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.
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.
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.
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.
The normal is consistent, and using the plate as a marker is not particularly helpful. The problem is that the normal anatomy is replaced or overlain by obscuring scar. 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.
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?
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.
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?
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.
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
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?
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.
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
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.
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.
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.
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!
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.
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!!
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.
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! :)
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.
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.
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.
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...
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?
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.
thank you for your help. Where are you located?. sincerelly Nick Zois
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.
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.
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....
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?
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
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.
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
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?
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
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.
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
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!
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.
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.
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.
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.
thanks for the reply, do you think that we should take out the metal rod or not?
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.
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
If the radiology indicates complete healing, removal of internal fixitives is usually safe.
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?
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
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
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.
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.
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 ?
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.
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.
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.
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.
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.
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.
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
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.
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
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
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.
The plate might have been cut intra-operatively. Let us know what your surgeon said !
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.
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.
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.
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.
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.
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
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.
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.
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".
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.
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
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.
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.
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.
Leighb. See earlier correspondence related to removal of fibula hardware.
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.
Walter. My personal preference is to get the joint moving immediately the metal is removed, using cycling swimming and walking. Please see other comments.
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.
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.
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
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.
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
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.
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.
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.
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.
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.
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.
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.
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.
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.
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!
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.
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?
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.
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?
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?
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….
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?
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)
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.
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.
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.
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.
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
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.
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?
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.
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!
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!
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.
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.
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
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?
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.
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
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.
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?
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.
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 !
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.
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.
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.
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.
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.
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!!
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.
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
I can email you the pictures from my x-rays. What is the email adress I need to send them to. Thank you, Letesha
Letesha Boner. There are many causes of heel pain. Perhaps you could send the x-rays along with those of your mother?
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
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?
Please see comment and reply, Lynette Coleman
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.
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.
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?
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.
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
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.
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.
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.
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?
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)
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.
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.
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
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.
**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!!
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.
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?
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.
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?
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...
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.
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).
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?
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.
Thank you very much indeed for your reply.
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?
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.
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.
Veronica. Six months is a rule of thumb. But is there any hurry, or good reason to have the metal removed?
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?
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.
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.
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.
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.
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.
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?
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.
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
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.
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?
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.
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?
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.
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 !
I would like to help if possible, but I need to know more about your mother. Please feel free to send the x-rays and existing reports.
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
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?
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.
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?
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.
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.
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
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.
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
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".
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?
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..
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.
To make any useful suggestion I would need to know why you had the osteotomy, where in the ulna, and where the "pop" occurs
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?
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.
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
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.
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.
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.
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.
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.
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.
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.
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.
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?
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.
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?
Unusual swelling anywhere in the body, whether related to the plate or not, should be investigated.
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.
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.
There is no urgency to remove the metal. Why not wait the year out and see?
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.
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.
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?
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.
My plate is on the palm side, does that make a difference?
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.
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.
Could you jpeg your x-ray?
DaLee. Bone grafting is conventional and has good results. Injecting various blood products has been used, but can be expensive and requires a fairly complex equipment set-up.
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?
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.
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
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.
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!
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.
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.
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.
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.
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!
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.
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!
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
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.
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.
It is difficult for me to say from a distance. Perhaps you could send the X-ray?
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
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.
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.
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.
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
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.
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...
"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.
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, or am I suffering two distinctly unrelated problems. I just don't know where to start in order to address the issue. I live where medical care is difficult.
Pain on the outside of the ankle can be caused by irritation of the sciatic nerve (sciatica), and could be coincidental to your having the plate. Similarly pain from the plate could mimic sciatic pain. While limping or a short limb can precipitate sciatica (which seems not to be the case here), there is no other relationship between these two distinct entities. You need an accurate diagnosis of the cause of your pain.
2 years ago I suffered a bimalleolar fracture. I have two screws on the tib side and a plate with 6 screws on the outside of the fib and two further screws through the bottom on that side. I have asked about removed due to the irritation, tenderness, heat & general nuisance they cause me, especially if I attempt any form of exercise. The consultant has told me that I will need to be on crutches for 6 weeks, the first two week requiring elevation of the ankle to prevent swelling. Having looked through some of your other queries on here I can't see anyone mentioning such a time frame - he has said I can put weight on it during the whole period however as long as I am careful. As I work in an office, I will need to make special arrangements for the first two weeks as I will not acheive the correct level of elevation (1 foot above heart level)with my leg under a desk. What is your opinion? Would a standard leg support ottoman be sufficient? I accept that the crutches will assist while the holes heal as I am 5 stones overweight.
An appropriately selected elasticized stocking (for some months) is probably all you will need to prevent swelling (see previous comments). Crutches (or walking sticks, which are less bulky) would be a sensible precaution, to assist balance. I would be astonished if you need crutch assistance for as long as six weeks.
I had an x-ray 9 weeks after having 4 screws put in to fix a broken 4th metacarpal shaft in my right hand, and the radiologist said that the most distal screw was broken but that it was still in the bone, and that the bone is still healing and the alignment is fine. The OT says I've had more swelling than usual, and I still have some now 11 weeks after my surgery. My range of motion is pretty good except that I have trouble moving my fingers separately - like to point or make a peace sign. I have also been getting some popping below my knuckle when I go the finger hyperextension exercise and sometimes in my wrist when I do the "prayer hands" stretch. I've been having some pain and more stiffness recently, especially after using the hand to write. The surgeon wants to see me in another 2-3 weeks to take another x-ray and check whether the screw has migrated, and I'm wondering what questions I should ask and what I can expect. Could the broken screw be what is causing the swelling? If it hasn't migrated, is it best to leave it in? If he takes it out, would he take out just the one or all of them? How concerned should I be about extra scar tissue? Will I be more likely to break it in the future, or will the bone be strong enough even with a broken screw in it? I decided to have the surgery instead of the cast because my surgeon said that it's what he would do, and I worry that I made the wrong decision. If there's a decision to make about this screw I really want to be prepared to make the right one.
It is surprising that the screw in a metacarpal has broken. You have had significant soft-tissue trauma, and the broken bone / screw might be the least of worries. The management of extensive hand injuries is complex, and I do not think you will serve yourself well by trying to engineer this management, or pre-empt the surgical decisions.
I am 56 years old and walk around 15 miles a day. I had an ORIF on my right ankle after a fall. The plate and screws are due to be removed 11 months and 2 weeks after being put in place. This is because of pain, swelling and the screw is sticking out under the skin. I have found it impossible to walk and recently I have had pain on the inside of the ankle. I and cannot wait to have the plate removed. I will update you when it has been removed.
Swelling often makes surgery more difficult, and possibly increases surgical complications. To reduce swelling I usually advise the wearing of an elasticised stocking prior to ankle surgery, and then replacing the stocking while the area is still anaesthetised, continuing the use for weeks (or longer) after surgery .
Two months ago I had plates and screws iinserted into the pelvis to reinforce my acetabulum and hold my ilium in place. Are these implants ever removed? The idea of having them removed is great (apart from the surgery!)
In order to break the bones of the pelvis significant force is required. Therefore the more vulnerable overlying and associated soft tissues are inevitably damaged. This damage heals by scar which can obscure and restrict the anatomy. Surgical access to the deep portions of the pelvis is difficult and usually requires extensive resection, with further scar deposit. Removal of implants into the pelvis is a significant procedure, adding yet more scar and should not to be undertaken lightly. For these reasons this metal is usually not removed.
I am a 66 year old active female, who walks a lot, inline skates and curls. Two and a half years ago I boke my ankle - got a plate and 7 screws in the fibula and a large screw in the tibia. The screws are poking out through the skin, prominent is how the surgeon decribes it. I am not in pain and never had pain since I recovered, but my ankle bothers me wearing boots sometimes and if the dogs hit my ankle. My OS said if it bothers me he will remove the hardware and I am scheduled to have surgery to remove the plate and screws in the fibula, but now I am questioning if I should have it done, do the benefits outway the risks. The OS did not advise either way, but I neglected to ask the risks of not having it done.
You ask about the risks of leaving ankle reconstruction metal in place. These are all relative risks, and there is usually no obligatory reason for removal. However complications can arise on occasion as discussed in the paper on this site. Protrusion of metal through the skin, improper surgical insertion with screw intrusion into the joint or tendon and infection associated with an implant usually demand prompt removal.
i broke the end of my fibula ski-ing 18mths ago and also dislocated muscles/ tendons in my leg bones and ankle. i had an Open reduction internal fixation procedure with a plate, 4 screws and a tightrope wire implanted to hold it all in place. I was non-weight bearing for 6 weeks and fully recovered but my surgeon recommeded the removal for 3 reasons: 1 osteoporosis, 2 the metal over many decades can start to corrode and 3 if i broke it again in a similar place it could have been very complicated. It wasnt causing me discomfort though every now and again i got a sensation that reminded me it was there. I had it removed last night and am a bit sore and tendor but pleased that I did as I can now go ski-ing again! I hope this post helps - I'm back to work on Monday, I have a little limp right now but expect to be more or less normal tomorrow (Sunday) and even better on Monday. Good luck to all.
Thank you for this reassurance to readers. Most have a relatively easy and stress free convalescence after removal of reconstructive hardware from the ankle. You had a “tightrope” instead of the “diastasis screw” which I mentioned earlier. One disadvantage of the “tightrope” is that it produces a lump under the skin on the inside of the ankle (medial aspect distal tibia), which can produce discomfort with high boots, notably ski-boots, and often demands removal for that reason..
What an interesting writing ! Compelling stories. I had a spinal fusion, C4,5,6. In Jan 2011. a spinal cage,( small, ROI-C.) All was going well, until July, I had sudden severe pain in the neck, went to Doc, X-Ray showed one of the titanium plates within the medical device cracked in half. No doubt in my mind, the cause of the pain. I am being told that it is not. I am very petite, healthy, have been very careful since surgery. No lifting, no activity, other than daily life chores. Still to this day, it is bad pain. I asked the doctor if he would consider explating ( not sure if this is the correct term) He said no. I am not comfortable going though life with a broken medical device in my spine. Any thoughts?
If the pain is still as severe, abd not lessening then you need a diagnosis of its cause. It is tempting to attribute this recent pain to the broken cage, but that assumption might not necessarily be the case. Should pain be the prime problem then your surgeon needs to investigate the cause of that pain with all the modalities at his disposal. Only once the site and cause is located can the appropriate management be initiated. On the other hand, if the problem is a sense of dissatisfaction that you have this broken device my earnest advice would be to leave well alone. Multiple spinal fusions have a higher complication rate, and removing a cage is more difficult (and hazardous) than putting it in. This is because the anatomical planes are distorted by the surgery and subsequent scar. The broken cage will be supported by your body’s healing capabilities in the form of scar deposition, and perhaps bone bridging. Finally: Assuming that there are no “neurological” or esophageal features, I would play this very slowly. Vertebral pain often resolves spontaneously, although it may take many months or more. In the interim non-specific analgesic management might tide you through satisfactorily.
Condition: Chronic lower back pain resulting from herniated disk and surgery in 1993 Lamonectomy only. Neck fracture in 2005 C6/7. Surgery in 2008. 2010 neck pain returned post surgery consistently increasing in severity until very extreme intolerable pain since June 2011. Right side fluid rushes persistent in the right ear and a flooding sensation into my right eye when laying down. My neck is broken again, severed from C 1to C 5 away from C 6 where the titanium plate is attached there is much degeneration above and below the titanium plate causing arthritic sensations. And worst of all there is a screw loose pushing against my esophagus making it life threatening. Severe and painful nerve and muscle spasms radiating into head, neck, arms and hands. Muscles weakening and engaged in atrophy and shortening especially my hands as they are always in pain and severe shooting pains stop me from all normal activities such as typing, opening food items, turning a door handle can stimulate severe pain. Daily headaches from the back of my neck up to the eyes, more severe on the right side causing me to wince/wink. Degenerative bone disease and inflammation throughout lumbar and cervical spine. Chronic burning sensation in both hips starting 8/09. Hip mis-alignment left side burning more severe than right. Right leg sciatica starting 3/11 extending down into the right leg calve muscle. These along with a cyst in my left inner knee cause me great difficulty in walking. It is a challenge to sit, stand, walk and talk and I have a promise of twelve screws and a whole new plate with a front and back neck surgery they will close me up and hope for the best. What is out there that I don't know about perhaps in other countries where I can do something radical??? I have international insurance and will go if I have to if there are alternate methods of stabilizing a neck.
I am sad to hear about these awful problems. The screw pressing on your esophagus should be removed as soon as the bone graft has united. Not only are these screws exceptionally uncomfortable, but they can abrade through the esophagus, a huge problem when it occurs. The pain on the points of your hips is likely a "gluteal bursitis". This is common in people with spinal pain. The good news is that it usually responds well to injections of cortisone, on to the point of focal pain on the greater trochanter. In the "chubby" I always use radiological control to position the needle, but it is otherwise a simple, safe, inexpensive and effective procedure. How much time do you spend in a swimming pool? My view is that this is vital to reinstating the balance and harmony of movement in the vertebrae - far better than trying to make the vertebrae a solid, fused mass. I will bet that much of your pain will be diminished by daily spells in (ideally warm) water. Take care, though, as with you back and neck problems you will need an attendant to be always in the water with you - it is easy for persons with limited neck movement to drown. I know so little about your injuries and the previous management that I cannot give you useful advice about centers of spinal excellence.
I'm a 30 year old female that fell on my right knee while taking a shower. Thinking i'd just sprained it i didn't go to the doctor right away and i had no insurance so i waited to see if it would heal on its own. after the fall in the shower i had zero stability and was wobbling and knee buckled on and off, but managed not to fall until i was getting in the car and forgot the knee was injured and put all my weight on the leg lost my balance falling backwards. I felt a rip or tear sensation like rope being stretched and giving away. 3 weeks after my fall I was told i ruptured my patella tendon and that i have it repaired. i elected not to have surgery and they warn me about making that decision. i was able to go back to that hospital, by that point i was 11 weeks and the dr's were approaching it as reconstruction using cadaver. they wouldn't know if my actual tendon could be salvaged until they went in. they salveged the original tendon and ii thought all was well until my 6 week checkup whrn the dr said i was not hitting the milestones. then they told me bad news that i would need another surgery because kneecap was riding too high up and that i was bending at 90 degrees too soon and the repair failed. i had the reconstruction 3 weeks ago and they put me in a cast for 2 weeks and now i'm in a hinged lock brace set at 30 degrees. i also am using a walker until my quad is strong enogh. at my 2 week checkup the dr told me the screws that i saw on my xray are permanent unless they give me problems. my question is they told me before this second surgery that i will need a lot of therapy and recovery will be longer. is that because of the cadaver is in there? also will i have to wear some sort of brace for the rest of my life. will i always have problems with instability? i'm scared i will not be able to do zumba,run on beach ever again. i should add that this sugery was way more painful afterwards than my first sugery and the doctor said that its because there was bone work done this time where they drilled holes in my leg so they can put the allograft bone tendon thru. The thing that confused me is that the dr said that the cadaver healing and the tendon healing time are two different things. what, i thought that the allograft is my new tendon so how are they separate? don't they just remove the damaged/original tendon?
Your question centers about the healing time for the cadaver allograph. That transplanted tendon was dead when implanted, and therefore without nutrient blood vessels. Blood vessels will now need to grow into it and vitalize it - a long, slow process in the dense, hard structure which is a patella tendon. Your original tendon, on the other hand will have been living and containing a blood supply in both of the separated parts.
I am 26 year old male. I had a tib fib fracture on 25 July in a motorcycle accident. Surgery to repair break took place on the 2nd of August. On sept 11th visit to Dr was told all healing well and I could put wieght on it. Today I went to Dr. I anticipated a surgery date to remove screws(stabilzing tib/fib) as this is what I was told initially . In PT last week something felt wrong so I stopped uuntil I was to see Dr. Was told today that screws are broken! I feel discomfort upon any movement of the ankle (walking). As the procedure to remove them was explained to me, it sounded really bad. I want them out because I can feel them "scrapping around". My question is: Is the Trauma to my leg to remove the screws(ie boring larger holes through the bone) going to cause a bigger problem? I'm young, and prior to this accident was very active. Is there anything you can tell me to help me make the decision either way?
Removing broken screws often requires a "boring", which means that a hollow drill bit is place to cut around the screw. It does enlarge the hole made originally for the screw, but not by much - I would guess about a 25% increase in the cross-sectional area of the original hole. The convalescence follows that of removing a screw which has not broken, usually immediate weight-bearing (perhaps assisted by a crutch for a week or so). There is no reason why you should not eventually return to all your previous activities
Dear JP, Thank you for providing orthopedic surgery advices to the public. I had also met an accident trauma before 3 years resulting in a minor fracture on the right ulna. At the injury spot there was only a cracking line (means the bone was not broken and detached fully), but in the course of surgery the system of ' Plate and screw' was applied. At that time the doctor had told me two options. (1) It can be cured by medicine itself, but substantial time will take (2) Through surgery as above for safety and early cure. However, I had opted for surgery in view of safety and early recovery. One plate fixed with seven screws are seen in the x-ray. Now, the problem is that now after three years, at the extreme bottom corner of the plate there has swelling and pain, especially in the night. Shall I have to remove the plate and screws ? Meanwhile, I do not hesitate to remain them there as a security measure. Is there any chance to have the bone strengthless if the hardwares are removed ? I am waiting for your valuable advice and suggestion. JAYARAJ,
After your long convalescence, and given the type of injury, it is probable that the ulna has healed entirely. Retaining the plate longer will not enhance the healing more. The swelling gives cause for concern, and you should seek information from an orthopaedic surgeon in relation to having the metal removed now.
As advised I contacted the Orthopedic surgeon on 11 October 2011. X-rays were taken. No fault is found in the bone or the hardwares. He prescribed ‘Hifenac-P’ and ‘Rantac-150’ for 5 days. 90 percent swelling reduced. At the second visit, he prescribed the tab ‘Meftal Forte 10 Nos: To take only if there has pain and recommended for removal of the plate and screws. As the swelling and pain was minor I had taken above ‘Meftal Forte’ at 3 or 4 occasions only within these 3 weeks, just to check the result of the medicine. But above tablet has not made any difference; remaining swelling and pain is still persisted. At some occasion the swelling is reduced even to 5 percent and without any reason or in cloudy atmosphere it increases to 10 percent. However, I think, it would be better to remove the hardwares now. Before that, I seek your valuable advices for my following queries: 1) There is no fault observed in the X-ray. Then what might be the reason for the existing swelling and pain? 2) Shall I have to remove the hardwares immediately ? OR Shall I continue with the existing position for a fortnight ? (because some unavoidable circumstance compels me to wait till then). 3) A part of my profession is Artistical, hence I am more concerned about my ‘right hand’. Is there any chance of infection or nerve damage at the time of removal of the Hardwares ? 4) All the eight screws were protruded (since the physiotherapy before 3 years) and its positions are clearly visible under the skin(except the 2 screws at the swelled area). Is the removal easy ? What would be the method of removal ? Again a surface surgery is required ? Dr. JP, really your advices are very helpful to the sufferers like me.
You raise important points which are answered in the post, Post Surgical Swelling of the Lower Limb.
Hello, I am 45 and had a screw implanted on the inside of my broken ankle thirty years ago. If I can remember correctly, the doctor wanted to remove it about six months after the break, but I never had it done. Other than being very ugly, the ankle works fine though at times I have some pain. I do have a concern though. Is there any chance that this screw will oxidize with time and could this degradation cause a iron overload in my body, throwing it into conditions simulating hemochromatosis. Though I am very active, I have had minor version of unspecified symptoms throughout my life. Is this a possibility?
Iron (in various chemical forms) is an essential component of human physiology, with sophisticated mechanism of regulation and adjustment to the dietary intake, and various forms of loss. The alloys used, even thirty years ago, were biologically stable, and unlikely to degrade to the extent of producing an iron overload. The greatest concerns are when screws are used to secure plates. The micro-movement between the two metals can produce micro-metallic debris. This fine powder can produce the reactive phenomenon, "metallosis". I first began to research this in the 1970s, measuring the blood level of chromium, cobalt and molybdenum, which I demonstrated to be abnormally high in individuals who received the Mackie-Farrah “metal on metal” hips, vogue at that date. One uncommon result is an adverse soft tissue reaction. This has come to the fore recently as a serious sequel to modern “metal on metal” hip joint replacements. Here are two of many lay press reports. http://www.nytimes.com/2011/09/16/health/16hip.html?src=me&ref=general http://www.msnbc.msn.com/id/3032619//vp/44778264#18665061 This cannot, of course, occur where the screw is implanted without contacting other metal. There is the outside possibility that you might have haemachromatosis as a genetic defect, and if you feel that your symptoms warrant it, laboratory studies of your iron metabolism might be justified.
First of all, great blog. Having had ORIF surgery 7 days ago, I have been scouring the web to find more information about the surgery and recovery. It has made me realise that I have been given relatively little information about my operation and the next steps. My fibula was fractured, ankle diplaced and ligament torn (dr. identified the tear via xray and by pressing the inside ankle bone (deltoid ligament?)) after a late football tackle 11 days ago. I was admitted to hospital 8 days ago and discharged yesterday. The ankle is still fairly swollen so am applying RICE and I have an appointment in 4 days time to review the swelling and mobility with a view to applying a 6 week cast. First of all, I have had a 6 inch plate inserted and would like to know when do you think is the optimum time to have this removed? Up until this point, they have not mentioned removal so I am not sure if they want to leave it in, but I want to get back to football as soon as possible and from the comments above I think that leaving the plate would dramatically increase the likelihood of another fracture, not to mention potential issues down the line. With regards to screws, I believe there is one holding the displaced bones together and I guess there would be a few fixing the plate to the bone. Would you recommend these all come out as well and how likely is it that the holes will heal? Secondly, what recovery time would you expect for a) the initial damage (have been told ligament will take around 6 months?) - time to walk unaided/run/play football and b) removal of plate? Also, I hardly got out of bed in the past week, with my leg elevated above my heart at all times. Now I'm home, I need to move around a lot more (including up and down stairs). Every time my leg comes down I feel a sudden rush of blood to my ankle causing a lot of pain. Is this normal? And should I bring the leg down at times throughout the day to allow circulation, or should that only be the case once the swelling subsides and the ankle is in plaster? The surgery took place even though my ankle was still very swollen and I'm concerned thist has affected my recovery. In terms of pain relief, I was prescribed morphine, tramadol, ibruprofen and paracetamol. I stopped taking the morphine after 1 day. And the tramadol 2 days ago. I have taken nothing for 36 hours as the pain isn't excessive unless my leg is down. Would you recommend taking ibruprofen though to reduce inflammation? I am a 29 yo male, semi-professional footballer and full-time accountant, with no medical history, except ankle twists and sprains (and one potential ankle hairline fracture 5 years ago). I can't/don't want to take time off work but i can work from home/hospital as I did last week.
Your letter which has been left unedited because it demonstrates some of the complexities of this injury. At times I hear a by-stander say "Oh, it was just a broken ankle". Not so. These injuries are massive intrusions into function, have dangers and require long convalescence. It is not an injury to be taken lightly. However the plus is that over the recent half century surgical management has evolved significantly and has been honed to give excellent prospects of full functional recovery. But the dangers and uncertainty remain underlying the surgical management and need constant vigilance. Leaving the plate in place does not dramatically increase the risks of fracture, which is not inevitable or even most likely. But on a percentage basis the risk increases. The plate often interferes with various soft tissue functions (tendon movement and the cold syndrome, for example) which justify removal often. The screw which you say is "holding the bones together" might be a "diastasis screw" between the tibia and fibula. These screws, necessary during early healing, invariably break after weight bearing commences. It is therefore advisable to have it/them removed after about six weeks. By an extension of that logic when I remove the steel screw it is often replaced with an absorbable screw. This refinement has not been demonstrated to be essential, but I do it on the basis of a "belt and braces" precaution. The rest of the screws and the plate should be left until union of the bone fragments is verified radiologically. It is not unusual to leave the metal in for six to twelve months. It is not possible to put a precise time frame on return to walking (see earlier posts) but many are weight-bearing at between eight and twelve weeks. Returning to football would need a "transition period" after initial weight bearing, then incremental increase of activity from walking to cycling to mixed walking and jogging, then running with sudden stopping and turning This is the most important discipline which you must impose on yourself, perhaps with physiotherapy / biokineticist guidance. Give yourself at least six months of this before returning to running / contact sports. The "rush of blood" feeling is common. This, and the swelling, should be managed with a below knee elasticized stocking. My practice is to use a stocking from the moment of surgery, whilst the patient is still anaesthetized. I suggest that this stocking is applied when your cast is changed. Anti-inflammatory drugs will not speed you healing, and may have adverse effects on healing. I would stop them forthwith and analgesics as soon as possible.
I am a 49 yr old female in otherwise good health and dealing with rheumatoid arthritis since age 2. I had joint fusion of the rt ankle on 9/6/11 and at two week visit one of the screws at the ankle was protuding at the heel. Attempts to insert it further failed and it was removed. I am concerned , will the one screw suffice in positive ankle fusion? I have a plate in lower leg with 2 screws. I had no bone graft at ankle just the plate and screws.
I am sorry that you have had this dreadful illness, for so long. It is always difficult to make this kind of judgment from a distance. Such judgments in orthopaedic surgery cannot be made on a "tick-box" basis, and cannot be reduced to a linear, arithmetic scale. Many variables need to be factored into the equation used to produce the final "yes" or "know" answer. The ability to make these judgments is one reason why the formal training of an orthopaedic surgeon takes 15 or more years. If your surgeon was content to remove the screw, then it is reasonable to assume he is content that it was safe to do so.
I had ACL reconstruction as well as PCL, and MCL repair in 7/2009. I had a meniscal repair in 2/2010. In December of 2010 I began to have unbelievable pains shooting up the front of my thigh. I had an MRI done that confirmed that an Internal non metallic fixture had backed out of my femur and snapped into 3 pieces. Arthroscopic surgery was done in 1/2011 to retrieve the pieces. The pieces were unable to be located. I was told that we would just monitor the situation. My surgeon stated that he was unsure of the situation given the fact that this had never happened to any of his patients before. Well, we monitored and the pain began to increase again. A MR Arthrograph was done and this time confirmed that 2 of the 3 pieces had not moved, but that the third piece had moved and was near the iliotibial band. Surgery is now set up for 2 weeks from now to debried and locate this fixture. My question is, have you ever heard of this happening? I can not find any information on the web and my concerns at this point are if these are absorbable in the bone, what is the rate of breakdown outside of the bone, i believe that my surgeon is only planning on removing the one piece that keeps moving, should I ask about removing all the pieces? I am at a loss at this point.
The rate of resorbtion depends upon the material of the device. Can you give me a manufacture's name? In terms of first principles all three fragments should at least be visualized at arthroscopy, and removed if practical. What might be "fixed" at one time might well become free later. Surgery always represents a considerable investment in terms of cost, pain, disability and risk. Any surgical event must therefore be maximally utilized, rather than repeated.
I hope this gets answered. I broke my ankle Feb. 3 2010. The talus was dislocated with respect to the distal articular surface of the right tibia. Acute comminuted fracture of the distal fibular metaphysis with moderate posterior and lateral displacement of the major distal fragment. Acute fx of posterior malleolus of distal fibula with moderate posterior displacement of the distal fragment. Plate and 7 screws. Now having pain, was re-x-rayed and it shows plate broke at a screw hole where there was no screw. I believe at this point hardware needs removed. Do plates actually break that easily? And how long is recovery time after removal of hardware? I do worry now about weakened bone but I think I have no option.
The loads on the lower limbs are huge, as demonstrated by the broken plate. If the plate is definitely the cause of your pain, removal is warranted. Healing times are addressed in other comments.
Thank you so much for sharing your knowledge with us. I'm skeptical of the idea that hardware should not be removed because the fracture might become unstable. I’m am a 27 years old male and endured a left tibial spiral fracture on May 28th, 2011. This was from a dirt bike accident which caused multiple fractures about 4 inches above my ankle. After a two week delay on the surgery the surgeon installed a distal tibia plate with 14 screws. The end of the plate is at the edge of the tibia near my ankle. It’s three months now and the bone has only started to heal on the left of the tibia. The plate side of the bone has yet started to close the gaps. The surgeon said I need to start walking without crutches and prescribed electronic stimulation therapy. I hope to see progress in the next x-ray, a few weeks away. I hate the idea of keeping this plate in for the rest of my life, but everyone I talk to recommends this because of the type of fracture I sustained. I’m already feeling an amount of discomfort near my ankle. Aside from all the other complications of hardware, I also fear the top end of the plate will create a weak point in the bone’s integrity. If the fracture has been healed with compact bone and completed the remodeling phase, wouldn’t it be ok to remove the plate even in my situation? Are certain fractures considered more unstable even after they are healed? I need piece of mind that if the plate stays in after my bone is healed (hopefully), it’s because the odds are in favor of it.
You are fortunate that there was that two week delay. Fractured ankles do much better if left for the swelling to go down, before surgery. [There is an irrational group which says "The surgery needs to be performed immediately, before swelling occurs". The swelling caused by the injury is going to occur regardless, and it is foolish to superimpose the swelling which surgery will cause, therefore maximising the swelling when it is at its most severe.] I seldom operate on smashed ankles earlier than two weeks - see earlier comments. The rate of healing varies with the type of damage, and in your case between six and twelve months to full union would not be unexpected (especially if a bone graft is needed). The fact that healing is now demonstrated on x-ray is a most optimistic sign. Bone is either fully healed or not - It is exceptionally rare for a partial union to be managed by relying of permanent metal support. Therefore your ankle will not be "unstable" once the healing is complete. At that date the metal could safely be removed, particularly if it is causing symptoms.
The fracture was on my left tibia but I assume the same concept follows. I'll follow up on here once the bone is healed in hopes of helping others.
I can't really understand some of the medical terms used here so I apologize if my question was already answered. December of 2008 I got into a car accident and broke my right leg and ankle. Once at the hospital my doctor told me I had a hairline fracture in my leg and that I had shattered my ankle in four places. The fracture healed really well but I had to wait a week to have surgery for my ankle. Two screws were placed to help stabilize my ankle and the fracture was left to its own devices considering healing. That was now almost three years ago and my ankle still bothers me everyday. I can't play soccer anymore because my running is so messed up, and alot of times after sitting or sleeping I have to limp to walk. The area is still inflamed and puffy, and at times gets really hot. There are even days when I can barely walk on it. However since I am a bit of a heavier girl, I worry about the surgery and if my ankle would be able to support itself after the screws were taken out. ( I am working on losing weight now but I still worry.) During the follow ups to my surgery the doctor said I could have the screws taken out when ready but I said I might as well leave them in since I didn't think they would bother me. Less surgery is always better you know? Well since the ankle is still bothering me, I was wondering if I should have them taken out? I was only 16 at the time and just recently turned 20, so thankfully my body should still be good with healing. However I'm worried about the holes that would be left over from the removal. Would they heal properly or would the surrounding bone get stronger to compensate? Also if I may, since I am a college student with only school health insurance, I can't help but worry about the cost of such a procedure as well. Since I wouldn't be coming to you personally I'm not sure if you can offer any precise insight but I couldn't help but ask. I apologize for asking so many questions but honestly this site seems to be getting the best and most thought answers. For any answers and information, I would be extremely grateful. Thank you.
The periodic signs of inflammation (redness, puffiness and heat) are a concern, as they might reflect a low grade infection. For that reason alone removing the screws is probably justified. You should not worry about the holes left after removal, since the bone is as weak with the screws in as with them out (remember the earlier post, describing a bamboo upon which a plate was screwed? Where would it break if subjected to stress?) Where high energy causes damage to bone the intervening and overlying (and much more vulnerable) soft tissues are invariably also damaged. These include the "machinery" about the bone and joints, the real functional mechanisms. Flowing from that concept it seems probable that the stiffness you have after being immobile is probably due to damage to the tendons which should move readily past the ankle. These often adhere when tethered by scar (or an inappropriately placed screw). A good clinician would be able to make a precise diagnosis of any impeding soft tissue, far better than I can from a distance. Real-time ultrasound examination of the tendons will enhance the clinical diagnostics.
I want to thank you for your response :) And I do remember that post, it was really helpful in calming some of my worries. I went to my local doctor yesterday and he took x-rays and said that the area was significantly inflamed, however that there was no infection. He placed me on crutches for a week until I am able to get an adequate brace that wouldn't put pressure on the ankle where it hurts.(Around the incision scar) He also placed me on Indomethacin 25mg to help get rid of the inflammation. He recommended that I try physical therapy after everything subsides and that it would be a good idea to talk to a surgeon back home about removing the screws. I'll be getting a record of the x-rays Monday, but from what he said, thankfully there wasn't too terribly a lot of scar tissue. However they didn't look at the tendons, and with what you've said, I think an examination of them could prove to see what I can do to help the stiffness. I know that the area where my scar is from the surgery is numb, which I would suspect is from nerves being severed. I had figured the tendons would ease themselves back to normal after the bone healed. IF I did have the screws removed, how long I would be unable to use the ankle? I know the ankle isn't the easiest place to heal since it's so far from the heart, but since I am a college student this surgery, if it happens, would be best over a break. Again I really appreciate you replying. I may be young still, but it helps to know that someone out there is genuinely trying to help those with questions and concerns! :)
It is difficult to exclude infection, and I recommend "prophylactic" screw removal when convenient. There is no point in using antibiotics unless the screws are removed. Even following screw removal (with samples taken for bacterial studies) washing the wounds at surgery might be sufficient to avoid using antibiotics. It is true that tendons can work themselves free from scar-adhesions, but this is not always so. I suggest real-time ultrasound examination of the movement of the tendons. After removal of the screws it should be possible for you to walk the same day, or within a few days (possible assisted by a crutch). I have reservations about "supportive boots". These can be expensive, awkward, and often of little benefit.
It is difficult to exclude infection, and a high index of suspicion about a low grade infection continues in my mind. "Prophylactic" removal of the screws would be wise, before any potential infection spreads. There would be no value in taking antibiotics until the screws are removed, and even then removing the screws, taking samples for bacteria and washing the wounds without antibiotics might be sufficient. You are correct the tendons, at times, free themselves from scar-adhesions, but not always. An ultrasound examination when you get home is recommended.
I figured I would let you know the findings of my x-ray from last Monday. Maybe that can help :) * Patient status post remain fixation of the medial malleous there is no lucency around the screws to suggest loosening or infection. Remote healed distal fibular fracture. No definite acute fracture or dislocation. There is medial malleolar soft tissue swelling. Lucency through the base of the fifth metatarsal could reflect remote fracture as it appears corticated. Impression: No definite acute fracture. Remote distal fracture, suspect remote fifth metatarsal fracture, and postoperative change to the medial malleolus.
The "lucencies" which may indicate bone infection develop relatively late, and infection is usually established by the time these appear. Therefore these X-rays do not exclude infection associated with your metal implants. The soft tissue swelling, reported to over the medial malleolus (inside ankle knuckle) might well indicate soft tissue infection.
My wife had an osteotomy 5 months ago below her left knee to straighten her leg and take pressure off a deteriorating knee joint. She now has a L-plate and 3 screws on the left of the of the kneecap. Will the plate pains subside? Is this hardware removable because of the location? If so, when would be the earliest?
It is likely that your wife had/has early osteoarthritis of the knee with associated pain. Therefore what you term "plate pain" might be an expression of the osteoarthritis, or other types of knee pain which reflecting changes which could follow this type of surgery. Said another way it should not be readily assumed that the plates are the cause of the pain. High tibial osteotomies - an excellent procedure when correctly applied - usually heal promptly and, if there is radiological evidence of bone union, removal after six months will be safe.
I am writing from Nigeria. Sustained a transverse fracture of the midshaft of the left Humerus on the 22 February, 2010 and had a corrective surgery on the 25 Feb, 2010. But ever since the surgery, my hand hasnt healed and from a scan it was noticed that screw and plates were not used, instead the bones were tied to a plate with wires. Is there any danger in this situation? And since I wish to correct the mistake, can you advice me on the best hospital in the US.
It is unusual for circlage wires to be used in transverse fractures of the humerus, unless the bone was also split axially. There might be a number of reasons why the bone is not uniting, including low grade infection. Do you have sickle cell anaemia? Do you take folic acid? Before searching for treatment in the United States, can I suggest that you contact Dr. H. C. Nwadiaro, Department of Surgery, Jos University Teaching Hospital, P. M. B. 2076, Jos, Nigeria? He has experience of non-union and other bone complications associated with infections and haematological abnormalities.
Thank you for your reply, but you may wish to know that the wires were used because, while the sugery was going on the surgeon realised the machine to push the screws into place were not available, as such used the wires to hold the bone together. You may not understand my decision, but if I was ready for another sugery in Nigeria, would have done that over a year ago. Delayed this long so I can afford a corrective surgery in the US (Dont want to take chances anymore). Shall appreciate a a contact for a dependable orthopaedic surgeon or hospital in the US. Shall also be glad to send you a copy of one of my several xrays to give you a better understanding of my case.
You may not have understood what was behind my comment. Your problem is not the lack of screws. Your problem will not necessarily be solved by inserting screws. Your problem is a delayed union. This is a biological, not a mechanical deficit. It is not unusual to treat transverse fractures of the humerus without any surgical intervention. Until relatively recently the standard treatment was to simply support the limb in a sling, and wait for the bone to unite, which they almost always did.. Therefore the question must revert to asking why you have a delayed union. Is it a low grade infection? Are the fragments being held apart by imposition of soft tissue? (It is unlikely that the bones would be held apart by the plate or circlage wires, which usually loosen fairly rapidly) Is this a manifestation of Sickle Cell disease? The latter is the reason why I suggested the surgeon in Jos, who has experience of your complication in the Nigerian context. Should you go the the United States you might end up in an institution which has very little experience of Sickle Cell pathology, or other pathologies related to the Nigerian context. Not all orthopaedics in the US is of a supreme quality. A good general rule is that it is far better to be treated in or near one's home town, for a variety of reasons, which deserves an essay in its own right. Please send your X-rays.
It's wonderful that you are answering questions on here. I really appreciate all your unpaid work!! I had a unicameral bone cyst in my femoral neck a year ago (I was 29) a pin and plate implant was put into my femoral neck. The xrays look perfect. It's been a year and I have really severe pain from my back to my groin. I had a ct scan which looks perfect. I was worried about AVN, because my pain feels exactly as AVN is described, but everything looks perfect still. I know this is probably not the right place for my query but you seem helpful and was hoping you could suggest something. I've been told it's chronic pain. What do you would suggest?
Avascular necrosis may be present but not show on CT more than a year after onset. MRI would offer the definitive diagnosis, because it demonstrates the "physiology", including the blood supply and oedema (which CT does not). "Chronic pain" is not a diagnosis, and seems a way of brushing aside your question. The source of your pain could be from multiple causes, including gynaecological, abdominal and vertebral problems (unrelated to the cyst). Are your legs the same length? (This is not as easy to determine as it might seem) Beyond that, from a distance, I am sorry that I cannot be more helpful.
Hello, My 8 year-old son fractured his femur when he was 6 from slipping and falling off a hayloft. Flexible nails were inserted in his femur. He recovered well, but four months later, he re-fractured his femur in the same spot when he jumped off a coffee table. They removed the nails and put in a metal plate with screws. Again he healed, and on August 3 (a little over a year later), they removed the plate and screws. We go back to the surgeon on September 15 (six weeks post-op), who has informed us that at that point our son will be able to go back to his normal activities. Currently he is restricted from running, jumping and climbing. Does this seem like enough time for the screw holes to fill in? Will the femur still be weakened where the screw holes are/were? What is an appropriate level of activity six weeks post-op, considering this was a re-fracture? We are fearful that if he runs into another kid on the playground or gets pushed, etc. in normal play, this could happen again. Should he be able to play sports such as tennis or golf at 6 weeks post-op or should we continue to restrict him until some further point?
The second break might not be surprising, since the presence of the intra-medullary nail is likely to have depleted mineral in the femur. Sliding nails are not as resistant to bending as the others. He probably bent the sliding nail, which is why it was removed. The strength of a limb (read that as resistance to injury) depends upon far more than the strength of the bone. Resistance to injury implies strong, fast reacting muscles, proprioceptive sensors with rapid triggering, and pre-existing "fail safe strategies" hard wired into reflex reactions. See an earlier post. Inherent bone weakness must be considered, as there are many occult conditions which weaken bone, even in a growing boy. These should be considered and perhaps investigated. My practice would be to advise against contact and rapid reaction sports (such as tennis; squash) for at least six months. However exercise should be encouraged - swimming is safest, followed by walking progressing to running. Exercise cycle work is good, but it is unlikely that you will be able to persuade him to overcome the boredom (even with an I-pod). He should be safe after a year to begin football and the rest.
I broke my tibia, fibula in 3 places around the ankle in Feb 2011 playing rugby. A 6" plate was put on the outside of my ankle fixed by 5 screws, and then 2 screws on the inner side of my ankle. They protrude and when I wear rugby boots one of the pins rubs on my boot. The surgeon says I must wait 6 months for a full bone recovery before they can be taken out. The 6 months is now up I wonder how long it takes before I can get back to contact or impact sport after screw removal? Do I have to go back onto crutches? I have been able to run and jump despite the screws, but I am keen to have them taken out.
You seem to have had a medial malleolar fracture with a spiral fracture of the fibula. These injuries can vary in severity and degrees of displacement / dislocation. However, in most a sound union occurs by six months and your activities seem to proclaim this. You have sufficient reason to remove the screw, and I suggest that all the metal is removed at that date. A necessary caution is to build slowly up to the point of return to rugby. This means a progression of jogging to sprinting then sprinting and changing direction by side-stepping and also reversing the direction of the sprint. A counsel of perfection would be to spread this build-up over a further six months. Many go back to limited training with their team but not playing during this time. You should not need crutches after the removal of the metal.
I broke my elbow almost a year ago and I am having the hardware removed this month. Do you have any recommendations for vitamins, foods etc. for healing post-recovery? Also, I am currently missing about 15 degrees and am unable to fully straighten my arm -- what is the likelihood of my gaining some degrees post surgery even if the hardware was not obstructing anything in the first place? I am nervous about the surgery.
One of the purposes of this web-site is to illustrate that reconstructive orthopaedics is never a single, reproducible "item". It is very different to "replacing the condenser in the 'fridge". This is because what might be regarded as a single, obvious and self evident term like "I broke my elbow" is far more complex than that. There are many ways in which the "elbow" can be broken, and many different strategies used in the repair. Thus the break of the olecranon is treated very differently to a supra-condylar fracture, a fracture of the capitellum or an epicondyle. My intention is not to "blind with science" or "confuse with terminology" but to emphasise that the terms used in anatomy and surgery are only many and complex because of the necessity to be unequivocally specific in terminology. Other factors which must be written into the management equation include the youth or age of the victim, occupation, dominant limb, other illnesses, surgeon experience and so forth. Therefore I cannot accurately answer your question, without knowing a great deal more. X-rays are useful tools, but often deceptive, and some of the interpretation lies in the mind or the interpreter. I have discussed healing and attempts to promote healing in other posts. However if there were a single means of accelerating healing, you would know about it already from the Readers Digest, and similar. You could not go wrong with most reputable propriety vitamin and mineral combinations, plus the addition vitamin D produced by daily exposure (15 to 30 minutes) to sunshine. Some loss of range of movement of the elbow is common with injuries in the precincts of the elbow, and is often irresolvable. Fortunately some loss of straightening is seldom a handicap - look around you...how many people are fully straightening their elbows?
Thank goodness for this site!! I am currently healing from my 3rd surgery to fuse some bones in my first toe joint. The first didn't work because the bones produced a non-union, so high doses of vitamin D and be on my way. The 2nd surgery didn't work because of a second non-union, so fuse further up the toe, now 3 joints are "fused" with screws. The 3rd surgery seems to be the keeper. Although, upon opening the site for the 3rd surgery, my Dr. noticed that 2/3 of the screws used from the first 2 surgeries were broken!! I had asked my first doctor, over the course of MANY months, why I still hurt. His reply, "It should not hurt, it's in your head." Please help!!
I am sorry that you have had this rough passage. I cannot be certain what was the aim of your surgeon. Please tell me more about the original pain which justified these surgeries. Can you send the x-ray as a jpg/jpeg?
I broke both my legs after being hit by a car when i was 13. My right leg healed well, but the breaks to the tibia and fibula in left leg hadn't healed after 6 weeks in a cast so my surgeon operated to plate and pin the bones. I remember asking whether they would ever be removed and was told they would have to stay in permanently because the bone hadnt healed. After the surgery everything was fine, I could run and jump onto the leg without any pain, although if I pressed on the bone through the leg it was EXTREMELY painful and cold weather caused problems. After about ten years it got to the point where I avoided weight bearing fully on that leg because of the discomfort. I am 40 years old now, and the plates have been in for nearly 27 years. Things have pretty much stayed the same since although I occasionally get soreness along the bone as well. This leg also has considerably less muscle than my right leg. I had always assumed that the discomfort was just something I had to put up with. I would welcome your opinion on this.
Your questions require lateral thought. The commonest cause of a "non-union" of a long bone is an injury to the blood supply. That there was no “inherent" (for that read "unknown") cause of the left “non-union” is illustrated by the prompt healing on the right. Therefore assume that the blood supply of your left leg was damaged by the accident. That is why the leg is thinner, reflecting damage to the muscles: Is the left foot smaller? Flowing from that is an important consideration, now that you are 40; is the left leg shorter? If so it might predispose you to accelerated degeneration in the vertebrae and back pain. Now to the cause of your leg discomfort: Damage to muscle always produces shortening, and that alone could cause some (or most) of your discomfort. Previously damaged muscle shortens further with ageing, making symptoms progressively worse, and this might be why you now write for help. Naturally the metal could also be an additional factor: in parallel the "cold syndrome" is often associated with implants. My bet is that you have relative "equinus", i.e. limitation of upward movement of the ankle. Compare the two. Is your pain less if you wear heels of 15 -20 mm? This is probably why you "avoided weight-bearing on the left" Difference in leg lengths can be difficult to measure, about which I will not now elaborate. Neither will I elaborate on the management of "equinus" - about which I have strong views, particularly regarding the undesirability of the - commonly performed - lengthening the Achilles tendon.
I am a 35 year old female, 2 and a half years post ORIF for a left tib plat fx (and torn meniscus). I have a plate and seven screws in my leg and I am wondering if hardware removal would relieve any of my continued symptoms? My OS did tell me that I will never be "100%" again however, I still have daily pain/lack of mobility in my leg. I did complete all of my PT (about 8 months worth) after I was NWB for 3 months. After that, I took up a biweekly spinning class in hopes of making more improvements etc. While I have progressed, I really want to feel better than I currently do. I did follow up with my OS about a year ago and he said my XRays looked good (no arthritis etc.). I will get sporadic, generalized pain in my whole leg which will throb and I cannot pinpoint where it is coming from. I also have direct pain on the side of my knee where the hardware protrudes a little. After sitting for any length of time,my leg is very stiff and I will walk with limp. I cannot run without a limp or squat/kneel without pain. Are these symptoms of the hardware and would removing it help? Since I have no frame of reference, I an unclear of these issues are related to my hardware or if that's the "not 100%" I was told about? Thanks for your help!
If the hardware is protruding and is palpable there is a good chance that it is (at least) adding to your symptoms. However there is no substitute for a clinical diagnosis by a sensitive, intelligent and experienced clinician. Should you wish to, send your x-rays which will give me a better perspective.
I’m 28yrs old Female, In November 2009 had midshaft humerus fracture with radial nerve compressed of the right arm. Then in the April 2010 we made a surgery, put a plate and seven screws. It’s been a more than a year and my arm is fully functional now. According to orthopedic doctors bone has been union, properly healed so implant can be removed. But I’m in dual mind, request you to advise on the removal of plate & screws. Will it more painful after removal of the plate?
The radial nerve damage indicates that the break was in an anatomical "danger land". Your nerve might now be surrounded by scar, with the normal anatomy distorted. This would make the surgery less easy. My first thoughts would be to say "Thank God" that you have recovered as well as you have. You should ask your surgeon for very specific reasons why it is desirable to remove the implanted metal.
I know that the removal of implanted metal can leave a scar and I would like to hide external scar of my arm by doing plastic surgery. For the same reason I keep asking my doctors and surgeons about implant removal to avoid multiple surgical treatment scar. Also guide, is it safe to keep the implant for life long period? Or shall I wait for some more time to go (i.e. 2-3 yrs)?
Any competent orthopaedic surgeon should be able to extract implants through the original incision scar. If the scars are unusually prominent then plastic surgery might improve matters. However, plastic surgery cannot abolish scars. The best the plastic surgeon can do it to ensure that the healing is optimal or, very occasionally, migrate the scar to a slightly different position or line. Are you using adherent paper tape on the scar to minimise it? Flesh coloured Micropore is one you could try: it would need to be applied constantly for at least six months. Irrespective of claims that various proprietary ointments and creams benefit, the only proven method of reducing scar prominence is sustained surface contact by inert material onto the scar.
I broke my radius, 2 weeks ago, playing football. I am in 2 minds whether to leave the 6 screw plate in or get it taken out once healed. I am 27 year old fit and athletic male and did heavy weights training and want to go back to the gym and football. Trying to weigh up the pros and cons but can't seem to get a conclusive answer from my dr or research I am doing.
I suggest you wait until the bones have healed before making any decisions about removing the fixation.
I'm a 35 year old female who was diagnosed with Ewings Sarcoma at 10 years of age. After the chemotherapy and radiation it was determined that due to the cancer and the fact that they over radiated my arm, I needed to get a bone graft, 2 plates and 13 or so screws in my humerus. I also had to be put in the hyperbaric chamber for the healing process. Over the years i have treated by arm as if everything was normal however, I have atrophy in my arm. That part of my arm is still the same size it was when i was 10. I noticed that i have had to cut back on picking up heavy things because it makes it hurts worse. The pain and ache goes to my shoulder/back and neck. I have a constant ache that is ALWAYS there. Recently it seems that I'm having more problems with it. I'm not sure if removing the plates/screws will help my situation. I don't want to trade one evil for another. I don't want to wait and do it when I'm older.
I would not like you to think that I can make the quality of diagnosis, which you deserve, from a distance. The possible causes of your discomfort include: 1. A progressive failure of the muscles and other structures which support the upper limb. You could test this possibility by wearing a supportive sling whilst you are upright, over several days. 2. You might be feeling the effects of the (likely extensive) scaring of the deeper tissues. Do your symptoms change with the weather, which might hint at this as a cause? 3. Perhaps you have an entrapment neuropathy, which could be illuminated by electromyography (these entrapments tend to exist where there is abnormal anatomy and fibrosis, and become more symptomatic with age). 4. You must be certain that you do not have a recurrence of the Ewing's tumor, or another malignancy - to which you might be more prone because of the past radiation. Check this with an oncologist. Having said all this, the metal present is a strong possibility as a cause of your symptoms, for a variety of reasons - which include low grade infection- and a bone scan (or perhaps an MRI) is warrented. As is always the case, clinical examination by an expert cannot be substituted. As I visualise your arm removing the metal may not be simple (radiology would help this assessment).
I broke my ankle December 2011, the tibia and fibula with a dislocation. 1 pin and one screw on the inside and 1 plate and and 7 screws on the outside. One of the screw that goes through to the other bone. X rays show that the bone has healed. I also have so far it is still doing okay, except when metal or any form of plastic touches the side the plate is on , it burns like boiling water is on it. Occasionally, I get little throbbing pains, but walk okay and do not have a limp. Is it too early to safely remove the metal?
It seems that you have sufficient reason to remove the metal, although the symptoms might relate to a nerve overlying the plate. I suggest you ask your clinician to explore the cause of your burning pain. Fixation metal can be removed as soon as the bone is healed (as demonstrated by x-ray) and as soon as the swelling is down. You say that you have a screw which goes through the fibula into the tibia. This is probably a "diastasis screw". These screws usually break, on average after six weeks of walking, which is why I remove them before six weeks. Should it have broken one or other fragment can "migrate" into a painful position. I suggest that this be checked by x-ray.
I broke both my radius and ulna on my right arm about 6 inches from my wrist when I was a senior in high school . A plate was fastened to each bone using 7 screws. I fell on this arm again and broke both bones right above the plates on the side closest to my elbow a year later. The old plates were removed and two new (longer) plates inserted with a total of 11 or 17 (can't remember) screws. After the second surgery the surgeon told me that the bone in my arm had started to grow over top of the plates and he would have to chip that away before he could remove the plates. I am now 25 and love to ride my mountain bike but I have been experiencing pain/ soarness/ discomfort, particularly with compression or tension in a parallel direction with my arm (ie jumping and landing). I have not specifically noticed discomfort with twisting motion. Although I have lost a little bit of pronation and supination after the surgery (but not much) and my arm sort of clicks when I twist it. I also play guitar and i know we get old and our bodies change but it worries me to death thinking that the plates may potentially increase my risk of say getting arthritis or carpal tunnel or something similar to this. I really don't want to go through another surgery on the same arm but the potential risks of having future problems/ complications worries me. If I had the plates removed is it likely I would get my full range of motion back? Could an additional surgery make it worse? I guess I am most concerned with long term effects and fear of it breaking easier with the plates in and if I fell on my arm again.
As always you need a diagnosis, and in particular an answer to the question “Is the metal causing your discomfort?" I cannot answer that from a distance. What I can say is that it is highly unlikely that the plates will cause a carpal tunnel syndrome or "arthritis". Any other such complications could be addressed when they arise. It is unlikely that your full range of movement will return at this stage. Supposing the bones were correctly aligned by the surgery the limitations will be due to fibrosis (scarring). Following two sets of surgery the removal of the metal will be (at least marginally) more difficult. The trade off now between the risk of an even more proximal (nearer the elbow) fracture and the risks of surgery. This would be best assessed by a surgeon who has available your x-rays, and who can examine you directly. Orthopaedic surgical management decisions cannot be made on a binary basis with limited information.
I'm a 30 year old female in good health and 6 months ago I had a pilon fracture of the right tib/fib with plates and 18 screws. My surgeon says the bones healed remarkably. The plates on the interior of my leg go almost halfway up the tibia and I feel pain whenever I try to walk straight, like the plates are pressing into the bone, so I usually walk awkwardly to prevent this. I saw him last week about it and he said "Well now that your bones have healed, you have too much steel in your leg" but only prescribed Pennsaid for the pain. It hasn't helped at all. I really think having the metal removed would help but I don't know how to ask or approach him about it. Is it still to soon after surgery for that to be an option? Also, I had problems with the incisions and developed what he called "skin necrosis" and had to go to a woundcare specialist for a couple of months until it healed properly. Is that a concern I would have with another surgery?
The solution to your dilemma is to develop a rapport with your surgeon. You should press him into answering your legitimate question. Your problem is a real one that requires a solution. There are a number of possible causes for the "skin necrosis" which means no more than "skin death". Infection is one cause, but others include skin which might have been damaged by the original injury, or the necessarily extensive surgery might have undermined the skin and interfered with its blood supply. Since it has now healed the probability is that it will heal satisfactorily again.
I asked my ortho today about having the hardware removed. He said he does do that sometimes, but not until at least a year post-op, which leaves me with six months to go. He did mention that if the pain persists, he might need a bone scan because he said it's hard to see exactly what's going on from just the office x-rays. Does this sound like an appropriate plan for now or should I maybe get a second opinion through another surgeon?
From what you say this is a very "mechanical" pain, that is to say that it comes with certain positions/activities. Otherwise you have no discomfort. One must therefore assume that the pain is related to a physical phenomenon, and not something like an infection. The pain of an infection would be fairly constant, perhaps marginally worse with hanging the limb down, and usually worse at rest at night, with a throbbing. I cannot see the benefits of a MRI now.
My sister (23 yrs old) had an accident one month back and the head of her right humerus was broken. Reading about Proximal Humeral Fractures (http://www.medscape.com/viewarticle/420763) and seeing the AP x-ray, it would be considered as 2-part fracture displaced little bit. Although the humerus head is broken in two parts it would not be considered as 3-part fracture. The doctor I was consulting suggested an operation immediately and told me if we delayed it would be hard to set all the broken parts. He did the operation and placed an implant with nine screws. Later we consulted another orthopedic surgeon as my sister was not able to pull her hand up without any support and she was feeling some kind of stress inside (where the plate is). The new doctor said the implant placement was not required it would have been cured without any surgery, but as it was in place suggested leaving it. He also said that two of the screw (3rd and 4th from the top of the plate) might touch the shoulder bone while she was trying to pull her hand up. He come to the conclusion that those screw are larger in length than required and should be removed or cut. So he suggested another operation (may be after two months). If we go for another operation will my sister be fine, and would she be able to use her hand earlier? If the surgery was not required then why had the first doctor gone for that (is it only for money)?
Different surgeons approach similar problems in different ways. That is because these surgical solutions are "art" in the sense that a multifactorial judgment is involved, and although the end goal is the same the route is often different. I would be cautious about surgeons who say that something should be done "immediately". It is rare for an injury to be extremely urgent. There are, of course, a few exceptions. These are almost always to do with injury to the blood supply or ruptured bowel and occasionally to do with the respiratory system. Even large, open wounds can (and sometime should) have their closure delayed. But outside those - very real emergencies - the majority of injuries, including breaks of bone, are not urgent. It is possible to control the only urgency, which is the pain, relatively easily. Usually it is panicky relatives who prompt the surgeon into acting rapidly and at times unwisely. There are many good reasons for delaying fracture surgery, and I usually try to delay for three or more days. It often does not make me popular, but the end results are far superior, and the complications far less. When I ask my colleagues why they are doing fracture surgery in the middle of the night they seem not to know, appear perplexed that the question should even arise, or give spurious reasoning such as "the health insurer require it". Bones do not "set" within hours like Jell-O: the consolidation process is very many days. Even after a delay of several days the end point to healing of bone is the same, whether or not the intervention was delayed. I cannot give advice about the desirability of removing the "too long" screws from your sister's shoulder - From a distance this is impossible. The dilemma is how to find the most capable surgeon.
Hi JP, Thanks for your comment in my previous request. My sister 23yrs had a humerus fracture. She still not able to pull her right arm up. The new doctor suggested he will do another surgery to remove the larger screw (may be after 2 months). I am attaching a link to the x-rays (removed during editing) so that you can suggest whether we should go for another operation to remove the larger screw or is there any other way to solve the problem without surgery. Because my sister is very afraid of another surgery as she just had a huge accident and surgery to place the implant, so I am looking for other option if possible.
The long screw has been incorrectly placed and is making impact with the shoulder cup (glenoid) and is eroding that bone. Therefor long screw should be removed promptly to allow prompt recovery of shoulder movement. This should be done under x-ray control, which will allow the removal though a tiny puncture wound. It might be wise to leave the rest of the metal, as removing it will multiply the dimension of the surgery, and increase the risks..
My father shattered his tibia and fibula 15 years ago and had numerous plates and screws fitted. He developed arthritis in his leg around 6 years ago and has now fatigue and headaches. doctors and found his iron count in his blood at 1,200 which I understand is excessive. Could this iron in his system be coming from the implants?
There are a number of causes of high iron levels, and several different laboratory tests are used to determine the type and possibly the cause of abnormal iron levels in blood. I am not sure which type of test you have quoted, but your father might have haemachromatosis. This condition of excessive iron can cause a specific type of arthritis. It is improbable in the extreme that the metal implants could cause large abnormalities in the serum iron levels. Your father requires specialised investigation and treatment on the starting presumption that he has haemochromatosis.
My son was 5 years when he had a proximal femur fracture, due to a cyst in the bone. he had a surgery where they insterted A plate, screws, and bone graft were implanted. The screws were removed 3 days ago, one year since the original operation. Will the screw holes heal? If not is his leg going to be too weak now?
Assuming that your son had a unicameral bone cyst, at his age you can assume that both the cyst and the screw holes will heal completely after successful surgery. Even if there is some radiological residue of his history the strength of the area will likely be normal in less than a year.
Thanks for your reply. One more question plz, he has school after 3 weeks, do you think I should send him or his bone would stil be too weak? How long does it usually take for kids bones to fill in the holes?
Your orthopaedic surgeon is in the best position to give you this advice: He knows the type and size of the implant, where and how it was inserted, and where and how big was the bone cyst.
On July 9, 2009 I broke my fibula and I had it fixed with a plate and screws. On August 11, 2011, I had the plate and screws removed because I kept having sharp pain shooting through my leg especially when walking down stairs. The removal of the hardware pain was not as bad as I thought it would be. I would like to know if there are any types of vitamins that will help heal and strengthen my bone. Will I be able to walk in 3 inch heels again? I will be 40 in August.
If it was only the fibula which you broke, and assuming that the reconstruction was back to the anatomical, you should recover entirely. Unless you are already short of essential nutrients there are no additives which will accelerate your natural healing. However if you wish to be sure a good proprietary vitamin mix will be sufficient.
Thank you Dr. JP
In 2004, I had the right side of my eye socket crushed and now I have two titanium plates. Other than feeling the screws and plate, especially the upper one, I don't have any particular. However, recently I have developed pink eye-like symptoms, now for the fourth time on my right eye-lid, three times above, the latest below. Could it be the titanium plates? I hesitate asking a local physician due to the language barrier (I am teaching in China), and possible repercussions should my problem be more serious - deportation.
You might have a "blepharitis" rather than conjunctivitis. There are a number of potential causes, as you already know. However an allergy to the metal implants is highly unlikely since the lids are affected at different times, and it seems recover spontaneously. Because of the potential seriousness the opinion of an ophthalmologist is recommended.
I broke my ankle during rugby a year ago and ended up with a plate and a few screws. . My surgeon has said that he doesnt usually remove the plates and screws unless they cause pain. I went back into heavy lifting of weights and squatting at around month 5. Now, at month 12 I am getting the itch to play rugby again. I have been suffering with psychological barriers to getting back playing, but have been jogging recently and it was nowhere as bad as I thought it would be (I was worried about twisting my anke etc). I asked my surgeon around month 3 if there was any reason I could not play rugby again, and he said not really. Now I have read this post, I am terrified - it has dawned on me that to play again, with plates and screws in, significantly increases the risk of another break because of the different stresses the plates and pins bring in. The last thing I want to do is break an ankle (or anything) again - it was hell!
Ankle injuries are relatively common in rugby. In part this is because the studs fix the foot to the ground, and the twisting kinetics focus on the foot-ankle level. I believe that you have an increased risk of breaking the ankle with the plates and screws in place - not an absolute risk but a significant one. Further, soft tissue injuries are common from direct trauma to the ankle: Since the tissues are comparatively thin and the plates are not padded by much tissue, this is also presents an increased risk to those tissues.
I had a tibial plateau fracture three years ago, repaired with a plates and screws. I have osteomalcia. I am currently taking vitamins to monitor my condition. I have an infection from the metal in my leg as well as pain and a fever and generally feel pretty unwell. I will have the metal removed from my leg in Nov. 2011. Should I have blood work done to monitor infection, pain and swelling in the meantime?Thanks for your advice.
What is the cause of your osteomalacia? There are a number of distinct causes, each requiring specific management. If has been established that your osteomalacia is a deficiency of (mainly) vitamin D, the supplements which you are taking (which could also include minerals such as calcium and magnesium - depending on the diagnosis) are not a way of monitoring, but are a treatment. Monitoring of the bone structural soundness is a separate exercise which might include bone densitometry. If you have an infection associated with metal implants those should be removed as a matter of urgency, and the causative organism treated assertively, ideally sooner than November.
Seven years ago I injured the right knee. An acl repair and screw fixation for tibial injurywas done; later there the joint got septic and I underwent calcaneal traction with implant removal. After that I was unable to flex my leg although physio excerises were done.Then a ring was placed over my leg to make it straight. Since then my leg has no flexion. Is there any possibility to undergo any surgery to make my leg flexible as I am 34? Is there any possible for knee replacement?
Thanks for all the help you are giving people here. I had plate, screws, bone graft and wires put into my humerus about 15 years ago after a motor cycle accident and really can't complain about the result. However as I get older I wonder how this might affect me as my bones get older and weaker, since fractures might be more likely. If so is it better to get the metal out now rather than later? I am probably fitter now than I have ever been and don't want to jeopardise that progress by being unable to exercise for a long period. I'm currently doing things like mountain bike riding. With the metal in am I more susceptible to a leg fracture during a fall? If I had the hardware out now what would be the likely recovery time? I'm currently 41 Given there is no immediate health concerns would I recover just as well/worse if I left it and had the metal out in my 50's/60's when I assume I would have slowed down a bit.
Your questions require a sophisticated answer, which would need to consider the anatomy of your injury, the way it was repaired, plus a number of other variables about which I cannot be aware from this distance. Removing metal now, since you are not troubled by its presence, is an exercise in betting. The bet is that something done now will prevent something worse happening in the future. The humerus is associated with "busy" anatomy: at times it is not practical to remove implants and ensure the safety of the surgery. Therefore there is a second gamble, which is that the surgery will be uncomplicated. 1. Your age at removal of implants (for whatever reason) is relatively immaterial: 2. It might be that in a tumble from a mountain bike you could re-injure at the original site as this is probably somewhat less anatomically robust than the normal would be. But this is yet another layer of gambling. 3. It might be that other bones (including those in the leg) might be marginally more vulnerable should you fall. That is because humans (and other animals) have “hard wired” into them various strategies to prevent injury when falling. This is entirely sub-conscious, as there is usually no time to perform calculated actions. These reactions can be improved by training (as in training the “break-falls” of the martial arts). In trying to protect the previously injured limb in a fall, you could interfere with this intuitive strategy of “falling safe”, and sustain a more serious injury elsewhere. Frequent examples are when individuals fall, but try to protect an object which they are carrying, and so incur serious – sometimes fatal – injuries which probably would not have happened otherwise. 4. Should the implants be readily removable, and without complications, your recovery will likely be less than a month. During that time you should be able to perform most daily tasks with that limb. I do not wish to discourage you from your active life style. This is because exercise is so important to your general health that some of these risks are worthwhile. Exercise programs really do prevent worse health in the future. Exercise is a winning bet, health- wise.
Thanks jp. That helps. What I take away from this is. 1. If I was to have the metal out now or later does not matter to much. 2. The bone may be a little weaker than normal but not so much that a fall will definatly cause a break there. 3. Rely on my innate ninja reflexes to ensure I fall safely should it occur. 4. Recovery time should I have the metal out and all goes well is not to invasive. Based on this information I think my gamble at this time will be to leave the metal where it is and I'll review it later should the implants start causing problems. Thanks.
14 months ago I broke my tib, fib and talus. I have a plate and several screws going up the tibia that have caused a constant minor pain. It was thought to be bursitis at first but now there seems to be cellulitis as well in that same area. I am currently on oral antibiotics as well as a 1x injection of another (rocephin?). I want the implant out of my tibia since it's painful at times. After my 1st round of augmentin & a single shot of antibiotics it felt the best it ever has....but the infection has come back again. My white cell count is decent, so I know its not a major infection. The infection seems to have happened 11-12 month mark from my surgery date. I thought I was in the clear. Do you think that the implant on the tibia should be removed? Will the infection have to be completely cleared before the metal can be removed?
In every break of a bone there is a greater or lesser amount of bone death. The volume of dead bone varies with a number of factors, such as damage to blood vessels, as well as the amount of energy imparted to that bone in causing the break. The risk of infection increases, inter alia, with the amount of dead bone and other tissue. It seems, from your description, that you suffered a high energy injury, and hence you might be at greater risk of infection than most. The "cellulitis" is ominous, and the benefit of the antibiotics also points to an infection. An implant should also be regarded as "dead tissue". It is therefore axiomatic that if an infection is associated with an implant then that implant should be removed whenever possible. In some instances (and I do not think that you fall into that category) a compromise is required with the implant being retained for a necessary period, despite infection. Your orthopaedic surgeon, with a full understanding of the history of your injury, will be the best source of information by far. I would not be a surprise if he recommends removing the metal. Please tell us your outcome.
I fell April 2010, shattered my left wrist and have a plate and 5 screws. Last week while gardening I pulled some weeds and now my wrist will not stop throbbing. the Dr. said she would leave it up to me to decide if they should come out. On one xray view, it appears that one screw is VERY high and evident it needs to come out, but they take additional xrays, doesnt look so bad. I'm concerned what to do as I am low blood calcium (metabolic bone disease), not so sure I can deal with this continued pain. Any suggestions appreciated.
You do not have a diagnosis yet. Since the pain appears related to activity, a mechanical cause should be considered, such as abrasion of a tendon against the implant, or tearing of adhesions related to the surgical scarring. Co-incidental causes must also be considered such as infection or DeQuervain’s teno-synovitis.
How do I find an orthopedic surgeon whose philosophy is to remove plates and screws as soon as my ankle is healed and fully functional?
The best orthopaedic surgeons will assess the many variables, and relative advantages and disadvantages, in the timing of implant removal. Do you want the best, or merely a technician?
I want someone in Maryland.
I suggest that you get help from a reader in Maryland. Would you like me to put up your e-mail address?
I'm 5 months post-op on a TP depression (10ft ladder fall). The surgeon used a plate and 4 screws. I'm 39 and in good health and physical shape, healing quickly and needing very little PT. Things look great on x-ray. I started using an elliptical machine about 3 weeks. For the past week or two, I have had mild to moderate pain walking and even swimming. Going up and down stairs hurts. I live in the desert with humidity only in July and August. I am wondering how to tell if my pain is weather related, exercise related or caused by my implanted metal. Any advice on how to figure this out? Thanks! This is a great site!
I assume TP means tibial plateau. Recovery from significant injuries to bone and the associated stabilizing structures is slow. It should not be compared to the few weeks recovery period for many of the soft tissues, including the skin. Therefore, in "orthopaedic" terms, you are still in an early phase of your rehabilitation, which might easily take a year. Another characteristic of "orthopaedic" recovery is that it is not a gradual progression, slightly better on Monday than the previous day, and then slightly better on Tuesday, and so forth. Instead the graph of "orthopaedic" recovery is a saw-tooth one. Significant reduction is symptoms will often followed by a return of symptoms, usually for no obvious reason. Then recovery occurs again, with the process repeating itself through many cycles. This "saw-tooth graph" would usually be, overall, upward. It would be by looking back weeks or months that the best judgments of progress can be made. Keeping a diary is recommended. One reason is that if people have fewer symptoms they (naturally) do more, and put more load on the recovering structures. Often this is not considered or even noticed as excessive, because it is regarded as "normal". By that the patient usually means that it was a "normal" activity before the injury. Hence it is assumed could not be of consequence. What you describe seems to be an entirely normal convalescence, 5 months after a not-insignificant injury. There is little point in speculating further, since nothing needs to be done now to accelerate or improve matters in the future. Wanting to know that is, of course, the reason why you have written to me The elliptical walker is OK. However give some thought to stationary (or real) cycling. That is the best way to build up your quadriceps - vital for your eventual full function. I predict that the injured thigh is still substantially thinner than the other thigh.
16 years ago I had a spiral fractured my fibula, dislocated my ankle, and tore the deltoid ligament. Of course I have a plate with 8 screws, and they repaired the ligament. I still have my hardware, and really I've not had many problems with it, but now I am having increased pain with walking just above the ligament repair. Wearing a brace sometime helps and sometimes makes the pain worse to the point that I don't want to step down. I'm also thinking this is causing pain in my opposite foot because of favoring it and walking oddly. Any suggestions? Is it possible the ligament repair is the problem now?
It is improbable that the pain is coming from the deltoid ligament after this time. That structure has good repair potential, and continues to scar and react robustly. A caveat could be if a non-absorbable suture was used in the original repair, causing a possibility that infection might be present asssociated with that stitch, or the stitch is migrating. If that were the case it would be tender to finger pressure and probably red and swollen. A further possibility is that if a diastasis screw was inserted, and which later broke. I have seen these fragments migrate to the medial (inner)side of the ankle, and penetrate the skin. Most likely, thought, this is pain in the long flexor tendons. I suggest a dynamic ultrasound scan of those tendons.
5 years ago I injured an acl and required screw fixation for tibial injury; later there was sepsis and I underwent calcaneal traction with implant removal. Again no improvment to straighten the leg. Then an ilarav ring which made my leg straight. Now my leg has no flexion. Is there any possibility to undergo any surgery to make my leg flexible as i am aged 34?
The infection was likely responsible for your stiffness, probably by destroying the articular cartilage. Depending on the degree of damage it should be possible to perform a total knee replacement. I realise that you are relatively young, but that could be used as a persuasive argument to give you maximal activity in what should be your best and most productive years.
The rehab doctor told me I should not play basketball with the plates still in and I have to the next season.
This type of judgement, when a variety of competing factors exist, cannot be made from a distance. You will need your ankle for life. The next season lasts a few months.
I fractured my lateral malleolus 4 and half months ago, had it fixed with a plate and 8 screws. I am thinking of removing these implants because my ankle is still stiff. My PT said I have ''foot drop'' when I run. I now need to protect the ankle. When can I have it removed?
I am concerned. I had a complex fracture(s) to my tibia and fibula on Oct 1st. I qas in the hospital for 6 days, they waited for swelling to reduce before doing surgery to put 3 long plates and 15 titanium srews in my leg. At my last check up, the doctor reported that 5 of my screws have broken in my leg. He asked about my pain level. I sais it has been better after about 7mos. post injury, but still hurts if I am on my feet alot (grocery shopping, working all day) and has significant swelling at the end of the day. He sais as long as I am not experiencing increasing pain we should leave the screws in. I don't like the idea of surgery but I also do not like the idea of complications down the road. What are your thoughts? Thanks
You had extensive surgery, relatively recently on the orthopaedic time scale . I suggest you allow yourself at least a year before thinking about further surgery. You will probably need an elasticized stocking, at least for the first year.
I broke my ankle in April: surgery with a plate with four screws on the outside of the ankle, and a screw from the other side of the ankle through the bones. After 2 months of no weight bearing I started to walk but about 2 days later I developed a staph infection. I began 6 weeks of IV antibotics and. I am almost there. but concerned with the screw holes how they heal. Can I have more of an injury because the bone is weakened?
There is nothing you can do now about the holes in the bone: Concentrate on the management of the infection. Once that is cleared your recovery will likely be routine.
I see several inquiries here regarding tibial plateau fractures. My husband suffered a bicondylar tibial plateau fracture 4 years ago. I don't know how many plates and screws were used but the surgeon mentioned a half pint of bone graft. We moved out of state 4 months after the accident and he hasn't had any follow up care since. Today, the plates and screws have been pushed out by bone regrowth at painful and weird angles - some almost piercing the skin. Can some of these be removed this long after the initial surgery?
Most tibial plateau reconstruction screws are usually very easily removed, and those which are protruding are usually the easiest - often under local anaesthetic. If these screws have been extruded that might mean that the anatomy of the tibial plateau has also moved from its optimal position. This occurrence, along with the inevitable damage to the joint, will make future osteoarthritis a strong possibility. I would like to suggest lifelong cycling and perhaps swimming to avoid impairment as long as possible. A common mis-apprehension is that an injured joint should be "preserved" by using it less. This probably derives from the mechanistic approach, such as using your automobile less if you want it to last longer. However biology is not like that, partly because there are self repairing mechanisms at work in the body. Weak thigh muscles will jeopardize the joints which they sub-serve, and will fail to protect those joints from impact. Keep those thigh muscles built up!
I have a plate and 5 screws in my right radius after a distal radio-ulnar fracture in April 2010. I have mild pain on loading, a sensation of temperature irregularities in my hand, and an early Dupuytrens contracture which became noticeable within a month or so after the injury. The palmer fasciitis extends into the proximal phalanx of primarily digits 2-4, but is also present in the web space. It seems that there may be a 'double crush' syndrome in that both the ulnar and median nerves are fairly sensitized and I can get N/T in the hand in the ulnar and/or median distribution. However, the symptoms are all fairly tolerable but what prompts me to want removal of the hardware is that I would like to minimize any systemic risks to my immune system. Do you think that an active 54 year old with very 'livable' symptoms, with very thin bones and previous cancer "scares" it would be advisable to have the hardware removed, given the concerns about possible infection when I have (anticipated) dental implants and/or cancer promotion associated with retained hardware?
Your core questions are the risks to you of infection and immune suppression which might be caused by implanted metal. There is no evidence that the alloys used surgically can suppress the immune system or promote cancers. But absence of evidence is not evidence of absence. There is a small risk that blood born bacteria from the mouth might dissemination and settle near the implants. However, taken overall, I do not believe that these tiny and ill defined risks would (in themselves) justify removal of the metal implants.
I had a tibial plateau break 10 months ago with a plate and 6-8 screws inserted during ORIF. My leg aches constantly, feeling like my leg is twisted, which I think is due to the discomfort on lateral and medial sides of leg. Pain doesn't increase with walking, stays the same, doesn't hurt when I am sitting, unless I hit the bone on the lateral side of leg. Surgeon said hardware should stay in, but I can only walk so fast, going down steps is difficult, and standing is more difficult than walking. Eventually, I start limping which then causes pain in SI joint in opposite buttock. I don't want to feel this way forever! I have good ROM but would like to be more comfortable. What is your suggestion?
Tibial plateau fractures are a spectrum of different breaks. Because you required so many screws it seems that your injury was extensive with multiple fragments. These are always difficult injuries to reconstruct and imperfect reconstruction is often unavoidable. As a result persisting problems with the alignment of the axis of the limb, and derangement of the join surfaces does occur. You do not say whether you needed a bone graft. However, to address present practicality such a large number of screws in a relatively small volume of bone might well be contributing to, or causing, your pain. These screws are usually not difficult to remove, and this should be considered. I could give a more accurate opinion if you were to send your x-rays (jpeg)
I had a compound tib/fib fracture 19 months ago. Both bones are plated with a total of 16 scews. At 10 months a bone graft was done on the tibia. The tibia has healed only half way accross. Leaving a void. The fibula is healed. My surgeon has given me the option of taking the plates out to see if the bonre will heal without the plates. My question is can a second bone graft be done at the same time? Do they ever try a second time with bone grafts?
I am skeptical about the theory that removing the plates might prompt healing of the tibia. The surgeon's rationale would be that removing the plates would allow compression of the two ends of the tibia against each other, and so reduce the "dead space". However if the fibula has healed that bone would act as a "strut" preventing the compression. Therefore the fibula would need to be cut through and perhaps a portion removed, to allow the compression. If the plates are removed simultaneously the fracture would then be unstable, once again, and require support by one or more of: 1. Replaced plates, 2. An external fixator, 3. One or other form of casting. Repeated bone grafting is a realistic approach. However the failure of the bones to unite reflects (almost certainly) a loss of blood supply to the ends of the tibia (the commonest cause of non-union in the distal tibia). Therefore grafting with a vascularised segment of the fibula or the use of hyperbaric oxygen should be considered.
Hi, I am a 77 year old male who broke right ankle in 1993 at 59 years of age. Just saw orthopedic surgeon foot specialist because podiatrist wanted to remove bone spur on toe of left ankle-required medical clearance. Am otherwise in good health. Specialist told me I should never should have had plate put in at that age, because, plates don't last more than 15 years, and I already have it 18 years . It is going to break shortly, and the bone will never heal at my age. I AM GOING TO BE CRIPPLED WHEN THE PLATE IS REMOVED. Is this true? This plate is I believe is titanium. Will the holes from the screws not heal and if so, are bone grafts possible, or what I read is something new is pixie dust? Fracture of the medial malleolus, with three loose bodies below tip of medial malleolusand bony excrescence projectimg off the tip of the lateral malleolus of right ankle, with internal fixation of lateral malleolar fracture, with extensive tearing and derangement of soft tissues, ligaments, cartilages, muscles, nerves and blood vessels. Had metal plate with 6-8 screws. Have been walking with full range of motion to date. I am not subscribed to Wordpress. Will your reply be only on email or also on this website? I very much appreciate your expert advice.
There may have been a misunderstanding about the life expectancy of the plate. Almost all plates are temporary devices used to position the bones to allow healing in an anatomic position. Once healing has occurred there is no load on the plate and it is now irrelevant. Therefore it will not break. Likewise, if the plate is removed that should not endanger your function (unless there is a complication - which is unlikely - or a surgical error -also unlikely. Although there is a popular perception that all implanted plates are titanium, the majority are a ferrous alloy. Small "loose bodies" near the malleolus are seldom loose and rarely of consequence.
I had an oestoid osteoma removed 25 years ago from the neck of the femur. A bone graft was put in place but I fell and broke the femur two weeks later. A pin and plate was put in, and while it was slow to heal I was off crutches after six months. I walked with a marked limp for another six months (my leg pulled to the right). The pin and plates were removed 12mths after they were put in. There was very little pain after surgery and the limp was gone in two weeks. (Personally I am so glad they came out) I would've said I had a full recovery. But now, 25 years later, I have pain in my hip joint and thigh similiar to that of the osteoma, and some swelling, though I always had a bit of oedema at the sight after. The scar is tender at one point too. There was a broken bit of screw left in at the time, I presume it was too difficult to pull out. Could that be the problem or is it possible to get a recurrence of the osteoma? Or could it be arthritis (I am 46 and active). I appreciate all your advice here.
Osteoid osteomas do recur (up to 25% reported). Whilst I have no evidence for the belief, on first principles it would be unusual for a recurrence after 25 years. More likely would be another pathology (perhaps obliquely related to the original surgery), including arthritis of the hip. You say that the pain you have now is similar to the original pain before the osteoma was removed. At that date (25 years ago) was your pain relieved by aspirin? (Mostly this is so). Is you present pain relieved by aspirin? However it would be wise to have your current symptoms investigated, and establish a firm diagnosis as to the cause of your present symptoms.
I have been searching for this information for a couple of years now so I am mightily relieved to find your site. I am a 66 year old female in very good health. Three and a half years ago I was hit by a motorcycle and the left femur neck was fractured just below the femur head. A DHS was inserted and the fracture itself healed well. However right from the beginning I knew there was something wrong about the way the plate held the joint in too rigid a position. Basically I think it may have been a bit too long for my body as it does not allow the full forward thrust of the joint. The iliopsas?? muscles have obviousy degenerated and so I have to limp. Physiotherapy tried to tell me that I need to do all the thrust exercises etc but I had the feeling there was no point in pushing it too far as the steel plate would only be forcing the femur. The joint is locked at a certain point As well as that there is discomfort all over and along the femur where the steel plate is attached. At the join point where the lag screw was inserted into the femur neck and halfway into the head there is quite often a lot of discomfort and some low level pain. . I was told there was AVN but I was lucky as it was only slight. The femur head is quite sore at times and seems to be negatively affected by weather conditions. I have some osteoporosis which appears to be the normal level for someone of my age group, as when I had the operation the bones were very strong and no osteoporosis was evident at all. . Is there a way of removing the DHS with some minimally invasive surgical procedure? I was thinking of smaller incisions at the sites of the screws where the screws are removed first. Would it then be possible to lift the steel plate out through an incision at the site of the lag screw insertion, or would the complete length of the plate need to be cut open again to get it out? I know I cannot go on indefinitely with the situation. It is not too disabling as I swim and cycle but unfortunately cannot walk for any distance without a lot of discomfort. I am very conscious of keeping some sort of alignment for the lumbar region and so far have kept it out of trouble by how I use my misaligned body. My real question is this. Would the removal of everything be better for the AVN situation as this removal of the screw might mimic to a certain extent the core decompression procedure sometimes used for AVN ? Might it be better or worse to have it all removed? I am getting worried as I am otherwise a very healthy person, not very aged and have great healing and recovery abilities. I have always been very active, mountain climbing and such activities. I want to do some more mountain hiking etc but would not be able to go for very long in this condition. I also do not want a hip replacement or general anaesthetic. I had epidural for the first operation so I hope that if the things can be removed it could be done with local anaesthetic. Thanks for reading and any advice or information would be hugely appreciated.
You say that the “plate held the joint in too rigid a position”. By that I interpret that you do not have the full range of movement in your hip, and perhaps hip movement is slower to respond, and you also have a limp. A number of possibilities exist: 1. The fragments of bone might not have been positioned exactly in their previous anatomical position. 2. The capsule of the joint might have been damaged, either by the accident or (less likely) by the surgery, and the resultant scar is restricting movement. 3. Damage to the muscles about the hip, or the associated nerves, might have made their function restricted or less powerful. 4. The attachment of the iliopsoas (the lesser trochanter) may have been separated and not re-attached (not an unusual approach) 5. The avascular necrosis itself might be limiting the movement. 6. A small or tiny fragment of bone of cartilage might be in the hip joint. 7. The DHS metal might have attached to the adjacent hip muscles by scar, and so restricting it. This might explain the pain and tenderness. The pivotal question is whether the metal should be removed. Should some or all of the above reasons be excluded it would be reasonable to remove the metal, as a “therapeutic trial”. This might require an over-night in the hospital, but apart from the ten days needed for the wound to heal, you should have minimal discomfort, and be able to walk immediately (perhaps with a crutch for a few days for comfort) The “coring” of the femoral neck as an attempt to reverse the AVN, although widely used at one time, has never been shown to be beneficial by any objective means. It is technically difficult to remove the DHS through tiny incisions, or subcutaneously. But if the original scar is reopened it should not cause any damage to other tissues. Feel free to send the x-rays, which would give me a better and more accurate perspective. I do hope you improve.
I had a total rt.knee replacement 4 yrs.ago.Then before the knee healed I fractured the rt. femure.The doctor put me together and it's been about 4 yrs. and two mo.since these surgeries.when I'm walking my rt. leg feels like it's coming apart,and extreme pain then ensues. I was told the femure broke because of severe osteoporosis. What will happen to me if this titanium rod has failed?
You need a diagnosis as to the cause of your pain. Amongst possibilities are that the prosthesis has loosened or become infected, that there is a non-union of the femur fracture, or there is a problem belating to the intermedullary rod (which seems to be what you describe as the titanium rod). Failure of intermedullary rods is unusual, but they often "back out" causing buttock pain, or the cross-screws loosen/break. Radiology would e the first step.
I am a 31 year old male. I suffered a type IV tibial plateau fracture of my left leg (high velocity high impact) on February 23, 2011. I had two surgies, the first a fasciotomy and then placement of an external fixator, the femur was used an anchor to pull the bone back towards the joint. Two weeks later the external fixator was replaced with plates and screws in the tibia. The pre-surgery x-ray looked as if my tibia had exploded and the post-surgery x-ray showed that the doctor had successfully realigned the bones with knee joint. It has been three months since the surgery and the doctors said that the bone had healed well and that I could start weight bearing on my left leg. At first it was extremely difficult to walk but a week into it I find that I walk fairly easy with only a slight limp. I am doing leg strengthening exercises using pain and discomfort as a guide. So far no pain and only slight discomfort. Do you think it would be necessary to remove the plates later in the future? My thought was that given the way weight is distributed throughout the tibial plateau, the plates would add strengthening support rather than compromise the structural integrity of the bone. Also where the fasciotomy was performed there is pitting (I press my finer into the skin and an indentation is left) and numbness. Will that ever go away?
I am delighted that you have had this degree of success. Because this knee is at risk of developing a post traumatic arthritis, strengthening the thigh and other muscles is imperative, both now and continued indefinitely into the future. Cycling and swimming are good methods. Ensure that you remain slim. The plates have now fulfilled their function, which was to align the bones allowing healing in the normal position. They are now longer providing structural support and could be removed if they are troublesome. The oedema (pitting) will likely improve to a degree, but should be assisted by wearing elasticised, below knee stockings for at least a year. The numbness will probably persist.
I have been reading about Glucosamine and MSM supplements to aid in the rebuilding of cartilage and easing pain in the joints. What are your recommendations and thoughts on this supplement?
It is an overly innocent view that a dietary supplement can "rebuild" body tissues. Only the inherent biology of the individual has the capacity for any type of healing. It is true that if a necessary constituent for healing is deficient, then adding the deficient substance can allow healing to improve or re-commence. I am not aware that there is any evidence that glucosamine or chondroiten sulphate remedy any deficiency. Many pharmaceuticals alter perception, and in medicine these mostly alter perceptions of pain. Complex psychological perceptions can also be altered, usually by suppression of neurological pathways. Alcohol is the most widely used example. Whether changing perception (and so producing comfort) is the case with chondroitin sulphate and glucosamine I do not know. Although widely and professionally researched, the benefit of these medications remains equivocal. Some individuals report benefits, others not. The probabilities are that there is an individual variation in response. There seems to be little risk in using these substances, although allergic responses – notably to fish products – have been reported. Why not try them? The cause of osteoarthritis of the weight bearing joints, despite one and a half centuries of research, has largely remained obscure. There are many associated predictors of the likelihood of osteoarthritis developing, but these are all correlates, not linear causations. This can be said because the presence of these co-factors is not an absolute prediction of future osteoarthritis, as illustrated by the many exceptions. It is probable that the end-result is polyfactorial. Having said that, it seems that you are seeking benefit for a degenerate joint or joints and that you need advice. In the lower limbs the most important co-factor (and one which is theoretically controllable and reversible) is excess body mass. Losing weight makes a great difference to the symptoms caused by many of these degenerate joints. Please see also the previous comment.
I am a 48 yr old female that had a plate and 7 screws placed in my right ankle in 1990. Within the past few weeks my ankle has started to be painful and acts as if it wants to give out when I walk. The screws have been palpable and visual for years, however within the last few days my pain has increased and I noticed last night that it has become swollen. I have been applying an ice pack off and on all day and it seems to intensify the pain. I am a 360 lumbar fusion patient as well, and am taking pain medication and muscle relaxers daily, but even so, I am still in a considerable amount of pain that is causing cramping in my toes and up my leg to my patella area. Should I seek medical advice from the ER and try to get an ortho referral since my pcp is out of the country, or should I just go on as usual hoping the swelling goes down?
Regard the swelling and pain as ominous. Whilst not an "emergency", I would regard your symptoms as an "urgency", justifying a visit to the emergency room. X-rays (perhaps including ultrasound of the deep veins in your leg) in the ER should expedite matters, in the event of your being referred by the ER to an orthopaedic surgeon.
Hi 12months ago, at 21yrs old, I underwent surgery to reconstruct the ligaments/muscles and bone structure of my left knee/shin after hundreds of knee dislocations. Recently I have been having pain,burning of my scar, pain through the scar at the site of the screws and shooting burning pains through the same areas when I walk or move the leg, I also have an itching burning sensation inside the leg around the area of the screws that is driving me insane as I cannot get to it and very recently I've noticed that one of my screws has started to stick out of my shin a little, the slightest knock to this area is absolute agony! My surgeon told me that these screws were for life as they were holding the muscle down to keep my knee in position. In your opinion do you think my surgeon is being quite dismissive? He has the "I am god" attitude.
It is likely that you were having dislocations of the patella, and this might have been addressed with a tibial tubercle re-positioning. Your symptoms deserve prompt investigation, starting with radiology. Only then can an appropriate treatment policy be constructed. If screws are used to position a muscle (which is extremely unusual, and it is more likely that it was the patella tendon) the only role of the screw is to hold the structure/s in place for some weeks until the tissues have healed one to another. After that they are redundant. Arrogant surgeons are a real and fairly common problem. This will best be solved by quiet persistence, describing your complaints. Do not attempt to rationalise, explain or diagnose. That is the surgeon’s job.
I have protruding screws (underneath the skin) on the end of my elbow. Does anyone know of a comfortable arm-band-gel-cushion arrangement (re-usable) that might protect my elbow screws - without placing too much pressure on the skin around the screw heads? I am the proud new owner of about a pound of new titanium plates and screws (comminuted olecranon and communited clavicle - both on right arm). It's eight weeks since surgery, the horrible bone aching is replaced by muscle stiffness , and physio-induced pains. Apparently I'm healing on track or better.
Once the olecranon is healed, which should not be longer than eight weeks, the screw should be removed. That portion of your elbow is frequently weight-bearing, and you cannot be expected to continue to have this painful projection indefinitely. Removing the protruding screw alone should be easily accomplished as an outpatient, and under local anaesthetic.
I am now approx. 5 months post operation for elbow surgery. I have hardware in there. I am still unable to extend my arm fully, even though my arm is fuly functional now. At what point can you say that the arm will never straighten again - i.e. you have hit the "end point" for physical therapy? Is there a window of time within which one should be able to straighten arm again? I don't know when I should just give up . . . Feeling very sad.
The elbow is a particularly "unforgiving" joint, and prone to lose range of movement. It is necessary to ensure that there is no "mechanical" obstruction, such as intruding metal or abnormal bone (a displaced fragment perhaps). If so it needs to be removed forthwith, and physiotherapy re-commenced immediately.
Is it possible to have a titanium plate removed if it is underneath s repaired ruptured patellar tendon?
I presume the plate was put onto the tibia after an injury which also divided the patella tendon, such as a "dash-board" or chain saw injury. It depends where the plate is positioned, but in general terms it should not be a problem as the patella tendon can be moved to one side.
Im a 34yr old female and I broke my ankle a little over 2 yrs ago. I had a plate and seven screws plus a long screw all the way across my ankle which recently broke and has caused me alot of pain for the about a month now. My orthopedic surgeon said there's no need to take the broken screw out and the pain Ive been experiencing should disappear in the next few weeks. Is it okay to leave a broken screw inside my ankle? Is it possible for the broken screw to poison my system or cause gangrene?
Screws crossing from fibula to tibia inevitably break. My practice is to remove this screw, under local anaesthetic, at between four and five weeks. At times I then replace it with an absorbable screw (which is not sufficiently strong for the first fixation, but sufficient once some healing has occurred). I do not think that you need to worry about gangrene; however the two broken screw ends frequently rub together producing a fine metallic dust. By first principle this is undesirable (see earlier posts). Your real problem is pain, and this alone should justify removal of the most accessible fragment of the broken screw, which should be simple. Removing the deeper fragment is usually not as easy, and might require extensive surgical exposure. This deep fragment is usually left in the bone.
I have a plate and several screws down the back of my right arm when I was 24 and I'm 30 now.. Is it to late for me to have them removed? If I have them removed will my bone break easier? I'm in so much pain right that can't sleep. I was told that I would have to have them for the rest of my life.
Apart from its interference with you comfort, this level of pain is ominous. I suggest that you talk to your orthopaedic surgeon to determine a cause (which might be unrelated to the implanted metal).
I have had an olecranon plate and screws for six years. I bumped the tip of the elbow and I have been in pain for 3 days; the skin gets tight over that spot when I bend the elbow and it feels like being poked with a needle under the skin. The pain is sharp but goes away quickly. Is the plate causing internal cuts or the sharp edge of a screw trying to poke through the skin? There is no bruising or swelling. What course of action should I take? Will this happen every time I bump my elbow now?
This may well be related to the implanted metal. Screws can begin to move years after insertion. However, perhaps more likely is an "ulnar bursitis". A bursa, an almost empty pouch on the tip of the elbow, is normal anatomy which allows the skin over the tip of the elbow to move more freely than elsewhere. Bumping could have caused bleeding into this pouch, with swelling and pain. At times this pouch contains a small bead of cartilage, aptly called a "melon seed". Leaning on the elbow and compressing this can be most painful.
I am a 47yo female who had a trimalleolar fracture dislocation in February. 4 breaks needed a plate and 7 screws. I was getting along fine until a staph infection erupted in the scar. I was admitted to the hospital for antibiotics for the infection and my surgeon said since the fractures were healed it was best to take out the hardware. I have been that when the bone re-calcifies and fills in the screw holes that it will be just as if I had never had the breaks in that bone. I had the hardware removed 5 days ago and I am walking again (slowly) w/o my crutches, have very little swelling and figure I will have little or no problems once the stitches are removed. I understand in some instances, depending on the type of break or number of breaks there may be justification in leaving the hardware in but in most, I don't understand why it is not common practice to get them out and avoid any future problems with the aches and pains, stiffness and lack of full range of motion that can be caused by them. I couldn't be happier that mine had to be removed so soon.
You are suggesting “prophylactic surgery” to prevent something which has not yet occurred from happening in the future. The problem is that prediction may not be accurate, and unnecessary surgery is then performed. Naturally there are circumstances where prediction of adversity can be made with certainty, and surgery becomes mandatory. Examples include infection associated with metal implants, cancer, and others. However, this is not always the case with implants used in fractures and it is often wiser to await problems and treat as they arise.
I'm 28 and fractured my medial malleolus a few days ago. The break is slightly displaced but not excessively. I've been told that I can either have 2 screws put in to help the bone heal, or leave it to heal on its own. My doctor has said there is roughly a 30% chance that the fracture will not heal without screws. Should I avoid the addition of screws? It also appears that I will have to wait a week or more to have the screws put in. I'm concerned that this wait may complicate the surgery. What are your thoughts?? Since the break my ankle has been put into back-slab casts by A&E, then the orthopedic consultants. This doesn't seem to be doing much and I'm concerned the cast is pressing on the fracture and displacing it further. Would you recommend keeping the cast on?
It is exceedingly unfair of your surgeon to ask you to make this decision. He has the expertise and experience (one hopes) and he should be in a position to judge what would be best for you in both the short and long term. That is what he is being paid for. “My doctor has said there is roughly a 30% chance that the fracture will not heal without screws.” This is improbable – the vast majority of medial malleolar fractures heal spontaneously. The purpose of the screws is to retain an exact alignment of the surface of the joint. A wait of a week will not risk anything – indeed my policy is ALWAYS to wait at least a week before doing ankle surgery, and to ensure that the swelling has gone down. To operate on fractures early (with few exceptions) is reckless. In a later paper I will discuss the reasons, and the frequently heard pseudo-logic “I will operate before the swelling occurs”. A badly fitting cast can be dangerous.
Re. Olecranon Fracture. (1) In the UK, is there a standard view as to *how long* a patient should wait before removing screws/plates associated w/ olecranon fracture surgery? (2) Do you suggest waiting at least 6 months OR do you schedule patients in for the removal surgery as soon as the bones are united? I ask this because I had heard from a nurse that one should wait at least 1.5 years . . . Thank you.