged extensively with some liters of saline, throughout the procedure. If diathermy is used (and I hope it is not required} then it should be no more than 6 watts (forty or fifty are commonly used, with considerable tissue damage around the blood vessels). No "antiseptics" on the wound, except perhaps diluted Betadine. Any antiseptic which would burn the eye will burn a surgical wound! No buried sutures of any type. They are entirely unnecessary (see an earlier post) No skin sutures - Steristrips held with appropriate glue onto the skin surface. Immediate application of elasticized stocking, below knee, and do not remove that for at least 24 hours. If there is minimal bleeding into the dressings and visible on the stocking, then leave for longer. With this approach it is exceedingly unlikely that an infection will erupt. If it does, it is likely to be manageable. I hardly ever use prophylactic antibiotics. But do work up pre-operatively with good micronutrients and iron chelates orally.

  • mary:

    45 yrs old, car wreck, broke my shoulder bones in 3 places. lots of pain, cant lift arm or lift objects. doctor said it can heal in a sling in 8 weeks then need therapy to use it. orthopedan said screws will make it moveable immediately. i need my hands to work. tentative surgery tomorrow, what to do

  • I am 58 and in mid-August I fractured a bone in my ankle and moved the tibia bone out of place. The doctor inserted a metal plate with 6 screws. My ankle seems to be healed as I feel no pain, but my knee constantly bothers me. Can the discomfort be due to the cold weather which I'm in most of the day?

    • jp:

      A possibility is that you injured your knee at the same time as you injured the ankle, and your present knee pain is unrelated to the ankle injury. Another possibility is that there was an underlying (but painless) arthritis in the knee which was "stirred up" by the fall. Finally hip arthritis can cause knee pain, even though the hip remains painless. The "cold syndrome" is a pain or ache caused by cold, or changing, weather. It does not affect normal joints, but those previously damaged by injury or arthritis. Some find that a warming "knee guard" helpful, where the underlying problem is in the knee (but not elsewhere)

    • jp:

      I have to guess much here. I assume that your injury was recent, and that you broke the shaft of the humerus - such injuries can heal without surgery, as you describe, in a sling. Surgery might get your arm moving earlier, but it is doubtful if this would be "immediate". There will need to be a convalescence of at least two weeks before you are confident and pain free enough to even approximate normal function. Surgery does have risks and costs which are avoided by non-surgical methods. If there are complications you might be out of work for far longer than you are planning at present. I seldom operate on broken limbs earlier than two weeks after the injury as the results are better and the risks less if one waits.

      • mary:

        thank you for the reply. i backed out of surgery today, got more questions answered about complications and non surgery healing. i do need both my arms to return to work but they told it me it was okay to tAke more time to decide.

  • Sara:

    I have a metal plate an screws in my right ankle in I have constent pain everyday had my surgery 11yrs ago in pain is bad. What should I do

    • jp:

      This is tragic. But because I do not know why you had the plate inserted, or anything else about you, I cannot contribute in a way which will help you constructively. However, whatever the reason you had the surgery, you could expect freedom from pain. You must seek help near home.

  • Russell:

    **revised** Hey i broke my tibia and fibia in a dirtbiking accident (compound fracture) 3 years ago. They inserted a tibial nail (titanium) and a screw above my ankle and below my knee and i was walking the next day on crutches as advised by a doctor to due so. My ankle screw is starting to ache and i feel bone growing around it almost over it. I am concernes about this because i am a kickboxer and often kick with that same leg and ankle sometimes gets bumped. Could i get both screws removed and leave rod in? Or possibly only one screw since its botherig me? Thank you!!

    • jp:

      Contact pain or discomfort is common with implanted plates on forearm and leg, and a valid reason to remove metal. There should be no problem removing the cross-screws (also called trans-fix, anti-rotation or locking screws). However if they are bent it will be more difficult and that will need to be known before embarking on the surgery.The rod could be left in which will make the screw removal less intrusive, and possible under local anaesthetic.

  • Kat. B. H.:

    I have a question.... I broke my arm in 94' and had a plate & about 6 screws put in to hold the bone together. Now 17 yrs later my arm is hurting,& uncomfortable. Ive never had any problems with it before so its really upsetting me . Should the plate & screws be removed?

    • jp:

      Symptoms after this lapse of time mean something new has occurred, and you need to know what that is. The new pain might or might not be related to your previous break. A diagnosis is necessary and the first step toward that would be a standard X-ray.

  • Russell:

    Hey i broke my tibia and fibia in a dirtbiking accident (compound fracture). They inserted a tibial nail (titanium) and a screw above my ankle and below my knee. My ankle screw is starting to ache and i feel bone growing around it almost over it. Could i get this removed or should i leave it in?

    • jp:

      You do not say when was this break, what the radiology showed or anything about yourself. Orthopaedic surgery is not as simple as slotting in or out a new car radio. Solutions need to be specific to the person. I need to know more...

  • jp:

    A result of a tibial plateau fracture is (not infrequently) osteoarthritis. This might be associated with, or mimicked by, cartilage (meniscal) tears or other mechanical problems within the joint. The screws (at this stage) are unlikely to be the cause of your pain.

  • Hello, I am 38 years old.and worked out and ran up until this year. Almost three years ago I had a car accident in which I broke my Ulna. It broke clean and in the middle of the bone. The doctor put in a plate and six screws. I have had no real issues with it until now. The pain comes from the break area, my elbow and my wrist almost like it is traveling the bone. I had a child this year too and gained fifteen pounds. I am wondering if the changes in my body are affecting my arm or if it could be another issue all together.

    • jp:

      I do not know enough about you to be precisely useful. the most likely cause of your recent-onset pain is the (not inconsiderable) repetitive load of lifting your continuously growing baby (and stroller and much else).

  • Angela Bednar:

    I am 58yrs and 6 years ago I sustained a closed # radius/ulna lower end. A year later I had an osteotomy of radius with bone graft, plate and screws because the bones out of position. The surgeon explained that one of the screws was longer than the rest and may or not cause a problem. The metalwork has now been in place two and a half years. I am not experienceing any significant problems to date. However, the longer screw has resulted in a raised bump,slight deformity, on my forearm above the wrist. The surgeon initially post-op said the metal would be removed. Later he said it would stay in place. My question: would it be possible to remove just the one screw?

    • jp:

      A single screw, which is that easily felt and therefore just under the skin, can usually be easily removed. I often do this in my office, under a local anaesthetic. It is often not necessary to even use a stitch.

  • Taylor W.:

    3 years ago I fractured my medial epicondyle and it had to be held with a screw. I bowl for my high school team and it always cramps durning, after, and any other time after that. The doctor that did the surgery said it might have to come out while growing. Is it time to get it out?

    • jp:

      Taylor W. You need a diagnosis as to why you are getting the cramps. It might be associated with the screw, but in any event these screws are often troublesome since they are below thin skin which is easily knocked and tender. It could probably be removed under local anaesthesia on a walk-in-walk-out.

  • Veronica Covarrubias:

    I broke my fib n tin and dislocated my left ankle on October 29th. I have three screws and a plate. I'm on my 3rd cast and was told I would move to a boot on December 12. I'm 43, thin and in pretty good health. I'm not in any pain right now but I'm wondering if I should have my hardware removed and what amount of time is reasonable since my surgery was just in October.

  • Karen:

    I had an ulnar shortening osteotomy in 2008 due to continued pain after wrist debridement due to a TFCC tear. Now I am being advised by my surgeon to have the plate and screws (7) removed because it is incredibly tender when bumped or with certain movements. This is my dominant hand and I was wondering how long it usually takes to make a complete recovery. Also, what kind of casting/bracing can I expect and for how long. I teach preschool and routinely pick up children; is that going to make a difference?

    • jp:

      Karen. The ulna will be well healed, and apart from the 10 days needed to recover from the skin wound you should be able to do most things within days after the surgery.

  • lokesh:

    hi, i'm 30, 5 years back i met with a accident and my left leg bone was broken and nail was insterted with three screws, my question is when the nails has to be removed, bcoz its already 5 years ago.

    • jp:

      The sole purpose of internal fixation is to hold bones in the correct position until the bones are healed with (very few exceptions). After that they are redundant.

  • Kat:

    I was wondering.. I broke my forearm 5 years ago and I have two plates and about 10 pins in there. Is it too late to take them out? I couldn't have surgery before but I can now and I'd want to take them out because one of them is a bit annoying. I'd really appreciate your thought on that.

    • jp:

      In these comments it is always difficult for me to get an exact perspective of the specific injury, particularly in the absence of X-rays. The treating surgeon will usually be better equipped to give the best advice. In some circumstances a generalized perspective can be useful, and hence the following comment. I will assume that you had a plate on each of the forearm bones. The most troublesome reconstruction plate is usually the one on the ulna, where the overlying flesh is thin. For that same reason the ulnar plate is the easiest and safest to remove. Depending on where was the break in the radius, removing that might be more difficult. Therefore if it is the ulnar plate which is troubling you, you might consider removing that plate alone.

  • stevie hardesty:

    I had surgery on my hip because my hips slipped so they put screws in it I got the surgery in. 1999 ever since the my hip hurt they go numb they both stiffin. Up now and Every once in a while I fill it pop is this normal what can I do to not have the pain an stiffness?

  • laura:

    Happy Thanksgiving...My 15 year old broke his elbow in July of this year - he split the ball of the bone (not the biggest,pointy part of his elbow, but the ball above that one) in half, requiring 2 screws. He is at about 20 to 30 degrees in staightening his arm and scheduled to have screws removed (which are poking out and hurt when bumped) in Dec. He just got on swim team, so my question is how soon after getting his screws out can he swim? And how long will it be before the holes left by the screws fill with in with bone?

    • jp:

      I think that he has split the humeral condyles. The elbow is a particularly "unforgiving" joint, which means that after injury / surgery there is reluctance to return to the full range of movement. This return to full movement will be essential for competitive swimming. Therefore the sooner that he exercises it the better. As an extension of that the sooner the screws are removed the better. The screw holes are of no consequence at this stage - he should concentrate on returning to swimming promptly - as soon as the wound necessary for removing the screws has healed.

  • Henrike:

    Hello, I just had 3 plates and 16 screws removed from my ankle. I have been on crutches with 50% WB for the past two weeks and am supposed to be on crutches with the same 50% WB for another 2 weeks. Apparently I am at a high risk for re-fracture because some of the holes in my bones are pretty close together and are exactly aligned. My question is: How long does it take on average for the holes to fill in or get to a point where the risk is significantly less? I am a female in my mid 40s, non-smoker, light drinker, not overweight = generally very healthy. Thanks

    • jp:

      In almost all cases, where the bone has healed and screws have been removed, four weeks of partial weight bearing - mainly to ensure you are steady and that you can react promptly to those reflex adjustments necessary for balance - is sufficient. These time periods have been provided by your surgeon (I presume) with detailed knowledge of your type of injury, the type of fixation and more. This judgment is based on a number of variables which I cannot know. However surgeons want a good outcome from their surgery. They do not want any complications any more than you do. It is unlikely that you would be allowed to full weight bear after your four weeks, if there was a risk.

  • yvette:

    Hi there, i had a spiral fracture of the distal fibula in my right ankle 15 years ago. the surgery involved insertion of a plate and 6 screws. in the last 1-2 years i have experienced restricted movement in the ankle which causes a limp. i had an athroscopy on the right knee 12 months ago (possibly relating to the ankle). i am now experiancing excruciating pain in the ankle joint, slight pain in the knee but worst of all a pinched nerve in the (r) groin causing unbelievable pain and collapse of the leg. over the years i have tried chiropractic, physio and currently osteopath. this has given short term (a few weeks) relief but now want long term. i went to my GP who has sent a referal off to the orthopaedic dept of the hospital where i originally had the ankle surgery so just waiting to here from them. i also had an xray. the xray report really only says that there is swelling around the ankle joint. when i look at the xrays it clearly shows the plate with 5 screws inserted BUT 1 screw nearby and not attached to the plate. as i dont have an xray of the placements directly after surgery i am not sure this is right. why would 1 screw not be attached. is this what is causing my pain (a loose screw!) if this is how the screw is supposed to be do you think i should have a MRI or CATSCAN to see if they pick up something else in the ankle?

    • jp:

      During ankle reconstruction following break(s) it is not unusual to have a screw placed between fragments of bone (and therefore not attached to a plate). This does not mean that it is "loose". It also does not signify that this screw is the cause of your pain. It probable is not, given that you have soft tissue swelling over a wider area than the screw. The possibility of an infection exists and you need t see your surgeon relatively promptly.

  • MB:

    Hello. I had foot surgery 9 months ago. A piece of the titanium screw/pin broke off so I still have a piece in my bone even though the other pins were removed. The dr said it is not necessary to remove it unless I'm having severe pain. He also explained that titanium is very compatible with the body, etc. I am worried about leaving it in though and that area on my foot often feels very strange. It's not really painful but uncomfortable at times. I would rather not have a foreign object left inside my bone. If I remove it, will it be a painful and dangerous process? Or Should I just live with it?

    • jp:

      You do not say what type of surgery you had, for what reason, and where anatomically is the piece of metal. If it is a tiny fragment, deeply buried in bone, then it might well be better to leave matters as they are. Having to "excavate" bone to extract metal can be a significant procedure. If the metal is titanium, and firmly fixed into bone, I do not believe that you will run any risks, or that it will cause discomfort. The disconcerting sensation which you have might be entirely unrelated to the metal.

  • RS:

    Hello Dr. My mother is 66 yrs old and she had a slip and fall and year ago. The bone between her elbow and shoulder was broken and she was operated twice. The first doctor put the rod and plates with screws but that tend to reduce the nerve movement in her wrist and had to be operated the 2nd time. The 2nd doctor removed the plates and screws and did a bone grafting (taking out bone from the waist). Everything went fine but out of 4 support bones (sorry don't know much about this), one did not join fine and she cannot function fully due to that. We took advice from multiple doctors and there are 2 suggestions: Either go fo another bone grafting or fit a plate. We are confused and we do not want multiple surgeries. Any piece of suggestion or advice is appreciated. I can send her x-rays and other medical repots on email if that would help in any way. Many thanks !

  • owen:

    Dr I had a fracture of my left tibula and a dislocated ankle of which I had a plate and 6 pins to help heal it, recently iv been having serious discomfort and pain whilst walking, I was sent for an xray to find one of my screws has totally conme out of place and is now seemingly floating in my ankle, I haven't had no doctor come back to me yet about the situation so was wondering what would happen since I presume it would need to be removed and what happens after surgery ie will I be able to walk straight away as if nothing has happened ?? Hope you can get back to me and thank you

    • jp:

      You should take the initiative and see your surgeon about the broken screw. Passive waiting for the “someone” to organize you is no sure way to go through life. It might not be necessary to remove a broken screw, but the surgeon who inserted the metal will be the best judge. You do not say when your injury was, but after three months removal of the metal should not be a problem, provided the bone has been shown to have healed on your last x-ray. Most people leave hospital within 24hrs and walk full weight- bearing within a few days, or sooner.

  • Hi My left ankle was broken in 2004. A plate and screws were implanted. I had a hard time, since I am obese and not being able to bear weight during healing was very difficult. However, I eventually healed with no real problems or discomfort, except for a slight soreness/stiffness every now and then. Since July I have had three celluitis infections in my left foot. Been taking antibiotics since 11/1/11 and had an abcess on my ankle over one of the screws drained. Started two different antibiotics. As of 11/18/11 the doctor evaluated and says I need to have the hardware removed. In addition, I had a minisus tear in my right knee that was operated on in October and I am receiving Physical therapy for. So my left leg with the screws in the ankle is the stronger one that I bear more weight on right now. I am still dealing with a lot of discomfort from this. My doctor has scheduled my surgery for hardware removal for 12/1/11. He says I need to have this done asap. My concern is that I wont be able to bear weight on my leg after hardware removal. What happens to the holes that are left after screws are removed? I fear that I will be totally not able to walk. I am trying to figure out how long I can expect to be out of work. Stressedddddddddddddd - Any words of wisdom out there?

    • jp:

      Treating your infection is the imperative, and removing the metal is probably essential. What-ever else there is you have to go through that step promptly.

  • april:

    I was in an ATV accident in Feb 2011 that resulted in a spiral break of my lower tibia and 2 fractures of my upper fibula. The doctor did surgery to place a titanium rod and screws to hold my tibia together. After about 3 months I was told I could slowly start weight bearing. Now at the site of the break it feels as though the break hasn't healed completely and feels as if there is some kind of build up on the broken area of the bone. My doctor said nothing about it the last time I had an xray but I'm a bit concerned about it because that spot is still pretty painful. I also have some pain in my knee and not really sure why as i didnt injure my knee but they did make an incision in it to put the rod in( the pain is not near the incision). Also, am I supposed to be able to see and feel the screws under my skin?

    • jp:

      April. The upper end of the (intra-medullary) rod (which may be below the scar) could cause knee pain, as well as the process of inserting the rod. Depending upon where the screws are, you might be able to feel them.

  • Hi Dr. My situation is that I had a dislocated ankle with a trimalleor fracture of my left ankle on August 19, 2011. In the ER they put the ankle back into place and the surgeon wanted to wait due to swelling to do the surgery. On the 29th of August I had a plate, 6 screws along with a screw across my ankle for stability. 11 weeks later I am doing PT but the pain in my ankle is outrageous at times. I try to only take Tylenol .due to the fact that I have to drive to work. I have always had a high tolerance to pain but this is really kicking me. Also along with this is the fact that I'm itching alot. There was a rash that started at the top of my ankle, my MD put me on some steroids and it helped for a while but I'm off of them and it has started again. Is there a way this could be associated with the placing of metal in my ankle? And my surgeon did mention that he might have to go in and take out the screw that he put in that goes across my ankle but nothing about the plate and screws. Can I have them taken out and still have mobility? The PT says I'm doing good but I missed my last appt due to all the pain I have started to experience. Is there a vitamin that will help with the healing? I am a 47 year old woman and want to get a handle on this so I can live my life without all the pain and excuses of not being able to do things.

    • jp:

      At two and a half months after this type of injury it is unusual to be getting severe pain. It is possible that this is being caused by tight "diastasis screws" between the tibia and fibula. These screws will invariably break, and my aim is to remove them before they break (at times replacing them with absorbable screws) at about six weeks post operative. It is improbable that the rash is related to the presence of metal. Did you have a cast? You need a precise diagnosis as to why you are getting this amount of pain.

  • Kieran Thomas:

    Hello, I am a 20 year old, about 5 years ago I broke both my radius & ulna in a rugby tackle, clean break, I got 2 plates and 13 screws fitted. When the surgeon gave me the option to have them removed a few months after it had healed I refused, due to me playing rugby, american football, and football. For roughly the past 3 years I get pain in the arm, but have always put off the thought of getting them removed, due to work commitments, at the mo I'm almost qualified as a Paramedic so I would have the opportunity whilst waiting for employment. Also, when I play rugby or anything really, and the forearm comes into any direct contact the pain is unreal, I have to sit out for a while untill the pain settles down. Just wondering if you'd recommend me doing anythin about it? Thanks, Kieran

    • jp:

      I am not sure that your reasoning for wanting to retain the plates "due to me playing rugby, american football, and football" is valid. After the appropriate convalescence your arm should be as strong as it was before the injury. Retained plates can accentuate problems with future injuries. Indeed the plates are now causing you pain. After having the plates removed absence from contact sport for six months would be prudent, but during that time much swimming and gym would be encouraged, and your fitness retained.

  • Natalie:

    Hello I broke both the radius and the ulna when I was eight I had metal plates in and a year later got them removed then three years later I did it again but couldn't get plates back in. To this day 20 years later I'm still having to go to the hospital once every two years because I've been left with holes in my bones. The pain is worse in the winter for sure. But yes get them removed

    • jp:

      The pain you are having is more likely related to the internal scars caused by the original injuries and the subsequent surgery. You are describing the well known "Cold Syndrome".

  • Ellen HIcks:

    Approximately 15 years ago (around 1986), I broke my tibia and fibula just above my left ankle, and they were repaired with a metal plate and 9 screws. I am 59 years old now. The affected part of my lower left leg has remained swollen ever since the operation. In the last year, I have been experiencing some weakness in my entire left side. I have seen an orthopedist and a neuerologist for the weakness. They've done a brain MRI and a nerve conduction study but haven't come up with a diagnosis yet. Could either the swelling or the presence of the metal in my lower left leg be causing weakness in the entire left side?

    • jp:

      It is improbable that the weakness in your left upper limb is related to the problems in your left leg. Can I suggest using a below knee elasticised stocking to reduce the leg swelling, as that could have some adverse long term effects?

    • im 25 year old and will be 26 this dec. i do have same thing as you do. my right ankle.. it remained swollen ever since the surgery also. i did used brace or wrap.. but not working.. so i didn't sure if it will get worse? because since few month ago, it getting hurts and keep pop noise every time i move my ankle wrong way..

  • Roseann:

    hello, i had ulna osteotomy about 4 years ago, it went very well however recently i am having wrist pain and it "pops" all the time.....is it advisible to have the plate and screws removed, i am 36 years old......also if it is removed how long does it take to heal...since removal would be an extenstive surgery.

  • Sandy Naughton:

    I am 47 and have had a plate in my right hips since the age of 2. Recently my mobility has worsened, as well as my arthritus. My biggest concern is the apparent clunk I appear to be getting part way down my thigh which is where I am told the plate now resides. Having had an x-ray, I have been told by my GP that there has been movement and I am awaiting an orthopaedic referral. My mobility and arthitus pain has worsened substantially and I am concerned what this could mean?

    • jp:

      My guess is that you are female and had a congenital dysplasia of your hip, which necessitated an osteotomy and realignment of the femur/hip in your infancy. If that was the case it might not be surprising that you have developed degenerative changes in your hip now that you are 47. The plate is now likely to be firmly buried in bone, and it is highly improbable that it has moved recently. Fortunately we live, now, in the era of hip replacement, with great benefit to those unfortunate enough to have these types of problem. I would not recommend having the plate out now, except if nessary for a hip replacement; the costs do not justify the cure. Recently there was discussion about removing metal in children, and your history demonstrates two possible consequences to having left the plate in place. I do not know if these apply to you, and used your letter only for purposes of illustration. The first is interference with a hip replacement, making it less than straightforward. The second is that the presence of metal, which has migrated with development into the shaft of the femur, will likely make that bone somewhat more vulnerable to injury should it be subject to great forces, such as a fall or motor vehicle accident.

    • Kurt:

      I am a 22 year old Male. 25 months ago I broke my 4th and 5th metacarpals. I had to have 2 plates and 8 screws put in. Since then, my hand has healed very well, but there is discomfort. I get numbness and tingling in the end of my pinky finger. I feel like it would be beneficial for me to get my plates and screws removed. Please let me know your opinion or any questions

      • jp:

        The numbness and tingling at the end of your little finger is caused by constriction/damage to that, specific, digital nerve. The site of this can be narrowed down by knowing whether it occurs on both sides of the little finger. I have to assume that the rest of your hand functions perfectly and there is no weakness or wasting of the muscles in your hand. I would also need the x-rays to correlate your symptoms with the plate. It is possible that the plate has nothing to do with the nerve symptoms.

  • Gertrudes C. Artajo:

    Good day Dr. JP, again I have some questions about removal of plates . As I mentioned before I had a Tibial comminuted fracture 5 inches below the plateau and slightly dislocated my knee. 2 months after the surgery the x-ray result is good the fractures started to heal. Now I'm on my 3rd month of full weight bearing. I am having a limp which I think my leg is shorter than the other but when it was measured there is only 3 mm difference will this affect my way of walking? What really affect me of having a limb? Can I really walk normally? Now I experience pain below my knee is it because of a long screw being put across in it? Sometimes I feel sharp pain in my leg. I can't stand and walk for long . My doctor used buttress plating, a plate and 9 screws.Is it hard to removed? My doctor told me that If ever I want it to be removed he will do it after a year so my question is having 9 screws in my bone. Having these number of holes will these affect the strength of my bone ? I have read different articles from the internet . Different doctors have different ideas but based in your learning, in your patients record is it true that after the removal of the screw the bone will heal and reverts? For how long after the removal? In my case I have nine screws and a plate is there anything to worry? I always pray to God that time comes these foreign object will be removed safely and I want to be back to normal. I hope Dr. JP you will continue to share your ideas to us. I know some people having the same situation of mine will be guided too. Thank you in advance.

    • jp:

      Orthopedically inserted plates and screws have a temporary function. That is to align structures and so allow them to heal into normal or near normal positions. Once healing has occurred the metal implants are redundant, and can be removed if warranted.

  • Dixie:

    A fall In July resulted in spiral fracture of my 3rd metacarpal. A plastic surgeon attempted external fixation. This Involved putting a pin into the 2nd metacarpal. Pinning was unsuccessful due to muscle in between the bones of broken metacarpal. This resulted In 2 screws being placed. Surgery was successful and went to hand therapy. 5 weeks post op I was massaging my hand, pulled on my thumb and felt a "pop". Had Instant pain and swelling to pinning site in 2nd metacarpal, lost my Index finger knuckle and lost ability to pinch. Saw surgeon 2 days later, had x-ray. Was told there was no fracture and that 3rd metacarpal was healing fine, and I as told to return to work (I’m and ER nurse), take Ibuprofen, and Ice It. 1 week later had another x-ray which showed a fracture. A splint was used to keep alignment. One week later I was told that I would need surgery the next day. He placed a titanium plate and 6 screws. 2 weeks later I began to have swelling, pain again at same site. Saw him again at normal post op follow-up and was told the titanium plate was broken in half. He has had me back in splint x 1 month. I have lost all progress from previous hand therapy. I have constant pain and I still have a nasty bulge to area over 2nd metacarpal. He says from follow up x-rays that bones remain in line, but if I continue to have pain or swelling the faulty plate should be removed. Have you ever had experience with a titanium plate breaking with no apparent cause? The plastic surgeon says "It Is because of repetitive motion". I don't agree because I have been in a splint that only allows my thumb to move. I am scheduled to get a second opinion from an actual hand specialist. I was wondering what your opinion was.

    • jp:

      I am sorry to hear this sad tale. Much of surgery is difficult and frequently unpredictable. The plates used on metacarpals are necessarily thin and weak. A message from these events is that most muscle actions in the body recruit multiple parallel muscle actions. Using your thumb necessitated bracing your hand (even if it was in a splint) to provide the necessary firm structural base. Many or all the muscles operating on the hand will therefore have been recruited and activated. These include the muscles acting on the metacarpal, and hence the "repetitive strain". That would have been sufficient to break the plate.

  • jp:

    As always, you need an accurate diagnosis as to the cause of your pain, not speculation. One way to check whether the plate is making contact with the talus is to look at the movement of the ankle, in real time, under the x-ray image intensifier. I usually film simultaneously. You also need to check whether or which tendons might be snagging - because of scar, on metal or at the edges of bone spicules. Real time ultrasound, in experienced hands, would be a good way to investigate this. Having said all that, eight months is a relatively short time in orthopaedic terms, and you might like to see if further improvement occurs over the next few months.

    • Michelle:

      Hello Dr. I have a question about a surgery that my son had on his legs back in April of this year called a Hemiepiphyseodesis. The surgery seemed to have went well and my sons legs seem to be straightening as he gets taller, but when we went to the doctor today to take his monthly x-rays and have his exam they told us that one of the scres had broken in his left leg. The docotr explained that it was no emergency to have the surgery done right away and my son has not been having any pain in this leg but it frightens me that a screw has "broken". How does this happen? Is it normal? Was something done wrong in the surgery? He is going to have a surgery next month to correct it and have another screw inserted but I fear could this happen again. My son is only 12 and I don't want him to coninue having surgeries. I only planned for him to have one more and that was to remove the screws completely once the legs straightened. Please help in any way you can with advice.

      • jp:

        The forces within and carried by the skeleton are much greater than many expect. By comparison screws - even metal ones - are relatively weak. Therefore screw breakages. where there are repetative loads, are common. It is improbable that a surgical error was responsible.

  • Joy:

    My 8 year old son had a fracture to his arm about four months ago that required a rod to be placed in his bone in order to repair the radius. An iodized titanium rod was used and we are grateful that his arm healed well. The surgeon prefers to leave the rod in rather than subject my son to another surgery to remove it. If we opt for surgery, the surgeon would create a window in the bone in order to retrieve it. Our concerns are what the downside may be of the titanium rod ie titanium in the bloodstream, bone etc.... Thank you in advance for your opinion.

    • jp:

      There are disadvantages in leaving metal in growing children, discussed earlier. However a particular disadvantage in children is that it becomes progressively more difficult to remove this metal as the child ages. At four months (in an eight year old) the break will be soundly healed and removal should be relatively easy now. My own policy (usually, depending on site and condition) is to remove implants in children at your son’s age and stage of healing. Usually the metal should not be a problem in terms of erosion (many people claim to have titanium implants, whereas they are usually steel). But one does not know what the future will bring. A number of potential complications exist (see the relevant Page of this web-site). It is because of that unknown, and the long life ahead of a child, that I believe it a wise precaution to remove implants. That is what I would do if he were my son.

  • Mariano:

    Hi doctor. I broke my distal fibula 8 months ago landing badly while playing basketball. It was fixed with a plate and 8 screws. Im back to playing now since last month but sometimes i feel some discomfort and occasional pain in the talus and on the medial side. The medial side is still a lil bit swollen, range of motion is still not the same as the other, when i flex it downwards its like the end of the plate is pinching the talus. Would you suggest to have all the hardware removed?

  • theresa:

    I am a 44 year old woman. 14 years ago I broke my two bones in my leg (dont know the names) My ankle has a metal plate, 6 screws, and 2 pins. They have been in there for 14 years and has never bothered me. I have had them x rayed once in the 14 yrs and everything was fine. I also have been a runner off and on during these years.

  • Jessica:

    I broke my ulna in 2001 and had a plate and four screws put in with no complications. In the last two days I have experienced significant pain and now my arm is swollen near my scar. Should I be concerned?

  • Frank L:

    On April 14th I had surgery on my calcaneus (heel) after falling off a ladder. My surgeon placed 12 screws and a connecting ring for the repair. Now after 7 months the incision is still not completely closed and I experience significant pain when I am on my feet more than an hour per day. I still take 10mg of lortab 2 to 3 times per day just to stay comfortable and able to work productively. I have been on several oral antibiotic, 30 hyperbaric treatments with no significant improvement. The MRI showed significant arthritic activity but the bone is healed. The culture of the incision showed tatumella..not Staph or mrsa. Now the hyperbaric and the surgeon are recommending removal of the hardware.They feel the bacteria may be resident on the hardware. Do you feel in my case I will see improved results and how long before I will be able to walk normal, being able to work and on my feet 3-5 hours per day.

  • Heather:

    Hi Dr, I Im 21 and broke my right ankle (two fractures on the lower part of my fibular) in May this year when pushed into a swimming pool whilst working abroad in Spain. I had an operation and had a plate and 8 screws inserted, i was in a cast for 7 weeks. I returned to the uk after the first week and had follow up Dr appointments and the final appointment he said that in a years time i am to have the plate out as it will cause discomfort, but the decision is up to me whether i want it out or not. It causes very little discomfort to me the only thing i notice is when i bump my ankle it hurts more than if i where to bump my other ankle and it is slightly tender. I am wondering if i did decide to have the plate removed how long the healing time after would be, as i wouldn't like to miss anymore work (i work in a travel agents so not a lot of manual labour required) . Also would it be detrimental to leave it in as i don't particularly want another operation. i would really appreciate your advice.

    • jp:

      There is no urgency to remove the metal. Why not wait the year out and see?

    • S. Anderson:

      Hi, I broke my left ankle in 2 places back in 2008. I had one plate and 8 screws total. The hardware caused so much discomfort and occasional pain, that I had to have them removed. I couldn't even wear heals! I finally had them removed in May of this year and truly wonder why I waited so long. I have my flexibility back and my ankle feels "normal". It was the best decision I could have made. Good luck to you. I hope you decide to have them removed.

      • jp:

        The difference between your experience and Heather’s is that she has no discomfort (you did); she broke her ankle six months ago (yours three years ago). We do not know the differences in the types of breaks or the types of repairs. Your letter illustrates the danger of "quick fix", "yes or no", and binary types of homespun medical advice. A surgical procedure under anaesthesia is not without consequences and needs careful, and experienced, professional consideration. If things were to go wrong with Heather's surgery, and she was worse than before, she would not be thankful for that advice.

  • Susan:

    On 13Aug2011 I fell and broke the distal head off my radius. It was repaired with a plate and 5 screws. I am now 13 weeks post surgery and according to multiple radiographs and a CT scan the bone is healed. Since my surgery I have gone to PT 3-4 times per week and 4x's per day at home do exercises provide by the therapist. My range of motion is almost non-existant and every day I feel like I am starting over in my therapy attempts. My surgeon is perplexed on why my range of motion is not progressing much and the pain I experience when stretching my fingers and wrist. In the past two weeks I have noticed my legs were sore (nowhere near the soreness felt in my wrist/fingers) while in bed and while trying to rise after sitting for a few hours at a time....am wondering if the plate is causing my issues with my legs, ie some sort of reaction to the titanium plate and steel screws. Am thinking about having the plate/screws removed to see if there is an improvement in any of my conditions. What do you think?

    • jp:

      You do not say whether the plates were implanted on the palm side of the wrist or on the back of the wrist. It might be that your pain is originating from parallel damage to either the tendons or muscles supplying the fingers and wrists. This could include abrasion of the metal against the tendons. While I cannot say why you have pain in your legs, I can say that it is highly improbable that your leg pain is related to the implanted metal.

      • Susan:

        My plate is on the palm side, does that make a difference?

        • jp:

          Different sets of tendons are involved in the different types of surgery. Knowing where the surgery was placed will allow an understanding of whether the restrictions are associated with the surgery. Plates on the back of the hand tend to cause difficulty with straightening the fingers and lifting the wrist.

  • DaLee:

    I broke my fibula on my right ankle, the break is at the bottom of the fibula. I was in a cast non bearing weight for 7 weeks, moved into a walking boot and now I'm walking just with a cane and limp. X-rays have been taken and the fracture is not healing. My Dr. calls it delayed union, and is starting me with a bone stimulator. This is the last step and if the bone stimulator doesn't work my Dr. wants to do surgery meaning bone graft and plate with screws. I really don't want to do this. I've been doing some research on bone marrow injections for non union and think this may work for me. What is your experience about this injection and do you think trying this before any surgery is a good idea. Also, how would a plate even be placed where my fracture is at the very bottom just before the fibula ends. Thank you so much and your opinion is greatly appreciated.

  • Brandon Nguyen:

    Hi, I broke my tib and fib when I was fourteen and now I have a plate with 6 screws on my tib and 2 screws in my fib. It's been about 2 years since my fracture and I've been researching all this talk about removing these screws. There is no pain whatsoever when I play sports and such, but I'm afraid for the long term effects of these screws. Should I go see my doctor and take out the screws or should I just leave the screws in my ankle until pain occurs?

    • jp:

      Brandon. Apologies for the slow response. There probably is no need to remove these at present. There is no need to do something now to prevent something worse in the future, which is why you write.

  • Shahan:

    Hello Doctor, i am 21 and i fractured my humerus about 13 months ago which was then operated and a metal plate and 8 screws were inserted. i have normal movement and i feel no irritation at all exept for a slight pain when i exert force on the hand. today i met a friend who happens to be a doctor and he adviced me to get my plate andscrews removed ASAP as its harmful for my hand in the future and will cause a lot of damage to my nerves in the future.. i want to know that is it a good idea to remove them or its fine even to just leave them in and not remove them.i am really confused as i dont want to have a second surgery again.. thanks

    • jp:

      I think that your friend is being unduly dramatic. Many people go through life with plates on the humerus, without consequences. See the earlier posts on humeral fractures.

  • Hello! I am from the philippines.I broke my humerus may 29, 2010. A surgical operation last june 11, 2010 put a Plate and 6 screws on my arm.. These screws gave me discomfort particularly in moving.Sometimes I feel pain. According to my doctor, i should be thankful that the veins were not destroyed.. He further said that the plate and screws can be removed but I shoul take the risk.. I want these screws and plate to be removed.. I want to have a normal movement and a normal life but I'm afraid of the risk. please doctor i need your medical advice.

    • jp:

      When you were told "(You) should be thankful that the veins were not destroyed", I think the structure he was referring to was the radial nerve. The radial nerve is damaged periodically, but is not likely to be harmed by a competent surgeon. Your surgeon is clearly worried about adventuring in again, thankful that the nerve was not damaged by the first surgery. Perhaps you have reason to be cautious. It is unusual for a plate on the humerus to interfere with function. I suspect that there was other damage which is preventing normal function. I have doubts that removing the plate and screws alone will return you to normal. A precise diagnosis of the cause of your impairment is necessary, before considering this surgery.

  • Interesting post, thanks. About 9 years ago I shattered my olecranon in a motorcycle accident. They first tried a plate and Kirschner bands, but they failed. The surgeon then used a screw and bone chips. Unfortunately it never did knit. After 3 years he said it would need to be looked at again someday, but to see how it went. Then I moved back to Canada. Last week (on vacation, of course!) it suddenly got very swollen and painful so I'm going to have to have it looked at when I get home. I hope the hardware can come out. Your discussion is interesting background reading for when I finally get to meet with a specialist, anyway, so thanks!

  • mayen q:

    I had a compound fracture of my right femur back in 1996 due to a motorbike accident. I was 24 when i had the accident. I am 39 now. I have a rod and 7 screws. 3 screws at the top and 4 screws at the bottom. I have been starting to have pains from my hip down to the knee. My gp requested for a femur xray and only to find out the 3 screws at the top are broken, femur looks ok. I am still waiting to see an ortho surgeon about this but I am getting so anxious. Will i have to undergo surgery to remove the screws and rod? or do they just leave it since my femur seems to be ok and fracture has fully healed.

    • jp:

      I am reluctant to pre-empt your surgeon, who will read more detail into your x-rays. The screws probably broke years ago, and may not be related to your pain. If there was misalignment of your (now healed) femur, or if you injured you hip at the date of your accident, the pain might be originating in your hip joint.

  • Maria:

    Hi. I broke my fibula last march and fixed with a plate and 8 screws. Ive been wanting to have all the hardware out. Would you recommend to have it removed already? The bone is fused already. It bothers me when im playing, im always thinking of the risk of re-injury and the place of my foot when i move and land.

    • jp:

      Only you know how much the discomfort is intruding into your life. If this is marked then establish (with an orthopaedic surgeon) that it is the metal which is causing the problems (and not other sequelae of your accident). The ultimate decision will then become yours.

  • Katheryn:

    I'm s/p trimalleolar fracture with a plate, 8 screws and a kwire for syndesmosis on 6/17/11...I'm wanting all the hardware out and was wondering if you recommend getting a ct scan versus just another xray to ensure full bone healing prior to surgery. Also, any benefit to waiting a full year versus 6 months to remove hardware if bone is shown to be fully healed? My MD basically said to just let him know when I want it out. Appreciate any feedback you can give!

    • jp:

      Standard X-ray is sufficient to judge bone healing. You do not want to unnecessarily get the higher dose of X-rays which CT causes. If the bones are healed, radiologically, and you have waited six months, there is no benefit in waiting further if the metal is troublesome.

      • Katheryn:

        Thanks so much for your feedback...wondering if it's rare for an avid runner to return to running s/p trimalleolar fracture and hardware removal? As long as running doesn't hurt and you have good muscle strength/form, should one worry that the weightbearing/pounding from running could make the traumatic arthritis from the initial injury significantly worse over time? Also just a quick note supporting your advice on wearing elasticized stockings. I started wearing compression socks (below the knee) about 8 wks after my surgery and it's done wonders...minimal to no swelling even after standing at work 8 hrs. I definitely would have started wearing them right after surgery if I had read your posts!

  • Donna Mobbs:

    My husband is 41 broke his femur (spiral fracture) about 5 inches below hip about 4 wks ago, they put a rod that goes from hip to knee with screw just above knee and just below hip and what looks like a small rod or screw that goes over to pelvic to stablize it. He has a lot of pain where the screws are and he can not lift his leg yet, he still he to take a lot of pain meds and tires out easily and just doesn't feel well is this all normal with this kind of brake and surgery? Thanks for the work you are doing

    • jp:

      I imagine that the "small rod or screw" goes into the head of the femur - common practice to prevent rotation of the rod. Lifting the leg while in the lying position might be too adventurous at this stage. Ever wondered how much the leg weighs? If the wound is fully healed he will do well in a pool, ideally under physiotherapy guidance.

  • Melissa:

    I broke my wrist at the end of June and had surgery shortly after July 4th were a plate and 12 screws were put in I am concerned that myp hand is out of place to my arm and I still can't bend my wrist and have limited use of 3 fingers. Could this be due to the plate and bone not healing or am I just rushing recovery.

  • Gertrudes C. Artajo:

    Thank you doctor JP for your immediate reply. At least I know what to do. Yes its too early to think about it but if ever I really wanted the implant to be removed in the future is it safe for my bone or will it not be weaken and as far as I know the metal implanted is stainless not the expensive one I am afraid of its effect in the future. Having this age 41 will my age affect the bone healing or the strength of my bone once the plate and screws are remove? I know New Zealand has winter time which I did not experienced in the Philippines, is it true that the coldness of the place really affect my implanted leg? If that so what will I do during that time? As of now I don't have any idea on what to do. I hope your valuable advice can help me. Thank you and more power

    • jp:

      Removing the plate will not reduce the strength in your bones, but there is a transition period of about three months after the removal and before your full strength/safety returns. This is related, as much as anything, to the recovery to full, rapid and reflex function of the muscles. It is the muscles which play such an important part in guarding against and preventing re-injury by falls or awkward movements. There is every reason to think that you will be normal, if the bones have been correctly aligned. Stainless steel plates are the most common implants, and you have nothing to fear from these. You might get the "cold syndrome" in New Zealand, which is more of an ache than a pain. Simple analgesia will be all that is necessary.

  • Gertrudes C. Artajo:

    I'm so glad that I found this site as I am 41 and have fractures of my tibia 5 inches below the knee and slightly dislocated my knee joint due to a vehicular accident in August 14, 2011. A plate and 10 screws were implanted, one near my knee. I am now in full weight bearing and starting to walk a little. Most of the time I feel pain beside my knee and my leg is swelling. I can hear sound at the back of my knee is it normal? I asked my doctor about the idea of removing this screw when the bone healed completely and he told me that I should leave them here unless there is an infection but if I really wanted to remove it he will do it after a year depending on the x ray result. My doctor told me that it could be removed after I move to New Zealand but is it better that my doctor in the Philippines should remove it because he was the one who implanted it? Another question, I feel that my injured leg is a little shorter than the good one will it remain the same if the metal is removed? I am a teacher and I wanted to go back to my normal life can I still walk properly after the removal of this metal because as of now I can't walk normally and I am almost 3 months since I had a surgery.

    • jp:

      Removing implanted metal can be difficult and requires expertise. This you will find in New Zealand. There is usually not much advantage in asking the surgeon who performed the implant to remove it (There might be some exceptions, such as fractures of the humerus or proximal radius adjacent to the radial nerve). It would be wise to obtain a report from the implanting surgeon after asking whether he felt there were unusual or important factors to consider. If your limb is ANATOMICALLY short removing the metal will make no difference. However it might be FUNCTIONALLY short, for example if you are unable to straighten the knee fully. Correcting functional shortening might happen if the implant is the restricting factor. Three months is very early, in orthopaedic terms, and you should expect a convalescence of about a year following this injury.

  • April:

    My daughter had a Femoral Osteotomy 3 years ago due to hip dysplasia. We recenty went to the doctor for a followup visit and he said it may be a good idea to remove the Plate and seven screws from her hip. She is 13 years old. Is it a good idea to remove them or could it cause additional problems. Eventually she will need her hip replaced, so I hate to put her through this unless it will help in the longrun

    • jp:

      You daughter may still have some growth potential in the proximal femur, which might be restricted by the metal. There is also a risk of the metal becoming covered with bone, which could make delayed removal more destructive than necessary. It is common to remove the implants following proximal angulating femoral osteotomy in growing children.

  • Elena:

    I had a compound fracture of tib/fib 20 years ago. The hardware (a rod and four screws) was extremely painful. My leg was always very swollen and bruised. After some research (and nagging my surgeon) I found out that I was having an allergic reaction to the hardware. It was removed four months after the initial fixation and I haven't had any problems since. Four months ago, I fractured my femur. Again I have a rod and four screws but no allergic reaction. Instead, I have very localized pain at the site of the screws just above my knee. I REALLY want the screws removed as I feel they are preventing me from getting full range of motion in my knee (due to the pain ie a "soft stop"). My surgeon doesn't even want to discuss removal until one year after fixation so I went for a second and third opinion. Second opinion took CT scan and said bone density is good enough to remove screws. Third opinion took xrays and said to wait at least 2 months to decrease risk of re-fracture. Any thoughts and/or suggestions?

  • December of 2009, shattered lower femur and broke tibia plus humerus and bones in hand. Constant pain below knee and above knee, laterally. O.S. in Nashville said bone has healed well but two screws in knee area that may be part of chronic pain. Said he was discussing removal of hardware with other surgeon from teaching hospital who is familiar with my injuries. Also, my lower leg is now directed outward. O.S. says he could realign my leg, buy has never done this surgery on anyone with as much hardware as I have. When looking at x-rays, I am always amazed by the number of pins stacked over my knee....Frustrated and would prefer hardware removed if bone is healed. I feel it is causing problems with tendons and I'm not sure what else...

    • jp:

      "My lower leg is directed outward" I understand to mean that you have a "knock knee". Correct alignment in the long axis (and the rotation) of the limb is imperative to protect you knee (and ankle) from accelerated degenerative change. Such misalignment also interferes with balance and (at times) vertebral alignment. Therefore re-aligning the limb is the primary task ahead. To do this it will probably be necessary to remove some or all of the existing metal. Further metal (and perhaps bone graft) might well be necessary.

      • Thank you for your response. Yes, my O.S. mentioned having to remove the hardware, but not feeling sure he is confident about moving ahead with this surgery. The O.S. said the impact when walking is now directed towards my outer leg down through my step. I'm already struggling with balance. I will see him again on the 11th.

  • Patricia Fua:

    I had an ankle break 17 years ago treated with a plate and screws, and told me to never have them removed. I healed, and have gone through some of the screws wiggling in and out etc. which I have seen described here, also occasional swelling. I had one Dr. suggest removing it all, but I got scared and backed out. I don't have pain unless it is too cold. I am 57 and my ankle is usually fine. This summer I got sciatica with bad pain where my plate is on my outer ankle. It feels hot with some swelling. There is a small area, about the same size as the plate (right above it) which is not really swollen, but kind of raised and (swollen?) It is not puffy or red, and it doesn't hurt to touch. Can sciatica add problems to the metal implant,