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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 riser, 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 Wolff’s Law. This has been called stress shielding.”

“Anything else?”

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

“So what?”

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

“Seems fanciful…”

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

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

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

“Well, I don’t remove plates.”

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

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

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

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554 Responses

  1. right after an accident in 2006 or 2007 i’ve got three of my lower thoracic vertebrae fused together. now i experience problems like sciatica, strange pain travelling through my back. could the fusion hardware be removed? what risks i might face? thanks alot.

    • The sciatica is unlikely to be directly related to your spinal fusion. (it might be indirectly related because of different patterns of gait, or a sequel to the original accident – think piriformis syndrome)

      Removal of spinal hardware is usually a significant procedure. However I know so little about the type of implant, or your original injury, that I am reluctant to comment. Your spinal surgeon will be by far the best source of information. Please ask the spinal surgeon.

  2. Hello,
    I am a 22 yr old healthy female. When I was 15 I fell from a fence and shattered my left elbow in I believe 8 places resulting in 2 plates and 7 screws. I was supposed to get them removed after healing but I didnt want my dad to have to pay for another surgery. I also didnt regain full range of motion as I was 15 and didnt do the correct amount of physical therapy. About 2 years ago I finally felt financially able to go through with the procedure. When I met with my surgeon he said I have waited too long and that it is best to just leave them. The arm is not as strong as the other one as I am always afraid of it breaking so I unknowingly favor it and use my right arm more. I am very thin and if I knock my elbow in even the slightest bit it hurts so badly because the skin and the plate getting pinched. The elbow itself doesnt necessarly cause me much pain but I do wish I could straighten it all the way.
    SO my questions are :

    Do you agree that I have waited too long and now they are stuck forever?
    Will they cause problems in the future and be even harder to remove?
    Will I ever get full range of motion back or did I mess everything up forever being a lazy 15 yr old?
    Is there physical therapy that could help me if removal is not an option?
    Many more questions as well but these are the main ones

    • It is always possible to remove plates and screws. The problem is if the bone has grown over the plates. That makes the operation, and recovery, more extensive. So. it is a trade off, benefit verses cost (in terms of pain and convalescence period).

      Having said that, the pain you have when the elbow is knocked could justify removal. Now, not all the metal necessarily needs to be removed. If it is only one plate, or perhaps even one screw then that metal could be removed alone. There is subtle diagnostics in these decisions – it is not all-or-one necessarily. Good surgeon decisions are required.

      The same applies to the movement of the elbow. Reduced movement is very common after this type of injury (as I interpret from your description). There might be one piece of metal that is “blocking” the movement. Once again the design of the surgery is critical to its success.

      While I would not dismiss physiotherapy help and benefit, I cannot be optimistic at this stage

      Should you wish me to look at the x-rays, send them as jpg or similar.

      Hope all comes right…..Best Wishes

  3. Thank you for all the helpful information contained here. I broke my wrist when I fell January 20, 2017. At first I tried having a fiberglass cast on it after they tried to put the bones in place, but it didn’t correct the injury. I was operated on January 24, 2017. It has been 3 months and the bones are healing quite well, without further complications and after my follow-up appt yesterday, the doctor would like to take the plate out asap because the screws that came with the titanium plate protrude past my bone and the doctor is very concerned about complications to my muscles, ligaments and nerves as well as the plate making any future falls worse. I am 60, btw. Female. Any insight into whether this would be good or not good would be appreciated. Thank you very much.

    • If your surgeon is concerned about the protrusion of screws through the bone, which is endangering the nerves and tendons, then removal of the screws should be performed promptly.

      A variant from removing the plate can be to leave the plate and remove only the screws.

      The advantages of this is a much smaller surgical procedure (the screws can be removed individually through small incisions under local anaesthesia).

      My patients usually leave hospital the same day, and instead of sutures adhesive strips are sufficient, so avoiding “follow up” consultations.

      The plate could then remain in situ continuing to provide support.

      Perhaps you could discuss this approach with your surgeon?

      Thank you so much! Didn’t expect such a quick reply. I will discuss this option with my surgeon. My question is, why even use screws that are too long? I couldn’t really understand his explanation. However, wouldn’t leaving the plate continue to pose risks as explained in the first part of your website?

      Many thanks!

      You are partly correct in that the retained plate might act as a stress riser. However, all surgery is a compromise. Because, once the screws are removed, the plate will be able to move slightly, a stress concentration should not be that important. Further, the removal of the screws will obviate the “metal dust” problem.
      However, having said that surgeons tend to repeat what they have done in the past, and it takes an exceptional surgeon to modify what has already become routine. My guess is that your surgeon will insist upon removing the entire plate and screws because “that is what he has always done”

      Thank you very much, Dr. Jon, for all this very helpful advice! Very kind of you.

  4. I had a plate out in finished last Jan. Screws in ankle ball and4-5″ higher.3 screws top 3 bottom. Had burning sensation throughout healing process. Now have an infection showed up two days ago. They drew fluid from infection for testing and then said plate needs to be removed surgery set Monday morning. Is this common or was it due to parts? Is this common.

    • Infection is an always-present, ever-present hazard of all surgery. It is more common in some hospitals and some surgeons have more infection than others.

  5. Hi there, I had a comminuted fracture of my tibial plateau in 2009. A horizontal plate and two vertical plates were put in my right leg, along with 12 screws. I also suffered permanent nerve damage down the right side of my leg and over the top of my foot as well as a drop foot. In 2011, it was determined that I had a non-union and was required to do an attempted reconstruction. The same format of plates were put in, plus cadaver bone, plus a bone graph from my hip. An additional 4 inch screw was put through my knee joint to stabilize it. I again came out with a drop foot, more permanent nerve damage. Now 2017, I have on multiple occasions torn my ACL, PCL, Meniscus, doing almost nothing and have had multiple bouts of tissue damage from simply moving the wrong way. The screws protrude from my skin, as do the plates. All this to ask, am I at risk of something happening if this hardware doesn’t come out?

  6. I fractured my leg right above the outside right ankle about 9 years ago, my orthopedist said I could leave it in for life then later I found out he was sued for some reason or other and now 9 years later I’m having pain and discomfort from the plate and 4 screws. I’ve actually had this problem since I began walking on it again after it healed. I also get swelling and pain right around the plate if I happen to step down too hard. I’m scared to have them removed but I feel it is necessary. After this long, is it possible to still have them removed without damaging the bone further?

    • Metal implants can usually be removed many years after implanting. If metal is causing problems it is usually best to remove it. The surgery is far less intrusive that the insert surgery, and many use the limb the same day. I hope it goes well and the removal is beneficial.

  7. Hello, I’m not sure if this is still active but will post anyway and hope. I fractured my ulna 3 year’s ago now, it was fixed with a plate and screws, everything has been fine up until now and now I and have been experiencing pain and slight swelling at one end. I’m going to the doctor tomorrow but wanted to get another experienced opinion. Many thanks for your time.

  8. Hello I broke my left forearm both bones and have a plate and screws in each bone. I did this when I was 15 years old and I am now 27. I have been wondering if I should take them out as I have been having joint pain in other areas of my body and that having those plates might be reducing my ability to heal and may be a contributing factor. Basically ware and tear there as im constantly using this arm with no pain mind you, however i am worried its sapping a lot of nutrients from me using it so much to heal that specific area not leaving enough for the rest of my body. I am concerned that might be happening. Please let me know your opinion.

    • You have no reason to believe that “nutrients are being sucked out”. That does not happen. If the metal is not troubling you directly, then leave it alone.

  9. Hi,
    I sustained a full open book broken pelvis back in Feb 2013 at 33yrs of age. WIth a clean break at the pubis joint and rightside SI joint. A plate was inserted on the front and the SI joint pinned. Shortly after surgery a Staph infection decided to come to roost. Further surgery to clean the infection followed by a course of Daptomycin Anitbitotics. Infection cleared. Pins were removed some 6 to 7 months later to free the SI joint. Plate has remained. All in all no mobility issues and no pain.

    About 2 months back I had a scan which showed one of the screws backed out by 1 cm; and as of today I am experiencing some localized discomfort right of the pubis joint in the region of said loose screw.

    So questions –
    Should I move quickly to have the plate and screws removed, or could I take my time? – My surgeon was happy to leave the plate in as long as necessary, but on the basis of reinfection did communicate that would be the driver for removal.

    In removing the plate and screws will that in fact further strengthen the joint [assuming the cartilage has indeed fused / healed correctly], I ask as I snowboard extensively at a high level and abrupt impacts are common.

    For reference, Male, 36, 215lbs, active.
    Kind regards,
    Shane.

    • In view of the infection, and since I do not know the extent of that infection, our surgeon is your best source of information.
      Ultimately it is the bone which will give you back the skeletal strength. The plate can be regarded as a “temporary splint” positioning the bone so that it heals in the appropriate alignment.

  10. Hello,
    I fractured my collarbone (butterfly break) and scapula a year ago. I have a plate and screws in the collar bone. After the surgery I noticed what I assumed was nerve pain running from the outer edge of the scar down to the middle of my bicep. NCS have confirmed suprascapular and axillary nerve damage that improved slighlty since the fall, but have remained steady in the last six months. My surgeon says I can now have the plate taken out but I am very nervous about further nerve damage. Could it be something other than nerves that were damaged by the surgery/installation of the plate? Could the plate be trapping ligaments/tendons which would be causing the pain?

    • I can only assume that the nerve(s) was / were damaged at the date of surgery. You have reason to be precautious…

      • Since the plate lies directly on the bone (or should do) it is unlikely that any other structures were “trapped” by the plate.

  11. Hello sir my fibular is fractured I had a surgery in which the plate inserted can tell me that my operation is right or wrong

  12. I had a plate put in my big toe for arthritis. This was two years ago. I now have pain in that toe..is this normal? Can this happen? I find myself limping again cause it is so painful. Should I go and see my orthopod about this?
    Chanel.

    • I assume that the procedure of “arthrodesis of the great metatarsal-phalangeal joint” was performed.

      If that was performed correctly, you should be pain free. It is possible that the plate, having performed its service has loosened, causing pain. See your orthopaedic surgeon about this

  13. Hello sir. I met with a road accident on 2nd Nov 2015. I had tibial condyle tubrosity fracture in the left leg. I was operated on 5th Nov 2015 with internal fixation with a butress plate and seven screws. On the same day I had a severe pain near the ankle. On the next day I was operated and a screw was removed from the top of the butress plate. Subsequently i had a foot drop. I under went phsio therapy and nerve stimulation by electric pulse for three months. I was back to duty in Feburary 2016 with a foot drop. My OS told that foot drop will recovery and recommended to use foot drop splint. I am using it now. I found to have improvement over past six months. I continue doing physiotherapy by myself every day. but still yet to recover fully from foot drop. I have no other pain and good in walking and little bit of jogging. I am nearing one year completion. Is it recommended to remove the plate as of now? . Will I recover from foot drop if so?

    • From this distance it seems that the Common Peroneal nerve was damaged by that screw (now removed).

      If full recovery occurs, that could take as long as a year.

      Because of the complication associated with inserting the plate, it might be wise to leave the plate in place.

      I suggest that you discuss this with the surgeon who inserted the plate

      • Dear Sir,
        On consultation with Ortho surgeon he recommended me for plate removal and I got it removed on march 24, 2017. Now after a period of one and half month, I am able to walk without foot splint. But my doctor recommended to use it for next six months. I am happy after hardware out. My foot is not falling down when I lift, but I am not able to lift further upwards. Sir whether I will be able to recover fully from foot drop ?. Kindly reply me.
        Thank you.

  14. hi i met wid an accident 17 months ago and my left forearm ulna and radius broken and plates were inserted .. now i want to remove the plates i am 18 years old . as i am going abroad that why ..is it good to remove the plates and i also want to join gym after how much time it will be normal..pls give me advice

  15. My name is MD Asfaque .
    Screws were implanted back in 2009 in my pelvis .
    After 7 years I admitted to remove that implant but doctors failed to remove that implant.
    I practiced cricket before operation .
    Is there any risk of infections or sceptic in my pelvis ?
    Can I ever come back in my cricket practice if implanted screws still in there .
    My weight is 95 kg .

    • The great likelyhood is that you will be able to play cricket despite the pelvic screws.

      The risk of sepsis is small, and that could be addressed even in the unlikely event of that happening

  16. Hello this is my second time posting, sorry if you get both.
    I’m am 26 y/o female, live a healthy lifestyle, drink all my vitamins and such and very active. Recently I broke my humerus, going on two months now that I’ve had the plate and screws in.
    I am debating on getting the materials removed, Doctor said they will not come out. I want them out as one of the screws on my elbow is very visible. I’m scared that if I bump it I might cause more damage. At first I didn’t feel the plate, but as I move my arm I feel the plate along the back of my arm.
    Should I get the plates removed before time passes on? I was kind of thrown into surgery, amongst all of it was never given any other option.
    Now reading, I want these foreign objects out.

    • I do not know why the surgery was performed in your case, but there could have been necessary if not imperative. These are sophisticated decisions best left to skilled professionals. I would therefore not anguish about the decision process having been taken away from you.
      It is possible to partially remove implants: for example a single, troublesome screw could be removed under local anaesthetic through a tiny incision.
      There are risks to the radial nerve when plates on the humerus are removed: please discuss this with the surgeon who implanted the metal.

      • Thank you for your opinion. I know I broke the bone, when I would move I felt the movement of the bones.
        Now just my concern is getting the plate removed only after two months. All the holes do concern me but I’m sure over time they will fill in.
        I’ve read, the longer you wait the harder it is to remove them.

        • I have no doubt that the bone was broken.
          There is no hurry to remove the metal – nothing much will happen inside a year.
          Ensure that the bone is healed (by X-ray) before the metal is removed.
          The holes will likely fill over the next year.

  17. Hi Doc,
    I am a 61 year old male
    I fractured my right fib just above the ankle about 25 years ago and had it pinned and plated. I had the long screw removed which i believe was holding the ankle in place. this was done 6 weeks after the op.. Whilst in hospital it kept swelling up and the pain was excruciating whenever i put my leg down and i was in hospital for about a week after the op.. On visiting the plaster room the sister refused initially to plaster it as i was in a wheelchair with my leg down and the leg had swelled up. I was laid on a bed and when the doc came it had gone down due to it being raised so he said it was ok and was plastered.
    A week later i had the plaster removed to take my stitches out. The plaster of paris cast was replaced with a fibreglass one. Over the next few days i was in pain, only relieving this by elevating my leg. On returning to hospital i was admitted for a week as i had a DVT and was told they should have put a plaster of paris cast back on.
    Over the years my leg has often swelled up to double the size and on elevation soon reduces. Such as over night whilst asleep.
    I do not have pain, it is the swelling.
    i have over the last 3 years developed drop foot due to long standing sciatica. I am waiting to get to see an doctor about my swelling and was told to do calf stretch exercises 3 times a day as they want to make a mould for my foot, however they cannot do this whilst my leg keeps swelling.
    Can the pins and plate cause such swelling and if so why does this do so. Otherwise are there any other reasons. My left leg is nornal.
    Many thanks
    Gordon Pickerill

    • The probability is that you have a “venous insufficiency” due to the long past deep vein thrombosis.
      The management of this could be an elastisised stocking. There is probably no need to remove the plate at this stage.

  18. Hi, I am 36 y/o male. Involved in road traffic accident 2 years ago. Polytrauma, fractures in pelvic bone, right femur, left humerus, and right radius ulna and had implant in all of them. My arm near where the ulna implant is, had been painful since after my operation especially when i knocked/rest my arm on the desk).

    Fast forward to now, my skin at the right ulna scar area, had some redness and swollen and it was painful since few months back and it came and gone for few times. 2 weeks ago, the same spot was painful and it had blister. Last week the ortho doc popped d blister, cleaned the wound and administered antibiotics. Send the sample for culture but we have not get the results. Xray shows the radius ulna have unionized and there is no loose screw at the interlocking plates. My doc highlighted that if it was an infection, we have to remove the plates.

    What do you think that causes this initially? What do I have to prepare myself for? What are the chances that I need to remove the implants?
    I can send you the xray sir, if you let me know where to email it to.

    • It is always difficult to find a cause for an infection which occurs after (at times long after) an implant. Bacteria circulate in the blood stream for a variety of causes which include dental and urinary tract infections and can “settle” near an implant.

      There seems little doubt that you have (or have had) an infection associated with the ulnar plate. This might be so even if the attempts to culture the fluid from the blister failed to demonstrate an organism.

      With good fortune matters might settle as a result of the antibiotics which you have received. However, my experience has been that recurrence is likely unless the plate and other implants are removed.

      Removing an ulnar plate is usually not difficult, often performed under local anaesthetic, with full function immediately. The stitches might require a week or more of care.

  19. Hello,
    I am going to be having lapidus bunion and hammertoe surgery for bunions caused by metatarsus adductus in a few months. The dr indicated he would be putting in a plate 3 screws and many pins. Most will not be coming out according to him. With bunion surgery is it advisable to have the screws and plates and pins removed?

    • The deformities of the forefoot are caused by soft tissues alone.
      It is irrational to cut and angle perfectly normal bones or ablate perfectly normal joints, and then hope that healing of the bone will occur.
      Consequently the question of inserting and removing screws should not arise.

  20. I was in a bad accident when I was 18. I broke a bone in my knee. I had 4 screws put in. I have had them ever since. In the last 3 years I’ve had a lot of issues with my knee because now there is bone rubbing on bone since I don’t have much cartilage left. I am not sure whether it would be safe to pursue getting them removed. I have had many medical issues in the past year. Would it be safe or wise to have them removed? Could it cause other health issues? Also I broke my pelvis in 3 places. I was told that eventually I would possibly need a hip replacement in my 40s or 50s. I am only 32 now. Is that something I should worry about orphan for?

    • It would be safe to remove the screws at this stage. Wise? Probably not, unless they are producing a specific problem. The loss of cartilage from the surface of the knee might be related to the original injury and is not likely related to the screws. Is there any point in worrying about what might happen in the future (e.g. your hip)? That is not going to advance matters!

  21. Hello, I am 21 years old and fractured my first and second metacarpals in my right hand on June 25, 2016 and elected to have surgery (screws inserted) done the following day. I chose to have the surgery done instead of a hard cast being put on because of a faster recovery time and assurance of alignment. However, a couple of days after the surgery I have had second thoughts about the surgery. I have had second thoughts about the surgery due to the fact that I mountain bike, rock climb, ski among many sports. I have a couple of questions, if I wanted to have the screws removed, when is the earliest time I could have them removed and what would be the recovery time (until pre-break bone strength) before return to activities of full intensity (sports listed above). Any feedback would be greatly appreciated.

    • It was wise to have the metacarpals aligned surgically. Apart from angular displacement a problem is often rotation. This causes the fingers to “scissor” and is a considerable handicap.
      I cannot see a problem about returning to your sports once the bones have healed (with or without the screws). A problem about leaving metal in the metacarpals (and the wrist) is the danger of the tendons abrading against the metal, and perhaps tearing. The screws could be removed once healing of bone is established radiologically. Be guided by your surgeon. After removal of the screws? Allow at least six months of normal function for full strength to return.

  22. Hello, my 9.5 year old child has a 4 week old clavicle break that is pretty displaced with 2cm of overlapping. We were told to wait to see if it would heal and recent X-rays show that it has not. He is scheduled for a plate this week with the removal after 6 months. I am distressed at the removal aspect and the thought of more scar tissue and more nerve damage. You give me food for thought and obviously the surgeon thinks it’s best to remove it but I’m still on the fence about a second surgery if it’s not absolutely necessary and my kid is having panic attacks about the upcoming one already. Is is that bad to take a “wait and see” approach to removal?

    • I believe the “wait and see” in itself is not unreasonable. The additional tissue damage caused by “removal surgery” is minimal, and would usually be the reopening of an existing scar.
      As it happens my approach to these breaks is to align by intra medullary pins, which usually extrude themselves after a few weeks

      • Hello again Dr. Well we took longer than expected but we had the plate removed for my 10 year old’s clavicle break. Three days later he woke up screaming in the middle of the night. We went to the hosp and the clavicle has broken through a screw hole three days post op! He was sleeping and hadn’t done anything to injure it. Now we’re supposed to wait to see if it heals and possibly get another plate!
        How common are breaks through screw holes? How could this have happened while sleeping? I’m so upset!

        • This is one of the reasons why I believe plates should not be used on the clavicle. There are other, safer, less intrusive methods of stabilizing the clavicle

  23. hello sir, way back on july 2014 i had a fall from, 4 th floor and got my humerus fractured.The surgery was done and i got metal implant and doctor had mentioned it that its imported and stays for longer period.after few month the wire was coming out so another surgery was done again.till now 6surgeries has been done. on the year 2015march i got my implant removed and on the same year just after a month again my bone got broke from the position where the last screw was removed and again implant was put..by the end of the year there was gap in the bone and bone grafting was done and bone was taken from asis..i want to know the best possible to increase and strength and what precaution to be taken..since m pursuing physiotherapy i can judge it better. also i wanted to ask i want to proceed for some sports so can i? and which one should i opt for..
    waiting for ur reply
    thankyou

    • There are many types of humerus fractures: My guess is that you had (perhaps amongst others) an olecranon fracture (this is often repositioned by inserting a wire band.) Therefore my advice has to be limited.
      In general terms there is no known way of speeding natural healing (In delayed healing electrical currents might help).
      However good nutrition, including mineral and vitamin supplements is necessary – including Lugol’s Iodine.

  24. Hello sir, I am 23 years old, last one month ago I fracture or broke my mussels that is above of elbow. And my operations with one plate and 12 screw. My surgical Dr.says there is no need to remove plate but many other people remove plate in 3 year so i confused So sir plz tell me when I remove my plate or screw. ? My age is only 23. How I keep plate inside my body.. If I not removed so what’s problems arrives in future. I most worried about that sir plz advice me..

    • The problem with breaking the humerus, which it seems that you did, is that there is a high complication rate associated with removal of the metal (in your case a particularly long plate). One common complication during removal is damage to the radial nerve – a significant problem. Of course I do not know where you are located, or the standard of healthcare available to you. Overall you might do best (and be safest) to leave the plate in. Most people are never troubled by leaving the plate on the humerus. If you start to have problems at a later date, then it can then usually be removed.

  25. Hi, I broke my elbow about 2 months ago, break was in my humerus along the medial epicondyle. I had 1 screw put in. Now am unsure whether I should have it removed or not, I am an intense athlete; cheerleading with lots of weight bearing in tumbling. I have not yet regained full motion and am still working on it in physical therapy. I know if I have another surgery, I will be set back with my motion a little from scar tissue. Also I do not know if the holes from the screw will heal. The screw does not bother me like some people’s do however I am worried it will increase my chances of breaking it again or is restricting my motion. The screw is very close to my ulna nerve and that also worries me. Does anyone have any advice?

    • Provided the bone has healed (as demonstrated on X-ray), the screw now has no purpose. It could be removed under local anaesthesa on a day-case basis.

  26. I was severely injured in an automobile accident five years ago. I have had trouble off and on with some(of the 152) plates, pins and screws off and on. But I injured my handa few days ago at home and now of course it’s swollen and painful but could that cause me to be dizzy and feel I’ll and lightheaded? I’m worried

  27. I broke my tib and fib three years ago and am starting to feel pain where the screw is. am thinking of removing it and what are the implications.

    • If the screw is the source of your pain, one implication is pain relief.
      If only a single screw is to be removed that could/should be done as a day-case under local anaesthetic.
      You are likely to be able to walk full weight bearing immediately after the screw removal (assuming the bone has healed – likely after three years)

  28. I broke by clavicle in a motorcycle wreck and got a Ti plate to reduce it in 2008, about 8 years ago. I then took a fall from a mountain bike in 2011 which caused some soft tissue damage to the same side, (out- stretched-arm fall)

    About a year after that second fall I developed a fairly persistent pain in my right traps, upper right shoulder blade area, right neck muscles, and right jaw. This pain worsens with stress and improves with certain exercise/movement.

    I have the urge to remove the plate because the tight muscles seem to all point in its general direction.

    Is it possible? The orthopedist who installed it said it’d be best to remove it at 1 year, or not at all. I’ve read that bone micro-bonds to Ti.

    Is it advisable? I’ve read your comment that the holes sometimes don’t heal in clavicles.

    I’m 39, and athletic although not riding 2 wheeled things as much anymore.

    Thanks so much

    • It is usually possible to remove a clavicle plate without difficulty. The screws (in the screw-holes) do not make the bone stronger, although the plate does give support in case of a further accidental impact. Micro-bonding to a plate depends upon the metal/alloy used. Titanium tends to bond. Stainless steel does not bond, but there might be overgrowth of bone (which should be seen on X-ray). Most plates can be removed even after many years
      From what you say the discomfort you have is more likely to come from the cervical vertebrae.

  29. I broke my left ankle 13 years ago. I also tore all the ligaments on the left and right which had to be repaired.Three months with my leg raised. It took me about two years without physio therapy to be able to walk and run as normal. I haven’t had much pain but occasionally after exercise the area felt a bit sore. I swear I could feel the plate and screws through my skin. After all these years I suddenly developed an infecton in the ankle and had to take antibiotics and anti inflammatories. Doc took X rays as well. Two of the screws were out and just lying there inside my leg. Freaked me out. Doc suggested removal of the plate and screws. A visit to the ortho confirmed it and last Thursday I went in for surgery to remove the plate and 8 screws. It’s huge! Can’t believe that was inside me. The ortho said some bone started growing around the plate already so they gad a hard time to remove it. The pain was bad straight after the op. I refused to pee in the bed pan and insisted that they wheel me to a proper toilet. I had to stand on both legs to get out of the wheelchair and onto the loo but I managed without too much pain. I am staying off the ankle as much as possible. Using crutches if I need to go to the bathroom etc. The pain is not that much but I have staples in the leg to keep the wound closed which is causing most of the discomfort. I also have slight curvature of the spine which makes it painful to sit for so long. It doesn’t feel bad when I walk but the wound feels tight. I have been googling anything I can to find out what happens now and have concerns about another break or not having proper function of the ankle. I am not a competitive sportswoman but I do enjoy gym and being active. I want to resume playing squash and start hiking and am a bit worried about injuries to the ankle. I am seeing my ortho on the 6th of June so I will have a lot of questions for him. Another concern is whether the holes left by the screws will close properly.

    • Thank you for your interesting letter. The post-operation pain might have been made worse by the “overgrowth of bone” (which happens often in the young).
      It is likely that the ankle will function as well as before, if not better, with the metal removed.
      Closing the holes in bone is addressed in other posts on this site.

  30. Hi I broke my tibia and fibula 16 years ago playing rugby. I had a rod inserted and screws inserted in the ankle and just below the knee. After about a year I had the screws removed but the metal rod stayed in. Recently I’ve been getting a lot of pain where the break happened across my shin bone which comes and goes but when it does hurt it’s really painful. It seems to be more painful if I twist my leg. Do u no what this could be

    • Pain developing 16 years after internal fixation must be taken seriously; There might be other causes for the pain, but infection and loosening must be excluded – by X-ray initially.

  31. Hi

    I fractured my right inner and outer right ankle 1998. The doctor put 1pin, 7 screws and a plate and told me it will never be removed again and i will have to live with it.

    As the years went by u started having alot of pain in my back and ankle. Every time something knock against my ankles the pain become unbearable and pain increase in my back.

    October 2012 i thought i will never be able to walk again because i was allready 6months in bed. U went to a specialise abd he told me that the elements was supposed to be removed 2 and a half years after the operation. He said he can remove the screws and plate from my ankle, but to find the pin is like finding a needle in a hay stack, but can’t promise if the pain will go.

    I said ” i beleave that it will be better than the pain im suffering now. October 2012 the operation was performed, and some screws were bent, and pieces of bone broke off.

    It is now 3 and a half years later and i feel a difference and lesd pain. I do have some tightness in my joints but i know due to my age which us 53years now it will take longer to heal, but i take all supplements including blackstrap mollasses and super oxygen therapy to heal my body faster.

    Thanks to the specialist who advised me, and i feel a big difference, and do my iwn physio.

    PS: DO NOT BELEAVE ANY ANY ONE WHEN THEY SAY THAT YOU WILL HAVE TO LIVE WITH THE SCREWS AND PLATE. ALLWAYS GET A SECOND OPINION.

    • Thank you for your helpful comments.

      It might be that the screws broke because of the long period over which they were retained.

      Your note is likely to help other readers, and is much appreciated.

  32. My son had a femur fracture nine months ago and a plate was inserted. He turns twelve in september. How long until the plate is safely removed? Best practice? Is the procedure necessary?

    • The plate can be removed as soon as the bone is demonstrated to be healed by
      x-ray. There is no optimum period to wait beyond completion of healing. However in children the bone might “overgrow” the plate if left too long, increasing the ammount of surgery necessary to remove the plate.

  33. Hello doc no specifics needed , but I just need to ask with all the red tape of insurance and hospitals and orthopedic specialists in the world they don’t want to remove these plates and screws because they can’t find any reason it’s medically advisable or necessary and me telling them about my discomfort or pain or numbness in my middle finger to my pinky and the RA in my wrist and the heurnia in on the back of my forearm doesn’t seem to matter or equal enough concern to them that I want them out they were put in me as a 10 year old and I am now 25 and as a consenting adult I now want them removed.. How or what must I do to get this out of my arm because no one is hearing me.. Apparently until they feel or see my pain “this is the best it’s probably gonna be” and that’s a direct quote from a orthopedic surgeon I spoke to today.. If I deem the rewards may out weigh the possible risks than why can’t I just say take these out please because I’m in enough pain to try it..

    • As is often the case the medical sense of superiority appears unable to be overcome. This is a significant problem in national health services. I suggest that you persist with your repeated requests. In other words, do not take “No” for an answer!

  34. Hi, this is my second attempt at posting. So I apologise if you get both!
    I’m a 47 y/o female. I fractured my middle metacarpal on my dominant hand in Jan 2015 whilst detaching a friends dog from barbed wire. The bone was pretty fragmented and rerequired internal fixation. I had a plate and 8 pins inserted. After several months they found that there was malunion and the plate broke. I had a 2nd op in June 2015 to remove the old metalwork, graft bone from my radius to the area and insert the new plate and pins. I got the ‘all healed’ in January this year. For the past couple of months I’ve been getting increasing pain at the injury site. It’s a deep gnawing pain at the point just below where my knuckle should be and also at the base of my hand. The points I assume are close to the ends of the plate. At times the pain becomes so bad I become nauseous. Would removal of the metalwork be advisable after 2 operations on the same site?
    Thank you
    Karen

    • Above all an accurate diagnosis of the cause of the pain is necessary. If the pain is caused (and demonstrated to be the cause) of your pain, then removal will likely solve the problem.
      But remember that there could be other causes, which might require a capable surgeon to elicit.

  35. hi I had a n operation 4years ago on my left knee(osteotomy) but keep having pains and whenever am having this pains I wouldn’t be able to walk. Also it looks as if my leg is pending again. what can I do? should I remove the plate?

    • You will need to give me much more information if I am to help: Which type of osteotomy and where anatomically? Which type of plate, and where is it implanted?

  36. Hey doc, I had a severe ankle break about 3 years ago I now have steel from my ankle to six inches above it . i recently started having mild sharp pains at the highest point of steel,it has been around 50° here , though it didn’t give much trouble during cold winter.Why now ? Should I be worrying or is this normal?

    • You say that you are having “mild sharp pain”. I interpret that to mean that the pain is short-lived. While pain developing three years after insertion is always a worry, it might be that you have been more active than usual, and now have a pain which is inconsequential. Hold back a few weeks, and see what results.

  37. Hi Dr. I fractured my left tibia plateau 7 months ago. I still have difficulty straightening my leg especially when walking. I have 2 plates and 6-8 screws. Also bone cement was used due to fragments. 3 of the screws are pushing out into skin and the left plate is just under the skin and is painful especially at night when turning over and after walking on it for awhile. My surgeon said he would probably remove screws and plates. My next visit is in 2 weeks. Do you think I will be better able to straighten leg and have less discomfort after walking when they’re removed? Would there be a chance of doing removal under local? Also when bending knee I can hear a crackling sound and can feel some movement under skin! What could this be? Thanks! I did PT and am going to gym now riding bike,treadmill and leg exercises 3x weekly.

    • It is difficult for me to know what the anatomy of your knee joint is now, following the “reconstruction”. Therefore I cannot predict recovery of full range of movement if the metal is removed. However if the screws are “migrating” and the plate is painful, then removal would be recommended. The metal has done its task and is no longer fulfilling its previous role

  38. Hi, broken wrist Nov 2011 with titanium plate (i think it is titanium) all has been pretty good up until recently when i started to have a few sore days. Usually l wait a couple of days and it eases up. It does hurt in cold damp weather but not too much. Today it started to hurt a great deal, pain on forming fist, up down movements, holding lightest of objects, pain going up to my elbow and shoulder with and after these movements. It’s fine if i keep it still but is stiff and hurts when i start moving it again. This is all just today. I’m a fit, slim 51 yr old female, not sure if i want surgery or recovery again. My wrist was broken taking my full weight falling playing soccer, i don’t know how many places but the radiographer said multiple fractures. Any advice very much appreciated.

    • Although it is always a concern when pain develops years after implantation of metal, it is equally important to know whether there could be another cause for the pain – for example Dequervaine’s tenovitis.
      This would be best diagnosed by your family practitioner.

  39. Hello doctor. I had a tibial fracture 6 weeks ago and lost some bone so surgery is performed and bone graft from iliac crest is used and a plate with 8 screws is inserted.after 6 weeks i have a hard mass like thing formed at the place where the edge of plate is present and screws inserted that hurts when it is touched. But the fracture area where bone graft is placed is fine did not hurt at all. The hard mass is present just at position where screws are present at plate’s edge.i want to know if it is kind of infection there or it is just due to plate? That hurts when touched . There is no wound remaining on my leg all wounds healed.

    • The swelling might have a number of causes, including new bone formation. However, to be safe, a further x-ray is recommended for diagnosis.

  40. Hi I fell off a ladder and shattered my calcaneus. I had three 4 inch rods put in and was sent home for two weeks to get the swelling down. Second surgery was to insert 14 screws 5 pins and a very large plate. I am very active and worked hard doing yoga weight bearing excercises, lots of stretching and stationary bike. It got to the point it was feeling ok but there was always pain by the end of the day that I usually ignored. It felt like I was walking on 14 screws 5 pins and a plate. I couldn’t wait to get it all removed. I waited 20 months and went back for third surgery. I am now hardware free… I have to say I felt immediate relief. My surgeon had to clip off 5 bone spurs that had grown around the taleous area and thinks this will help movement as well. I have a follow up apt 6 weeks after surgery. My questions are;
    1) will the bone fill in the holes and how soon? X rays look like Swiss cheese down there…
    2) is it bad for me to be walking around barefoot in my home?- can I hurt it? I have read movement and weight build bone,right?
    It’s been 4 weeks since removal and 8 days since stitches were removed.
    I will be start riding stationary bike this week to get it moving… Movement helps.

    • The holes in the bone often (but not always) close as the bone heals. However even if they do not “close” as demonstrated on x-ray, the bone as a whole does not appear to lose strength. That is because the adjacent bone strengthens. Further, the calcaneus is not a “long bone” with that type of “lever arm” load which might cause damage.
      Walking without shoes should not load the calcaneus any more than walking in shoes: the loading of your body-weight remains the same. However the “bare” foot is able to adapt better than when it is constrained in a shoe, and so it is able to dissipate energy better.

  41. Hi! I am Esther Osawaru, I’m 22 years old. I had an accident on the 19th of July 2014 which left me with a crushed foot to my toes and a broken thigh. After a lot of surgerys, I am able to b on my feet again but I have a plate and screws on my right thigh, I feel discomfort with it sometimes, I can’t sleep well with it, after walking some distance I feel so much pain. My doctor told me that I will have to undergo another surgery this year (which is after 2 years) to get the plate and screws out of my thigh. But I’m afraid, I don’t want something wost to happen to me.

    • Should you have the plate removed it is highly unlikely that “something worse happens”.
      Most people can walk the same day as having a thigh plate and screws removed, and the stitches are usually removed after a week or ten days.
      From what you say, you should be pleased that you had the plate removed.

  42. Hello sir I am 62 years old man.five years back I was under going surgery in my left hammering arm with plate&screw . I am not any problems in my arm . should I do for surgery for remove?

    • If you do not have problems now, please leave well alone….

      • I had pins and a braket put in my tibia after snapping it around 15 years ago as it’s on bottom of leg top of foot on outside I catch it on stuff all time and it realy hurts as there not suppose to be there and my foots gone purplish as if circulation is poor? Could I get them removed? Thanks

        • What you describe might be a plate on the fibula. At this stage healing is likely complete and the plate now has no function. If so it can be safely removed, provided that there is no problem with the overlying skin. Have the blood circulation checked by your surgeon!

  43. I broke my arm and dislocated my wrist in an ATV accident, now 2 years after my surgery, my implant site on top of a screw started to swell and had become very painful. Pretty much if I bump my arm it is in a ton of pain and aches for a minute or so. Does not look bruised but very swollen. Wondering if my screw is migrating.

    • The screw might well be migrating. Such migrations can be associated with a (localised) infection. The pain might be associated with an abcess. Orthopaedic opinion is advised.

  44. I have a plate running from my wrist to my elbow and the way that it pertrud above my wrist I’m forever catching it on everything and can’t take it anymore I’m disabled and on social security and not very much money and don’t know what to do anymore.

    • It is unusual to have such a long plate, which might reflect multiple breaks. However, assuming the bone has healed sufficiently, it seems that the plate is a significant intrusion into your life, and removal should be considered. It might be possible to do this under regional anaesthetic and “percutaneously” as an outpatient (which will reduce costs)

  45. i am 82 years old and had a serious break and dislocation in my ankle 22 years ago which ended in 1 – 3″ screw inside the leg and a plate with 6 screws on outside, this gives me more pain now than when i did it.most days, how can i relieve the pain.

    • It might be that as a result of the alignment following the break that you have developed an “arthritis” in the ankle. It might also be that changes or movement of the plate or screws are causing the pain. You need a competent orthopaedic surgical opinion.

  46. I had an ORIF of my right wrist, it will be 4 years ago in March. I had reached for an item under my vehicles seat, which was a tight fit and pulled my wrist out to free it. By the time I got inside my home I noticed on my wrist a “knot”. I did not experience any pain but of course was concerned about the knot but not overly concerned because no pain was experienced. This was a few days ago and am starting to feel an annoying pain perse but nothing that I’m concerned with but my concern is what the knot is and am afraid it is the actual hardware has possibly been compromised and am not sure it warrants a visit to the Dr or not. Of course I’m not insured and am concerned if I actually need to be seen or not. I am experiencing more discomfort and have felt a brace would be beneficial to wear till I obtain the information if it is something that requires medical attention or not. My financial situation is the only reason I’m searching for reasons to justify a Dr’s visit at this time and if so should I call my PCP or the surgeon who preformed the surgery originally. Thank you for any advice. Sincerely

    • You do not say when the “tight fit” injury occured. I will assume that it was recently.
      It is difficult, I know, to describe the “knot” more accurately. The most likely cause of a rapidly developing swelling after trauma is an accumulation of blood. A “ganglion” is another possibility.
      The issue is whether someting needs to be done now to prevent somthing worse in the future. The high probability is that you do not need to hurry, and can watch developments for some days. Matters might resolve spontaneously.
      My caution is that you might have ruptured a tendon which has curled up to form a knot. If so that might need a surgical repair.
      Thus, to resolve your dilemma, has the knot changed (i.e. got smaller) since the injury? Does the “knot” move when you move your hand or wrist? Is there any sign of bruising?
      If you feel there is a need to get more advice the surgeon would be the best first stop. He will likely request an ultrasound examination, which is relatively inexpensive. Or get the ultrasound first if that is possible.

  47. Hi I am so glad to see this post. My question is that my had a mva that he end up breaking his femur, screws and rods was inplaced. The accident was 6 years ago now. He is been experiencing intense pain mostly whenever the weather bad like either too cold or too hot. What can you suggest?

    • At this stage (six years after the break) the femur should be well healed and the metal is now unnecessary. It seems that an intramedullary rod was used (with transfixation screws).
      Things can go wrong, even six years after the surgery. An x-ray is advisable.
      Removal of the rod (if that is what was implanted) is straightforeward, and immediate weight bearing is usual.

  48. I have a plate installed in my humerus for two months now and I still do not have full motion. It was a fracture in the lower humerus. However, I can feel two sharp points in my elbow, which if I touch feel like the two ends of the plates (and not like some screw since screws do not have edges). One of them is so pointed that it hurts even with a slight hit, and I am so worried it might even puncture my skin some day if it accidentally gets hit hard. The other end of the plate hurts in the morning as if something is irritating my skin from inside. I am worried it will even obstruct my full elbow motion when I start physio.

    Is it normal to have end of plates popping out like this? I’m 26; can plate removal help or do I always have to live with this pointed elbow now?

    • Although it sounds (from what you say) that the plate is so close to the skin as to be uncomfortable, this can be deceptive. (Fragments of bone, for example, might give this feeling).

      The solution will be given by x-ray, which I suggest be arranged.

      Once the bone has repaired itself (also demonstrated on x-ray) there is no reason why the plate should not be removed.

      • Hello doctor
        X rays confirmed that the protruding part near elbow is end of the plate. Now I have got swelling in my elbow with pain if I touch it or move my arm. The swelling is right where the end of plate protrudes out. I was getting back range of motion which has also got affected and I cant move my arm much.

        What do you think it could be? I am worried if the swelling persists and needs immediate removal of plate. It has been three months now post surgery.

        • Has the plate completed its task? said another way is the expected healing complete? That would usually be determined by X-ray.

          Once the plate has done its task it is usually possible to remove it.

  49. I shattered my wrist 10 years ago and still have the plate and 8 screws. It bothers me on a daily basis. How do I have it removed? Do I have to go to a specialist or my regular doctor for a referral? I did t realize it was worse to have it stay in. I was not informed that it should be taken out after it healed. They told me that it might have to if the pain remained and got to be bad. Please what do I do next? Thank you

    • If it “bothers (you) on a daily basis”, and if you are certain that the plate is the cause of this “bother” then removal is justified.
      Removal should be done on a day-stay basis, under regional anaesthesia, with near full function immediately.
      I do not know where is your domicile and I therefore cannot suggest a pathway to the orthopaedic surgeon.

  50. Hi Doct.. i have a plate in my right-leg its been 1yrs 5 month now. i just want to ask should i removed it?

    Thank you for your respon.

    • I assume that this plate is on the tibial. If so it should be relatively easy to remove, without loss of ambulation during convalescence.
      However, it needs certainty that the bone is satisfactorily healed, as judged by x-ray.

  51. I recently broke my femur in the bottom section near the knee and I plan to play rugby once im better, I was considering removing the plate as I was told it restricts movement slightly and your bone can break again at either side (I don’t want to break my femur ever again) what’s your opinion? I’m 3 moths in and there’s still lots of swelling and my leg does t bend beyond 70% I’m fully weight bearing, off my crutches and able to run slightly what should I do

    • Three months might be too early to remove the plate unless there are compelling reasons (such as the need to increase knee range of movement).

      Your surgeon is the best source of information.

  52. Hi! I got a fracture in my humerus about four weeks back and have got a plate and 8 screws in place to fix it. I want to get it removed after the bones have healed because I do not want to keep a foreign material inside me throughout my life and I am still in my early twenties making chances of a quick recovery high.

    I have read there can be complications if plate removal is postponed too much and that it should be removed within 18 months of initial surgery. However there are people who had it removed within 9-10 months.

    What is the optimal time to get it removed? Also, is it possible that my surgeon refuses to remove it just because I didnt have any complications? I mean is it okay to get it removed just because I dont want to live my whole life with a plate inside me and also because I want to avoid any complications that may arise later in life?

    • The plate can be removed once the bone is healed. The healing time varies, even although you are as young as you are.
      A risk of surgery to the humerus is damage to the radial nerve, and in some institutions that is regarded as a reason for not removing the plate.

      • Hello doctor..Is it okay to ask my surgeon to remove the plates because I want to avoid complications that might arise if it has to be removed several years down the line? I also want to be actively involved in many tough sports and activities such as martial arts, rock-climbing which I don’t think I can do with the plate in (the fear of a having a plate inside is too overwhelming).

        Specifically, is it normal for patients to ask for hardware removal because they consider it a foreign material or they always have to wait until some complications arise to justify its removal to their surgeon? Can my surgeon say “no” just because I am opting for it even when it is not causing any problems at this stage? I feel hesitant about what if my surgeon gets upset or angry if I insist for hardware removal. What is the usual healing time after which I can bring up this idea of hardware removal to him?

        • Your surgeon might advise you not to have the plate removed, or “not yet”.
          Since he shoulders the responsibility for the surgery, that decision must be at his absolute discretion.

          • I wouldn’t remove the screws. I have had the plate and 8 screws in for 13 years now I’m 31. I can do everything now. Run, golf, baseball etc.. I have limited range with inside movements. My pain levels are low. Takes about 2-3 years to feel normal though. Why risk another stressful surgery you’ll be fine soon!
            Best of luck

  53. I’m a 47yo female with Vit D Resistant Ricketts. Approx 27 years ago I had multiple surgeries to straighten my legs. I still have plates and screws in both femurs. My surgeon told me he wanted them removed approx 1 year after the surgeries but unfortunately that never happened and due to my husband being in the military we have moved several times. Any time I go to a Dr. and complain about unexplainable pain in my legs, an X-ray is done and unremarkable. I’ve recently started PT, I am having pain in my (L) femur and if I had to guess it is right where the plate ends. I’m nervous to demand the hardware be removed, d/t my Hx. But I also feel as though they are doing more harm than good at this point. Suggestions on further diagnostics, should I request an ortho consult? Thank you in advance.
    Paige

    • I understand that you have a specific pain at a specific site (as far as you can tell).
      It is not unreasonable to request an orthopaedic opinion again, for this “new” complaint. To preserve you from additional radiology the previous films could be correlated with your present site of pain.
      One way to ascertain the site, if not the cause, of the pain is to inject that specific area with local anaesthetic. If that (temporarily) abolishes the pain you have good reason to expect that to be the site of origin of the pain (other causes are possible, but that is where good clinical expertise is valuable).
      Should the origin of the pain and the implants coincide then removal of the implant/s would be justified.
      Another approach would be to use radio-isotope uptake as a test for latent pathology (including a low grade infection)

  54. Hello my name is Joses, it’s been one year and three months ever since was involved in motor vehicle accident. I got serious injuries on my neck, left arm and right foot. To date i still feel pain on my neck especially when I try to look around. My humerus bone was broken and had a couple of wounds which once pressed I feel sharp pain all the way to my fingers. The doctor fixed me with a metal plate and six screws to aid healing of my left arm. To date i still cannot stretch my arm beyond 90 degrees on my elbow. For the right leg I suffered serious injuries on both fibula and tibial bones slightly above the ankle. I have a metal plate fixed on my fibula to date. As for my tibial bone the doctor who first attended me was for the amputation of the leg thus he took of my crushed tibial bone pieces leaving me with a gap. The doctor advised for a bone graft once the wound on my right foot was healed which has not been done to date. Please advise will the plate on my fibula be removed to pave way for a bone graft and could there be a possibility I will be permanently disabled as my left leg keep growing am afraid one leg will be shorter than the other. Thanks.

    • I am saddened by your letter.
      It might be that your radial nerve has been caught or tethered to the plate or scar at the site of the humerus break. (Is the pain on the back of your hand when you press on the wounds?)
      The elbow is a very “unforgiving” joint, and loss of bending is not uncommon. Swimming might help you much.
      The fibular plate might need to be removed. I cannot say with certainty, knowing little about you.
      You might well have a short leg. But this can be well compensated by a raised heel on the right (only).
      If you are still growing the left leg growth can be stopped by a surgical procedure (epiphysodesis)
      Please write if you feel that I can help you further

      • I am a 56 year old female with a plate and 6 screws in my right arm from 35 years ago -open reduction /nerve damage-lost use of my hand for 6 mos. recently I have had pain in the right arm that is different from arthritis. The plate wasn’t removed because of chance of possible permanent damage if re-fracture occurred. Could the plate be shifting or a screw coming loose?

        • I am sorry to hear that your radial nerve was damaged during the initial fixation of (what I guess to be) a humeral fracture.
          Although the reason for retaining the plate (“because of a chance of re-fracture”) was not valid, I can understand the caution re. the relative merits of removing the plate (and the risk of further nerve damage, which still applies).
          You do not say whether the pain in your right arm coincides with the site of the plate, or whether the pain radiates into your hand. Those are important considerations.
          Only you know how troublesome the pain is, how much it intrudes into your life, and how much it justifies a surgical approach.
          Implied in your question is “Do I need to do something now, to prevent something worse happening in the future?”
          It is unlikely that prophylactic management is necessary. However there are many variables which are best answered by an experienced orthopaedic surgeon. [I certainly would not let an inexperienced surgeon remove the plate, and if that is done it should preferably be done by an experienced “upper limb surgeon”]
          In the interim an X-ray is fully justified. It is possible, even after all these years, that something has gone wrong.
          Please let me know the outcome.

          Only you know how troublesome is the pain, how much it intrudes into your life, and how much it justifies a surgical approach.
          Implied in your question is “Do I need to do something now, to prevent something worse happening in the future?”
          It is unlikely that prophylactic management is necessary. However there are many variables which are best answered by an experienced orthopaedic surgeon. [I certainly would not let an inexperienced surgeon remove the plate, and if that is done it should preferably be done by an “upper limb surgeon”]
          In the interim an X-ray is fully justified. It is possible, even after all these years, that something has gone wrong.

  55. Hello, approximately 12 years ago my left wrist was broken in multiple places due to a football accident. A plate and six screws were surgically implanted and for the most part I have been pain free….until the last couple of weeks. At times I get nealry knee buckling pain around the wrist area however mostly the pain starts there and radiates down my arm to about my elbow. I’m contemplating a visit to my orthopod however I was wondering if you think the pain is a result from the plate or something else. Thank you in advance for your response.

    • The recent onset in pain might be the result of a number of causes, inclding loosening of a screw. However other causes must be considered. An x-ray is obligatory now.

  56. Hello, and thank you for your post. I am a 47 year old active female in overall good health. Last May, I had ORIF and external pinning of an intracondylar fracture in the pinky of my dominant hand. My doctor is now recommending removal of the internal screw to increase motion at the joint and decrease pain. Your article clearly explains the benefits of such a procedure. So my question is…other than the normal risks associated with surgery, is there any reason NOT to have the screw removed? Is there any potential for my hand to get worse instead of better? Thank you for your help.

    • At times damage to the digits is irreperable, leaving decreased function (and – rarely – pain).

      A counsel of perfection would be to have an assured diagnosis as to the precise cause of the functional loss and the pain. It might be, for example, that the digital nerve was damaged during the surgery, resulting in a “neuroma”.
      There is no substitute for an astute and experienced clinician in this respect.
      However, if all else fails removal of the screw is a very reasonable and usually successful procedure.

      In my practice I would usually use a regional anaesthetic block, rather than a general anaesthetic.

  57. Thank you for the informative posting and article. How would one determine if the pain experienced was due to the hardware, arthritis, or another issue? I fractured my left ankle 13 years ago, which was repaired with a plate and 6 screws. Over the years I have had occasional discomfort but nothing serious until now. In the past week I have experienced a great deal of pain in and around my ankle although no real swelling. The pain is sometimes so acute that it is very painful to bear weight. The pain is worse after periods of inactivity (first thing in the morning) but also after moderate use (climbing stairs). Perhaps at 37 I am just beginning to experience arthritis in this ankle, but if the issue could be the plate and I might have relief with its removal, I would pursue. Curious is there is a difference in symptoms between hardware pain and arthritis that would point me in the right direction. Thank you.

    • There are a number of ways that metal implants can cause pain:
      1. Overt infection can develop adjacent to implanted metal at any time, even years after insertion. This is usually fairly easy to identify since there might be evidence of systemic infection. Radio-isotope and other studies (including laboratory studies) can help.
      2. Abrasion of adjacent moving tissue against the plate – or often screws which move from their original site. This is usually a clinical diagnosis, but one which a skilled diagnostician will manage.
      3. Various sensitivities to metal.
      4. The “cold syndrome” with changes in ambient temperature of pressure.
      Standard radiology would be the starting point in diagnosing such causes. Thereafter “dynamic” radiology, where movement of the joint is visualised under image intensified screening, to identify a position associated with the pain.
      Judicious use of local anaesthesia can help
      As could be expected arthritic changes can begin at any time, particularly with avulsion of a fragment of cartilage.
      You need a good clinician to help with this diagnosis. Will you let me know the outcome?

  58. Hi sir,
    Thanks for this post. 🙂
    I got a plate and 6 pins for my little pinky fracture in 2011. 5 years later, it hurts with temperature difference and also certain movements. Should i get it removed? Read that if it isnt so bad, its better to leave it in. What do you think doc?

    • Only you know how much the plate is inconveniencing you and intruding on your activities. There would be no other reason to remove it, unless your discomfort become worse.

  59. Hello broke my clavicle two years ago got a plate and 9 screws have been having pain in my upper back,trapeze on side with plate and a lot of pain in opposite side lat muscle, went to see surgeon and he will be removing the plate this month was wondering if you have heard of any of the issues Iam having any info would be great thanks

    • It seems that your symptoms are some distance from the repaired collar-bone. However these kinds of apparently unrelated pains are not uncommon in orthopaedics. One cause is “adaptive posture” where an abnormal postural position is adopted to “protect” or avoid using a (previously) injured area. I cannot tell whether removing the plate from the collar-bone will correct all your symptoms. What I can say is that plates on collar-bones are replete with problems, including long term symptoms. Did you injure any other regions when you broke the collar-bone?

      • Hi Dear I broke my shin bone due to car accident. It was a comminuted break. A plate and 7 screws inserted and were removed after 17 months. At first I wasn’t sure whether Its good for me but luckily I did the best decision ever. I am plate and screw free and my leg strength came back to normal sometimes I forgot that I had a broken leg or I had an accident. So go for removal of plates and screws. God bless you.

      • Not that any doctor brought up to me so I would say no I did not injur anything else. Another question I have is once the plate and screws are removed will the holes fill in and how long after is common for people to return to working out like bench pressing and other shoulder and chest workouts thanks

        • You wrote about your clavicle fracture originally. The clavicle is an unusual (“membrane”) bone.
          The screw holes often do not fill, and I have seen clavicles break again through the erstwhile screw holes.
          That is one reason why I oppose plate fixation of the clavicle. Instead one can use intra-medullary rods.

  60. sir i’d rod in my left femur with screws i have pain on the screws if that screws are loosed what happens sir

    • This depends on how close the break is to uniting (joining). If there are signs that it is joiing (on x-ray) the “transfixation’ screws can (and should) be removed without danger, under local anaesthetic preferably.

  61. I suffered a trimallelar(sp?) fracture to my left ankle in October, three screws on the inside, and a plate and several screws on the outside. Bring in construction, seeing those plate screws at crazy angles were alarming to me, to say the least. I had the inner screws removed in June, and was planning to have the plate removed in October. I’m 61 years old and I see pain and problems down the road if I don’t get rid of this thing. And the inside portion of my ankle feels much better with those things out. Am I right in my thinking? Thx in advance for a reply, D.

    • It is not wise to assume that you will have problems with the implanted medtal in the future. Many go throughout life with metal in place. Should problems occur, of course, the metal can be removed.
      Removing the plate from the fibular side should not present problems in terms of complications or prolonged convalescence (you should be able to walk unaided from day one).
      Was there a screw in the “posterior malleolus”? This is often not so easy to remove, and might be best left.
      Best Wishes

  62. I had ulna shortening one year ago on my right arm, plate and 6 screws. I lift weights and the ulna was crushing the bones in my wrist during heavy lifts. Its been one year and while my wrist feels fine now I have significant pain where the plate it. I cant lift as much as my left arm due to the pain. It manifests mostly on the “edges” of the plate. Could it be that the plate is not allowing my bone to move normally like my left arm? I want to return to lifting heavy again but the pain is so intense during workouts I cant curl more than 20lbs where before I was curling 40lbs. (I’m a 44 year old female).
    I think the plate is the problem and want to get it removed. Does that sound like the issue?

    • Symptoms developing after a symptom-free period, confined to the site of a metal implant, are characteristic of a plate related problem, probably – as in your case – loosening.
      A recurring theme of these letters-of-advice is the benefit of good clinical diagnosis. There are many ways by which a sound clinician can arrive at accurate diagnoses via clinical examination and history alone. In your case a supplementary x-ray would be useful.
      Removal of this plate, which is likely close to the surface, should not be a problem, with prompt return to all activities.

  63. I dislocated my ankle and broke my tibia and fibula 15 years ago. My ankle has never been the same, however this week I have had real bad pain and swelling around the metal plate. It almost looks like it is sticking out of my leg. This happened after playing softball and basketball. Can this just be temporary or should I look into removing the hardware? Thank you!!

    • In probability the plate has loosened. If so the new position will not be temporary, and removing it will be the solution.

      If, as I visualise it, the plate is under the skin removal of the plate under local anaesthetic could be a possibility, with walking immediately after removal.

  64. Hello please help me I have 2 plates in my arm and 20 screws my bones are really small so my doctor didn’t recommend removing them I hade surgery when I was 14 I’m 23 now and every know and then my plate on the out Sid sticks out and is really swollen but seems to go away after a couple days now its been swollen for a week and its sticking out pretty far very sore and keeps hurting troubling pain any ideas? Thank you so much hope to hear from you soon

    • “Small bones” are not a reason to refuse to remove implanted metal.

      Swelling and pain are reasons to remove implanted metal; and also to get a diagnosis as to why things have changed after seveal years.

  65. My husband had an auto accident in 2003. His left hip was shattered along with his pelvic bone. The surgeon placed a plate under the sciatic nerve and put a lot of screws and wires in his hip to hold it together until it healed. He told my husband he may get about five years use out of his hip and then would have to have it replaced. My husband has been in awful hip, back and leg pain from that day to present with the pain being worse in the the afternoons.

    Do you recommend him getting the hardware removed to releave the pain? Mayo Clinic would not do this because it was caused by an accident.

    • As always, your husband needs a diagnosis as to the exact source of his pain. It cannot be assumed that the metal and/or its proximity to the sciatic nerve are the cause.
      A good orthopaedist or a neurologist could clarify any involvement of the sciatic nerve (including the possibility that a spinal or piriformis problem exists)
      From what you say the hip joint itself might also be the source of the pain. That can be identified by injecting the hip joint with local anaesthetic. If the pain is temporarily abolished, that would be persuasive that the pain is originating in the hip, and the appropriate management could then begin.

  66. I had a fractured shin bone after an accident in the Philippines. The ortho placed a plate and 7 screws to hold the shattered bone in place. After 4 months my family and I moved here in New Zealand for good. After few weeks I consulted our family doctor and asked if it’s alright to remove the foreign bodies. He said it’s all depends on me but he himself said it’s good to have them removed. After a year of waiting I had my second operation. It was successful. I wasn’t given any cane because the doctor said I was alright. The bone was strong enough after the plate and screw removal. I had enough rest for one week and noticed that the wound due to operation easily healed. Though I walk limp for few weeks then a month but after a month I went back to work. I don’t have any regrets. Removing plates is the best decision that I made. It’s more than a year since the plate and screws were removed and I noticed that all my activities that I usually do before having an accident came back to normal plus the sore on my broken leg doesn’t bother me anymore during winter time here as I felt before. I should suggest go for removal of plates.

  67. I got a plate put in my fourth proximal phalanx of the hand 7 weeks ago. I want to get the hardware out asap before I run out of insurance and move to Germany. I practice combat sports and want to return to training as soon as possible. My surgeon’s office told me I will have to wait another 5 weeks to get them removed. I’m confused because before when I broke my first metatarsal, a complete fracture not requiring surgery, I was able to assume full use at 8 weeks, under the assumption that the bone was healed. When is the earliest point hardware can be removed, under normal circumstances? Can I have it removed earlier if I splint it regularly and are extra careful?

    Thanks

    • It seems that you have two, distinct, reasons for wanting to have the hardware removed.
      The first reason is to have the removal whist your insurance is still valid. At this stage that seems reasonable. However, the degree of healing must be established first, usually by radiology. That is necessary since the healing times of different bones and different injuries varies. You cannot assume that the time periods of your metatarsal break will be the same as the phalangeal break, since soft tissue factors must also be factored into the equation. In any event the potential surgeon who will be involved in the removal must have the final say.
      The second reason which you have listed is your desire to return to martial arts as rapidly as possible. I cannot see how you could return to training as soon as possible by “splinting it regularly” and being “extra careful”. By its nature the martial arts involve unpredictable forces.

      • Thanks for the reply, I really appreciate it. I don’t want to do any full contact striking while the plate is still in my finger due to the weakening of the bone and complicated fractures it might cause. Broken hands, after all, are very common in martial arts. For this reason I want to get the plate out and start the recovery process as soon as possible.

        • It is true that plates and screws relatively weaken the bone to which they are fixed. However, it is essential that the bone is allowed sufficient time to become completely healed. The loads, even on the phalanx, can be extremely high as the powerful muscles of the forearm contract. You will need your hand for much time ahead, and a little patience is a small price to pay for that benefit.

  68. I had femur and tibia fracture. Have plate and screws since last year August. My doctor wants to remove it on the 7/6/15 but I am so scared. Please

    • There is likely to be a good reason to remove the implanted metal.
      I will assume that the break has healed in which case the new incision will be through the old scar and thus you are likely to have little pain.
      If the bone is healed you will be able to walk, full weight bearing, immediately and leave hospital rapidly.

    • I had plate and screws after tibia/fibia fracture back in Dec. 2013 – Just had it removed (except for one screw). A lot easier than the original surgery. Feeling pretty good now–no achiness or tightness in my ankle. Good luck

    • I have both my legs fractured and screwed with plates. And I removed plates from both of my legs at one time. After a few weeks, I suffered a crack fractured due to I was trying to stand up very quickly. I was treated with external fibre to let the bone heal. After a year, I fell down from the staircase and I broke one of my leg(left tibia) at the same fracture part. But so far I don’t feel regret to have them removed, provided that the bones are healed and densed up.

      • Thank you for the reassuring letter, and your optimism despite all your trials.
        What your story demonstrates is the long period required for the larger bones to heal. Your balance might not have recovered yet, and a precaution could be to use a walking stick for another year

  69. I got surgery in march to put in a plate and screws on my ankle. 2 large ones running through the ankle and 5 small holding the fibula. I got hurt playing soccer and my doctor said something anout removing them in 6 months but I don’t know what to do because I would like to keep on playing soccer but I’m scared of getting hurt again.. what would you recommend?

    • It might be wise to wait until September (when the decision to remove the screws will be made), and in the interim rehabilitate the injured joint by cycling, walking and swimming.

  70. My 12yr old daughter is scheduled for surgery tuesday 5/12/15 to reattach her medial epicondyle. Four yrs ago she broke her medial epicondyle and it never fused. It has moved away 1cm over the yrs. She is a high level gymnast now and has plans to test for elite after this (or more like a future )season. She has been wearing a neoprene brace with two metal hinges which has worked well for levels 4-9. the skills are now bigger in level9 /10. She fell landing on her arms and chest, the brace was stretched out, the x band which prevents hyoerextension was not tight enough, and she had pain, prolly having broken whatever scar tissue bond or cartilege bond that was developing. She can not do her sport without the brace and after talking with surgeons, decided she wants a screw or pin to putthe medial epicondyle back as close to original position as shortened, scarred UCL will allow.

    Options are to continue to heal as is and hope the brace failure only is occasional although she has lost trust and may not compete again if left as it.
    Second option is to have metal installed to secure epicondyle which requires drilling hole in humerus for the screw. Painful process and not sure if she will be able to return to her sport, from comments we are reading on line about pain resulting from pins and screws.
    Gymnasts pound and twist on their arms and elbows four to six hours per day 5-6days per week. What are the chances her surgery will turn out well enough to be able to continue gymnastics at the elite level?
    This is her passion and she is only 12 but has worked so very hard for 8 yrs of her life. I hate to allow her the wrong decision.
    To make it more exciting, she can not wear earrings that are not gold. She must wear only gold earrings or the ear gets swolen, infected and bleeds. Will her body have a similar reaction to the metal screw or pin?
    Thanks for any insight you can offer.

    • Was it a break or epiphyseal separation? Has she stopped growing?
      The aim of the screw fixation is to return her to normal (adult) anatomy. This is a standard technique, with minimal soft tissue intrusion. I can only see benefit, given that she cannot do gymnastics at present (even with a repaired brace?)
      The screws are a steel alloy and allergy / sensitivity is rare. If there is a reaction to the implant it is a small matter to remove the screw, probably under local anaesthetic.

  71. Hi — thank you for this insightful post & for all your comments. I suffered a supra- and intercondylar fracture of the right femur following a really bad / unlucky fall while running 2.5 years ago. Osteosynthesis using DF LCP (SYNTHES) metal plate (5 distal, 4 proximal screws). Active male in my mid-20s. No other health issues.

    Bone healed well and I returned to normal activities within a year. However, even 2.5 years after surgery, my knee gets very swollen, particularly following exercise. I still run regularly and bike, but some days there is significant pain, swelling, and stiffness even while walking. Even without strenuous exercise, baseline size for knee is much bigger than my left one. I feel like plate is irritating knee / tissues around it. I can feel the edge of the plate on the right hand side of my knee. Leg extension is particularly painful often as the pulls on my knee or digs into it. I’ve also had slightly elevated CRP over the last few years (25 mg/L as of Dec 2014; possibly due to swelling in leg?). ESR was 16 mm/hour. Recent x-ray showed no loose screws.

    After several consultations with orthopedic surgeons, I’m scheduled to have it removed in a few weeks. Surgeon also wants to do an arthroscopy before taking the plate out and examine the integrity of the knee / clean up any scar tissue. I’m nervous about getting another big surgery and thus wanted to check with you. What are the risks of complications, particularly 1) blood clotting, 2) infection following such a procedure, and 3) nerve damage? How long would recovery take?

    Thank you for your help!

    • I am sorry about your accident –at the time of your life when you did not deserve or need that.
      If it was a supracondylar fracture I am surprised that the plate extends down to the knee.
      It is possible, naturally, that you injured the knee in the original incident, and that might justify the arthroscopy.
      It might be that you have an “iatrogenic ilio-tibial band syndrome” caused by the plate.
      The incapacity following removal of the plate would depend upon the extent of the incision, which I expect would coincide with the existing scar. It is often possible, incidentally, to remove some plates “per-cutaneous” with the screws being approached individually through small incisions, and the plate slid out through a relatively small incision, top or bottom.
      The convalescence following implant removal is much shorter than following insertion (and bone healing), and many leave hospital the same day as surgery, or the following day, walking full-weight-bearing.
      Because of the rapid mobilization the risk of venous thrombosis is small. Infection is possible, but I would grade it as “slight” and worth the risk. Infection is substantially reduced if the wound is washed copiously, and I would request the surgeon to do that. Washing also reduces post-operative pain, but sadly washing the wound intra-operatively is not routinely performed.
      Nerve damage is highly improbable, if the original scar is used to access the plate.

      • Thank you for a quick and thorough reply — this is helpful and reassuring. Well I fell on my knee and the shock of the fall went up the femur causing it to snap just above the epicondyle. In initial report, surgeon wrote that there was a slight intercondylar fracture too. And after removal of the plate, the screw holes usually fill on their own?

        Thanks again for your time.

        • The screw holes do fill often. When the screws are in place those holes are effectively “open” from a structural viewpoint but the surrounding bone tends to compensate re-instating the natural strength (it is the plate which makes the bone vulnerable to re-fracture)

          • I wanted to post a follow-up to my experience getting the plate out. It came out successfully about 3 weeks ago. Surgeon said it was a lot of work to get it out & seemed surprised that plate was all the way in the knee. He reiterated that it was a great decision to get it out since it was causing synovitis in the knee, which he observed via arthroscopy.

            Having experienced my life now without the plate, I completely agree. Despite my anxiety going into surgery, it went extremely smoothly. Very quick recovery: discharged from hospital the next day, on crutches with full weight bearing tolerated for 5-7 days. Back to biking 2-3 weeks after. Not much pain after surgery – I only took oxycodone for 2 days, then stopped all pain medication other than a daily dose of aspirin for 2 weeks as a blood thinner. Swelling subsided quickly and my knee is already smaller than it ever was with the plate inside. Definitely the correct decision.

            Thanks again to this great thread for providing such useful information.

            • Much appreciate your reassurances. Removal of metal is often thought to be a more intrusive procedure than is the case.

  72. im a 43 year old female i had a plate ,screws n bone graft done after removal of chondrosarcoma ,in my hip area ,i am having pain when its cold ,if i lift heavy things i have pain,walking pain ,bursitis …its been 9 years since the plate was put in ,my ortho would like to remove ,im scared to death to do this and he cant guarantee ill walk …help please

    • It might be that the purpose of removing the plate is to check whether there is recurrence of the tumor. (Plates can obscure x-rays and scans). Talk to your surgeon again about “he cant guarentee that I will walk”. If you are walking now, I cannot see any reason why you should lose that ability by removal of the plate.

  73. I’m a 29 year old female. I just discovered your website and think it is wonderful how you help people like me. I hope this is not too long-winded. I have had to look up the various terms that I’ve used, so it’s possible that I’ve misused them.

    At age 16, I misstepped and instinctively reached out my right arm to break my fall. Instead of the arm breaking the fall, the fall broke the arm. It was a clean break of the radius and ulna. The skin was not broken. The surgeon said it was one of the worst breaks he’d seen for that type of fall. He also said that without surgery to put plates in immediately, I wouldn’t be able to open my fist again, so of course my mother and I agreed to the surgery. He operated a few hours after I arrived at the emergency room. He put in 2 titanium plates and 13 screws. He said they would stay in for the rest of my life, unless they bothered me, and then he would remove them.

    I had some loss of sensation on the side of the radius, on and around the scar. On the ulna, the bone/calcium grew out quite far where the plate was. That side of the arm still hurts a lot when I put pressure on it and still does, so I avoid that. The arm ached in the cold and was extremely sensitive to any pressure to the point where I would cry if I bumped it on something. I avoided heavy lifting because I was afraid of straining it. Eventually I got used to it.

    However, when I was about 23, I experienced new pain and an odd feeling of something scraping over something else in the arm when I turned my wrist. I returned to the surgeon and he said it was the tendons scraping over the plate and that he could remove the plates to solve the problem.

    I agreed to the surgery, which went well. The recovery was painful, though. I had an allergic reaction to the tape and the wound kept opening on the radius side near the elbow. It didn’t fully close there for months – slight movement would open the wound in that one spot and it would bleed and it did not clot well.

    I asked what would happen to the many holes in the bones where the screws were, and the surgeon said they would fill in over time. I asked about how the bone on my ulna was grown out, and he said that was calcium that would go away in time. I don’t know about the holes in the bone, but nearly 6 years after the plates were removed, the ulna still protrudes farther out where the plate was. Sometimes the ulna gets caught on a desk, etc. because it sticks out.

    After the plates were removed, my arm hurt for a long time after the pain meds ran out, and Aleve, which was recommended, didn’t help. About a year and a half after the plates were removed, it finally felt pretty good – not as good as before I broke it, of course, but better than it had felt since. It is still sensitive to pressure, but less so than when the plates were there. I still have some loss of sensation on and around the scar on the radius. It got to feeling achy only on a few cold days each year. I made peace with it again.

    But about two months ago, my arm started hurting again. It’s a little like how my arm felt before I had the plates removed, though not as severe. It hurts when I use my arm/hand even a little, when I move my thumb, write, type, drive, etc. I can feel something catching like when the tendons scraped over the plates before the plates were removed. There has been no recent trauma to the arm and I am not athletic.

    I may ask my GP to refer me to a new orthopedic specialist, as I have found my surgeon to be rather uncommunicative and dismissive of my questions – he gives short answers and dislikes talking to me, so I believe meeting with him again would be unproductive. I just want to understand what has happened and what is happening now, as I have to live with the arm for the rest of my life.

    Questions:
    1. Is physical or occupational therapy typical with such breaks as mine? The surgeon did not recommend it, but my therapist friends express surprise that I received none.
    2. Did I wait too long to have the plates removed? Though they had bothered me for a few years, it was only 7 years after the plates were put in that I couldn’t bear the discomfort and pain any longer.
    3. Why aren’t the calcium deposits on the ulna gone and my bone the size it used to be, as the doctor said? It’s only slightly smaller now than it was immediately after the plates were removed.
    4. What do you think causes my current pain
    5. Should I expect that my arm will bother me further as I get older, or might it stabilize?
    6. Do you have any advice?

    I appreciate any/all insights. Please let me know if I can provide further information.

    Thank you!

  74. My 16 year old son had a triple pelvic oseotomy (think that’s how you spell it) in December 2014. He has a plate and screws which will probably be removed in October 2015.
    He know wants to return to playing full contact rugby (he’s played since he was 5).
    He has full range of movements and is back to sprinting and xiong leg work in the gym.
    I say he can play again; his dad says no.
    Any recommendations?

    • The reason for the osteotomy is pertinent. Does he have hip dysplasia?
      Since it is planned that the plates will be removed, that implies that the bones are, or are expected to be, healed at that date.
      However the strength of the bones might take a further year or more to re-establish. [Significant osteopaenia resulting from the surgery can be assumed]
      While I cannot comment on the underlying pathology (the reason for the osteotomy) and its implications, a prudent approach would be to allow another year of “rehabilitation” in the gym, swimming pool and running before returning to rugby.
      As always, the surgeon involved should be consulted.

  75. I had an Ulnar Osteotomy and TFCC repair in September 2008 (6.5 years ago.) Over the last 2 years I have had some pain on and off – it feels like it is pulling. For the last week, I have had intense and almost constant pain and swelling on my ulna side and closer to my elbow. I have had XRays and they show soft tissue swelling. Blood work does not show infection. I am nervous to have it removed, as the surgeon said he does not like to remove hardware, especially after this long. He also mentioned there is the chance the screws could strip upon removal and create a more traumatic injury. I am leaning toward removal because the current pain is intense and I really do not want to endure this indefinitely. I am a fairly healthy and very active 41 year old female. I am glad I found your article and wonder if my pain could be associated with the ‘micro-movements’. Can you please give me your opinion regarding the screws and screw holes?

    • Foremost you need an accurate diagnosis as to the cause of your pain. I do not think that you can assume that it is necessarily attributable to the surgery six years ago. I cannot give you that diagnosis from a distance.

      I am sorry to say that I cannot accept your surgeon’s explanation for not removing the metal. More likely he is not certain of the diagnosis and reluctant to remove the screw speculatively.
      I think you must persist with a demand for a diagnosis. Ultra-sound is a useful tool for soft tissue changes.

      (Blood tests for “infection” should usually be more correctly termed “non-specific inflammatory marker” tests – unless you had blood cultures preformed – which is improbable. These can be negative even in the presence of infection.)

      Please keep me informed of your progress, and if I can be of more help, I will do so with pleasure.

      Best Wishes

  76. After having elbow surgery with pins and plate being removed a screw they couldn’t find is now starting to pertrude out of the bone what will be a he outcome painful to move

    • Now that the screw has shown itself, and is migrating, it should be simple to remove – probably under local anaesthetic, with immediate use of the limb.

  77. Hi there
    I had a surgery on my left arm 5 years ago..
    My arm was pached with a plate and five screws..i didnt remove and and even i dont feel any pain or anythng…should i remove that or not..?

    • You do not say how old you are, or where in the arm was the injury..
      Whether to remove implanted metal requires consideration of many variables, including age.
      I think you will get a satisfactory answer if you carefully read the posts and comments in the web-site. You need a good reason to undergo surgery again, and because of some possible danger to your radial nerve when the plate is removed, I would be inclined to leave the plate in place.

  78. Hi There,

    My 12 year old son broke his femur on his left leg 3 months ago at school ( colliding with another child as they both didn’t see the other whilst running and my son fell on a garden sleeper causing the break) he was rushed to emergency and had surgery on it the same day ( it was a clean break but not a compound break) a plate and 6 screws were inserted and he has finally been given the clear 2 days ago to weight bare. I want to find out the risks of having the plate taken out and also the risks of leaving it in.. and what your thoughts are in regards to this.. also what the recovery time would be approx.? I have heard conflicting recommendations form each surgeon who’s seen him in the last couple of month in regards to if he should take the plate our or leave it in…thanks heaps in advance.

    • It is early to begin to be concerned about the stage of removal of the plate.

      Factors to take into account are whether he gets pain or the “cold syndrome”, or complications such as loosening or infection – which might not reveal themselves for a year or more.

      A factor is where the plate is positioned, and how easy (and safe) is removal.

      Potential sensitivity. to metal (or metal dust) is more nebulous, and there can be no firm guidelines..

      Also to be considered is where in the femur is the break. Does the break (or the plate) involve any of the growth plates?

      Has he reached his adolescent “growth spurt”? At times these breaks cause the bone to overgrow, and be longer than the other leg. This might give problems like back-ache in later life

      My inclination is usually to remove plates and other implants in children..

  79. i fractured my pinky metacarpal shaft and had a plate inserted during surgery. I was told it was made to stay in forever, but i play rugby, a contact sport, is it really worth removing if it does not bother me?

    • You do not say whether the bone was broken by a twisting of the foot, or a direct blow. Given the protection offered by the rugby boot, and if it does not trouble you, the broad answer is “no”. However if the fifth metatarsal was injured by a twisting (inversion injury) you might consider ways of ensuring that this is less likely in the future – such as the regular use of a “wobble board” and ensuring that you do not have a vulnerable distal tibio-fibular synostosis. The latter could be assessed by a capable orthopaedic or sports practitioner, or various forms of imaging. What you do not want is to have the same injury repeated with the plate in situ. These things are never as simple as they might appear to be initially!

  80. 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

    • The term “slightly bulging disc”, which I have heard so often, fills me with horror. If the shoppers in Sainsbury today all have an MRI, a great number would demonstrate asymptomatic “slightly bulging discs”. To operate on these is as much a random walk as epidural steroid. Indeed I regard spinal MRI as an exceedingly dangerous instrument, since it allows the tyro latitude to “explore”. Pain was never found with a scalpel.
      It is seldom that a piriformis entrapment can be found on MRI/CT alone (although I have given an example on the website of one which was, unusually, revealed). Incidentally MRI positioning to demonstrate disc pathology does not show the piriformis, and different positioning is required.
      The diagnostics of piriformis entrapment are so simple and safe that I regard it as obligatory where any diagnostic uncertainty exists.
      If your surgeon believes that an entrapment of a spinal root is present at the level of the neural foramen, then a selective block of that root is a relatively safe and (relatively) easy diagnostic tool.
      In the interim I suggest that you begin to manage yourself in a swimming pool. See my post/page.
      Please ask if I can help you further. I would not like you to be subject to un-necessary (and perhaps damaging) surgery at your age and with your history.

  81. 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.

  82. 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.

  83. 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

  84. 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.

  85. 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.

  86. **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.

  87. 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.

  88. 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…

  89. 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.

  90. 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).

  91. 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.

  92. 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?

    • The elbow has precise mechanics, and the epicondyle is associated with a number of moving structures. Given your symptoms, and the relative ease with which most of these screws can be removed, I would take it out. It should be possible to do this under local anaesthetic on a walk-in-walk-out basis, perhaps even without sutures.

  93. 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.

  94. 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.

  95. 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.

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

    • My guess (and I have to guess) is that you had a Slipped Upper Femoral Epiphysis. If so, this condition can be associated with “stiffness”, by which I mean a reduced range of motion. It is unlikely that this is related to the screws. If necessary these screws can be removed once the growth plates have closed, as you reach adulthood.

      • so is this something I need to have looked @ or is it normal

        • You have not confirmed my from-a-distance diagnosis. If you had a slipped upper femoral epiphysis you will need monitoring for many years. If you had screws in only one of the hips, even more careful monitoring of the OTHER hip will be essential until you reach adulthood. Keep going back to your surgeon – that person undertook to treat you and therefore committed to the responsibility of overseeing your future progress (at least in the structure that he treated).

  97. 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.

  98. 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.

  99. 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.

  100. 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.

  101. 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.

  102. 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.

  103. 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.

  104. 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.

      • Well went to the doctors on Wednesday before Thanksgiving and had surgery this morning to remove the screw that was across the ankle. I actually walked out of the hospital without the boot!! Cannot believe that the “tightness” and pain is gone. I still am going to go to therapy because I still need this for movement but the pain is under control! I still have the plate and six screws and my doctor said that if I start to have problems he likes to take them out in a year from the original surgery but if I have a lot of problems then he will re-access as needed. Thank you for your reply because it made me to be proactive in finding a solution and just not accepting it as normal.

  105. 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.

  106. 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”.

  107. 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..

  108. 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

  109. 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.

  110. 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.

  111. 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.

  112. 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.

  113. 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?

  114. 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.

  115. 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?

  116. 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.

    • The heel is a complicated structure, with a number of attachments such as the plantar fascia and the Achilles tendon. There are also structures running past it – a number of tendons, and it is a route for nerves and blood vessels. Things can go wrong with the bone itself – an occult cyst in the calcaneum might now have become symptomatic. The joints between the calcaneum (heel bone) and other adjacent bones are potential sources of pain. It is also possible that irritation of the sciatic nerve, where it routes past your total hip replacement, could also give the perception of pain in the heel.
      Your pain could be arising from any of these.
      This partial list is not designed to confuse you (which it might have done) but to demonstrate the complexities of this very “busy” anatomical area. You need professional orthopaedic expertise to get your answer.

    • My view is that it is essential to remove the metal. Many would assert that attempting to treat infections of bone (osteitis) piecemeal is doomed to fail. All modalities should be used concurrently, which include removal of metal, debridement, lavage, excision of necrotic material and hyperbaric oxygen. It might also be wise to ensure that the serum iron levels are optimized, and all necessary micro-nutrients are supplied.
      In one well reported case a professor of orthopaedic surgery claimed that “the failure to administer the appropriate antibiotic” (a dangerous one, requiring hospitalisation, with numerous potential complications, including hepatic and renal failure) was responsible for the loss of the leg – which was lost after he had taken over the management! The reality is that some osteitis can never be cured without amputation.
      The “arthritis” which you report is common after the type of injury you suffered, and may prove to be the most incapacitating aspect. One form of management is to fuse the sub-talar joint – but wait until the infection has abated before that is attempted.

  117. 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.

  118. 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.

  119. 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.

  120. 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.

  121. 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.

  122. 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!

  123. 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.

  124. 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.

  125. 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!

  126. 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.

  127. 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.

  128. 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.

  129. 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.

  130. 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.

  131. 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?

  132. 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.

  133. 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.

  134. 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.

  135. 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.

  136. 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 .

  137. 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.

  138. 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.

  139. 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..

  140. 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.

  141. 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.

  142. 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.

  143. 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

  144. 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.

  145. 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.

  146. 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.

  147. 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.

  148. 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.

  149. 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.

  150. 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.

  151. 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.

  152. 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.

  153. 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.

  154. 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.

  155. 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.

  156. 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.

  157. 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?

  158. 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?

  159. 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.

  160. 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.

  161. 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.

  162. 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.

  163. 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).

  164. 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.

  165. 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.

  166. 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.

  167. 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..

  168. 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.

  169. 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.

  170. 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.

  171. 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.

  172. 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.

  173. 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.

  174. 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?

  175. 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.

  176. 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.

  177. 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.

  178. 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?

  179. 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.

  180. 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.

  181. 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.

  182. 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.

  183. 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?

  184. 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.

  185. 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.

  186. 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!

  187. 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.

  188. 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)

  189. 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.

  190. 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.

  191. 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.

      • An update if you can bear it… I have seen a neurologist and three orthos over the last two and a half years. There is no osteoma but there has been a lot of focus on the broken drill bit in the femur. There is osteolytic reaction around it. It is the site of most of my pain. I have had slowly but steadily increasing ache when lying, sitting, standing in that part of the bone. And it’s worse after exercise, when the whole thigh can ache. Its there every day. One surgeon has given me two steroid injections in the site. The first I nearly leapt off the table with the pain, he also aspirated but found no infection. The injection numbed the terrible nerve type pain(not unlike shin splints) I was getting for about six months when I walked/ran. Its been slowly coming back. A second injection recently made no difference, though didn’t particularly hurt going in. This surgeon has no interest in removing the drill bit (too difficult) and doesn’t believe it’s the source of the pain. Another surgeon feels it’s the likely source and he will remove it but also highlights risk mostly about fracture and infection and the possibility of the drill bit not being the source. I have had blood tests, no sign of inflammation and an MRI that although distorted with metallic artefact doesn’t show any evidence of osteomylitis. is it possible there’s a small infection that doesn’t show up in the tests?

        I read in an earlier post that you believe it’s possible to have trouble/infection years later(in my case 27yrs later). Is that right? I have a decision to make about surgery. I am active, tennis, pilates, walking and don’t want to give anything up but some nights I can’t sleep with the pain. I appreciate your time.

  192. 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.

  193. 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.

  194. 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.

  195. 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.

  196. 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.

  197. 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.

  198. 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.

  199. 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.

  200. 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).

  201. 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.

  202. 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.

  203. 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.

  204. 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.

    • The removal of these implants is “elective” which means that there is no specific, fixed time. Therefore once the bone is demonstrated to be united the metal can be removed according to convenience. Most olecranon breaks have healed at six months. Occasionally the metal can obstruct movement of the elbow. The elbow is an unforgiving joint, and stiffness is a major handicap since loss of range of motion limits the volume through which the hand can be moved. Therefore, on occasion, the metal might need removal sooner, in order to gain mobility more rapidly.
      I suggest that you act only on advice from an orthopaedic surgeon.

  205. I broke my ankle bone playing baseball 3 years ago and had some screws put in. During surgery the Doctor placed a screw through my tibia and fibula to hold them together during healing. This screw broke in two places within 6 weeks during therapy between my bones there is now a small piece of screw ‘floating’ between my tibia and fibula. I have not had any pain or discomfort, but have often contemplated having the screw removed. The doc said at the time that the piece of screw is embedded in tissue, but I often worry about this piece migrating in my body? Is this possible, or are my fears unfounded?

    Thanks!

    • It is common, if not inevitable, for screws which transfix the tibia to the fibula to break or migrate (by spontaneous un-screwing or in-screwing). In an earlier post I suggested that such screws be removed before six weeks. My practice has been to (occasionally) replace the metal screw with an absorbable screw.
      There is practically no danger of the fragment migrating. To remove fragments of metal which lie between the tibia and fibula requires extensive surgical exposure which is not without risk.
      I suggest you let well be.

  206. In 2001 I had a compound fracture of the radius and ulna in the same arm. I had plates and screws put on both bones, regained practically all flexibility, but was left with that strange pain whenever I would use my arm to push against something. Arm wrestling for example was particularly painful to the point where I just couldn’t do it.

    I saw my doctor 5 years later and had the Ulna plate removed but he recommended that the other one be kept in due to its depth and the nerve complications. Much of the pain i used to feel from the plates went away with the removal of the Ulna plate but i do continue to feel discomfort with the Radius plate.

    Do you recommend that I have the Radius plate removed? I am now 25 and I feel that if I wait any longer it will only become more problematic to do. Is infection still a possibility even though no symptoms have occurred after either surgery? What complications might I experience from the plate later on in my life?

    • All surgery is a trade-off between discomfort/danger and the risks/loss caused by the surgery. Only you can decide how much your symptoms intrude into your life, and whether these exceed the risks as they have been explained by your surgeon. At twenty five the risks of leaving this plate in place probably do not exceed the risks which concern your surgeon. I suggest that nothing need be done now to prevent something worse in the future.

  207. Hi, I broke my left Tib/Fib in six places in a skiing accident in Italy on 22nd February 2011. I had surgery on 2nd March back in the Uk and had two plates and 17 pins/screws inserted. I was in a regular plaster cast for just over two weeks replaced with a fibre glass cast due to come off on 20th April if healing commenced in the bone. My questions are, if I have problems in the future with my plates/pins and have them removed, will I have to be in a cast again for weeks or can I walk again soon after?

    • The plates would be removed once the bone has healed. Therefore there would be no need tor a cast. The surgical incisions are usually healed in two weeks, after which you should be able to return to most of your activities – but avoid contact sports and high loading (e.g. jumping and skiing) for about a year.

  208. I’m glad I’m not alone. I’m 39 with 2 plates and pins in my arm since 1986. Some xrays show one of the screws/pins is loose; others show that it is back in place. I’ve had a history of adhesions, pinched nerves, bruising/swelling for no reason. Right now it’s bruised/ swollen and I have a lump almost an inch from my elbow which I can press and eventually move. I had an MRI done once 5 yrs. ago and got told never to have one done ever again for as long as I have plates/pins in my arm as it could damage me more. Same goes with carpal tunnel tests. The drs. wanted to make sure that my plates weren’t causing carpal tunnel. If anyone can offer any help or solutions to make living with plates easier please let me know. As far as scarring goes, I don’t really care. The drs. in Florida don’t want to remove the plates, but what other options do I have?

    • To first put something to sleep: MR scans and nerve conduction tests will not make you worse. The MR might not show the anatomy well because the magnetism in the metal produces distortion on the pictures. The surgeons might be wary, particularly in a high litigation area, but it is very seldom indeed that metal is “irremovable”. If your symptoms are caused by the metal implants, there might be good reasons to remove your implants. Can you send the x-rays (jpeg if possible) for a more specific comment?

  209. I shattered my elbow and dislocated my wrist when I was 17. The dr. removed all the hardware in my elbow except a piece of a pin that he couldn’t get out without rebreaking the bone, but he left the 3 pins in my wrist and said he’d never remove them unless they became a problem. I’ve started having occasional sharp pain in my wrist when I move it. It just started happening within the last 6 mos – year. Could a pin be backing out or interfering with my mobility? It’s not constant pain. It’ll hurt for a day or two and then stop.

    • I am not sure what you mean when you speak of “pins”, which I have to assume you see as different from screws. The the wrist, like the elbow, is a busy and compressed space. The hazard thefore is that a sharp pin backing out might damage a blood vessel or tendon. Radiology is recommended.

  210. I live in the U.S. I broke my right elbow 6 months ago. I have a plate and 7 screws in there. All is healing normally. Doctor suggests removal of the plate/screws in the next month or two. (1) Is there a benefit to waiting more than 6 months to remove such hardware? (2) Is hardware in elbows typically removed? (3) Will my arm be more susceptible to breakage after the removal of the hardware?

    • Hello Lyndy.
      Implanted reconstruction metal is probably removed more often from the elbow than many other sites because:
      1. It is a “busy area” anatomically, with two complex joints – each having a large movement excursion close to one another – which could be obstructed by the implant.
      2. The elbow is not forgiving of immobilization and it is desirable to get maximum range of movement as soon as possible; therefore protracted obstruction to movement by implants is undesirable.
      3. It is an important conduit for three major nerves, which should be able to move freely without distortion of their paths or abrasion by adjacent metal or excessive fibrous tissue (which might be stimulated by adjacent metal or metal dust).
      4. There is little soft tissue covering the elbow into which the metal can be “buried” and made less intrusive or obstructive or vulnerable to knocks which are common on the elbow.

      Provided the bone is united the metal can be removed. Initially the joint will be more vulnerable to re-injury, but in the long term (two years plus) strength should be normal or near normal. Leaving the metal in place will not make the joint “stronger”, and may well make it weaker (see the relevant post on this web-site).

  211. My husband broke his left elbow almost 2 years ago and had pins and a plate put in. Other than some discomfort when leaning on that elbow he hasn’t had any problems. A few days ago he noticed that his arm was swollen. He says it doesn’t really, it is just uncomfortable. He saw his GP who recommended icing it and taking Advil. Could the pins or plate be causing this swelling? Should we be concerned?

    • I am sorry that this reply has taken so long – I travel and lecture abroad much.
      By now matters have probably resolved one way or another. Swelling near metal previously implanted is always a cause for concern. If it did not resolve rapidly on the anti-inflammatory medication, I suggest you consult the surgeon who implanted the metal.

  212. I have 3 plates and 13 screws on my distal humerus because of an osteotomy/fx. I plan on getting them all removed soon but am anxious about the recovery. If everything is removed and there are so many holes present in the bone is there a large risk of shattering/fx of the bone afterwards for awhile? Is the recovery usually a “breeze” in comparison with the original injury?

    • You do not give the reason for the osteotomy, or when it was done. The usual reason would be a supracondylar break in childhood which left you with a deformity. If this is the case the removal, if not a “breeze”, should give far less pain than the original surgeryand a recovery of less than two weeks. The screw holes, as well as the effects of the plate, will make the humerus more prone to injury, and I suggest a precautious approach for at least a year after the removal of the metal. Ultimately the strength should be near normal.

  213. I broke my ankle/tib/fib Had a pin and screw placed on my inner ankle. Had a plate several screws and pins on the outer side. During my recovery I was having a problem on the inner area so they removed the pin and screw. Now its 11 years later and the outer area is still there..I have the normal pains and pain when its cold. I can feel the screw heads and it gets itchy and sore if I bump it (which seems alot) Never red or swollen. I have been wondering if I should have them removed.

    • If the metal is uncomfortable it could be relatively easily removed. I often remove fibula plates (such as the one troubling you) under local or regional anaesthesia, on a day case basis. You should be able to walk unassisted immediately, dependent only upon any residual anaesthesia in your foot (which could be hazardous). The eleven elapsed years should not be of consequence.

      • in 1987, I had a pin & screw in my inner side of my right ankle because the break actually caused a piece of the bone to detach – I had the pin taken out in about 1995 because it was rubbing the skin causing irritation. However, never felt the screw and aside from some irritation during weather changes, no issues. About 4 months ago, i was hit with sharp pain going down the inside of my foot from the screw site. Now, it is a constant pain (about 4-5 on a scale of 1-10 daily; sometimes 8-9) and I have a consult tomorrow to see about getting it removed. After almost 25 years, why would the hardware all of a sudden start causing this kind of problem?

        • A common misconception is that bone is inert. Bone is very much a living tissue, so much so that the mineral content is gradually, but entirely, replaced every few years. Therefore changes can happen, notably the changes of ageing. Sever pain associated with an implant, where there was none before, requires the exclusion of infection. Blood borne bacteria can “settle” adjacent to inert tissue, since that area has less ability to provide immunity.

  214. I broke my olecranon six months ago and have a plate with seven screws in there now. I have regained almost full motion and strength except for my grip strength. The neurologist is saying neuropathy in the ulnar nerve due to the position of the hardware. I don’t see the specialist for another month to discuss hardware removal and am wondering if the feeling will return with removal to the pinky and next finger and the inside of my arm , or should I learn to live with it.

    • If the neurologist is correct, it becomes imperative to have the culpable metal removed.

      The loss of ulnar nerve function is a serious handicap, and the prevention of any further damage is important. It may be necessary to free the ulnar nerve from scar, or other compressive material.

      Although it was customary in the past to re-route the ulnar nerve, this should only be done with circumspection. Re-routing the ulnar nerve and burying the nerve in muscle is hazardous, and is not recommended.

      Was the nerve damaged by the accident or the subsequent surgery?

      • My 15 year old son fractured his humerus and olecranon in February of this year. He had 17 pins and 3 plates inserted during surgery as the surgeon had to cut the ulna to gain access to the joint. He healed well and gained strength and mobility, but in July he did a lot of swimming and developed a hemotoma and swelling just below his elbow, which settled down after a week or so. Since then he has developed a lot of weakness in his triceps, and experiences pain wwith exercise. He tried to play golf, and it caused pain and stiffness, and has recently had swelling at the incision site below the elbow. An ultrasound revealed bursitis and a tear in his triceps tendon. Should we have the metal removed, and if so, what are the risks for damage to his ulnar nerve?

        • The risks to the ulnar nerve are twofold. The first is that any distortion of the path of the nerve might produce abrasive damage. That nerve moves through a significant range frequently, with the mobility being assisted by a sheath of fat. If the fat is damaged by injury or infection abrasion can occur. Likewise if there is a protrusion of metal which makes contact with the nerve or its surrounding fat. The bony canal in which the nerve moves can become deformed by breaks to the bone. Over time, often many years the ulnar nerve can therefore be jeopardized by the presence of metal or anatomical abnormality.
          The second risk is the surgical risk. This should be minimal if performed by a competent surgeon.
          One other problem is an entrapment of the nerve, well below the ulnar groove in the bone. This is the commonest site of entrapment, but often not recognised in the textbooks. Because of that I will post a page on the technique of surgical release of ulnar nerve entrapment at a later date.

  215. I have screws and plate in ankle from injury 6 months ago. Everything has healed very nicely but ended up with blood clots that have not completly dissolved so still on Coumadin (warfarin) … what type of wrench does this throw in the plans to have hardware removed?

    • You do not say which vessels are involved in the blood clots. If this was a pulmonary embolus (blood clots swept into the lung) then the use of anti-coagulants will likely be many months. You should be investigated for a cause of the clotting, to ensure that you do not have an inherited or other abnormality which may predispose you to abnormal clotting, before further surgery is considered.
      If the clots are in the arteries or veins of the limb then a precise assessment of the competence of those vessels should be determined before any further surgery to the limb.

      • CT scans showed mild emoblism in lungs ( recent CT showed nothing). The clots are in the right leg l and a followup doppler showed clots still exist, so still on warfarin. I have never had issues with clots until now. What do you mean by “precise assessment of the competence of those vessels” in your reply? Thank you for your response!

        • It seems that you had the relatively common deep vein thrombosis in the right calf, and that you are on the way to recovery. Incompetent veins (or valves) in the lower limb tend to jeopardize healing, and it would be wise to reach maximal recovery of vessel competence before removing the metal. If you have persistent swelling in the right leg an elasticized, below knee, stocking should be used to minimize the swelling before and after surgery.

  216. I am 23 years old and I broke my fibia and tibia on Thanksgiving. I had surgery 2 weeks after that. The ortho told me he was only going to put two screws in but two weeks ago he told me they put seven screws and a plate. I dont know if this is ok he also told me a could start walking now but im a little scared also im so confused because one orthopedic told me i could remove the screws in a year but another told me they would stay in forever, I hope you can answer this questions.

    • At your age it is likely that the bones are well healed, but x-ray verification would be wise. Plates and screws near the ankle are notorious for causing discomfort and, again at your age, removal can be justified

  217. I had 2 plates and 18 screws removed from my tibia and fibula on November 18th. It has been wonderful. From the moment I awoke from the surgery, my bone felt better. No more pain when I walked. It took time for my ankle joint and ligaments to all feel better due to a long recovery (broke in 5 places 13 months previously), but I am now pain free. My advice is to listen to your body and your doctor and don’t be afraid to get the hardware out!

  218. I broke my pelvis (pubic sympysis) and had a plate and 6 screws to repair it. Around the 4 month mark, everything looked good on the x-ray and physio. I am very active and started to slowly get back into condition. I was thinking of getting back into ski racing shortly and decided to get an x-ray and CT scan as a precaution, even though I feel really good. The doctor told me however that I cracked the plate right over the pubic symphysis (ten months since the accident). What are my options, I havn’t talked to my surgeon yet and I am nervous about getting surgery again.

    • The plate is now not providing any function. The probabilities are that it will loosen further, and likely become uncomfortable. However this type of break heals predictably well. You should get back into your previous life and begin skiing again. If the plate troubles you it can easily be removed from the symphysis pubis, at a convenient date.

  219. Thanks for this, to the doc and all. It’s really helpful. I just had a metal strip and screws put in on a broken fibula (broken low, near the ankle) 7 weeks ago. I’m already thinking about when I can get the metal out. I have six screws. There was a seventh one through to the tibia, and I had that out two weeks ago. What an incredible improvement! That shouldn’t be too surprising, though, I guess, as those two bones are supposed move in coordination and it’s not natural at all for them to be joined. I have reviewed the various arguments for leaving the metal in or taking it out, and it seems sensible to me to take it out. The main question open for me is when to take it out. It seems to me sooner is better than later, as this will encourage the bone to heal and strengthen itself more thoroughly. Also, it seems to me that the screw holes would be more likely to fill in more completely the sooner the screws are taken out. I’m 52 years old, and I have to assume my bones won’t rebuild as fast as they would have 30-40 years ago and the sooner I start that process the better. My doc is of the school of thought that it’s better to take the metal out, and when he put it in he’d said we could take it out in about a year. I’m thinking it might make sense to take it out even sooner, but I don’t want to do anything foolish. I’d like to ask Dr. JP his/her opinion as to when is the earliest that these things might be taken out. I’ll be visiting my doc next Friday and will discuss it with him. Meanwhile, I’ve found some good articles on the web (thanks for that initial link!) and will be examining the science on this.

    • It is good practice to take out the screw between the tibial and fibula within 6 weeks, as these screws tend to break quite early. I sometimes replace that steel alloy screw with an absorbable screw.
      As for the rest, they should remain until the bone is healed (as verified on x-ray). This is unlikely to be less than four months – taking them out earlier will not have an additional benefit, and could be hazardous.

  220. My 82 year-old mother broke her ankle and had metal hardware implanted. Since then the wound will not heal. The surgeon has recommended taking the metal out. She has multiple health issues and when the wound was cleaned a few months ago, she hallucinated for weeks and was not ambulatory for a while. We have concerns as to whether she can survive another procedure. Is there another option — maybe some treatment that would promote healing and healthy tissue growth? Who would do that, a wound specialist or infectious disease specialist?

    • It is always sad when these things happen at this age.
      As always, what is needed is a diagnosis. Pus coming from a wound is an observation.
      A possibility is that the screw or fragments of dead bone is associated with this infection. If so removal would be reasonable.
      I often do this with local or regional anaesthetic: at times when the wound is open screws can be removed painlessly without anaesthetic.
      However, many other aspects need to be addressed, and corrected such as her general health (is she a diabetic, does she have anaemia, is her serum iron too low?)
      The vascular supply to her leg needs assessment. At that age venous incompetance is likely, and a below knee elasticised stocking is usually mandatory. Have the arterial supply checked by ultrasound. Of similar benefit is keeping the leg elevated when possible. Walking must be encouraged, but not sitting.
      Nutrition is a concern, since the elderly often do not absorb or metabolise as well, and this includes vit B12, vit D, iron, and perhaps trace elements like zinc.
      Who should look after the wound? The orthopaedic surgeon who claimed the authority to put the screws in. He is expected to know the potential complications of his surgery, and ways out of those complications.

  221. Our family was in a vehicle wreck about a year ago. My husband was trapped in the car and fractured the leg that he uses to push the gas pedal in several places, all below the knee. He was 38 at the time. He has had 4 surgeries: Ankle fixation & debridement, three surgeries to place/replace 2 plates and multiple screws. The screws keep breaking or backing out. The fractures are not completely healed. Locally, the physician said that an ankle fusion is the only recourse. We traveled to a specialist that recommends removal of all metal, followed by MRI and other various scans & tests to determine the status of the injury and if there is infection, then a hip graft and injection of his own platelets. He is concerned that he will break the bones further after plate removal and before the graft. Is this a valid concern? Do doctors normally remove the hardware prior to the graft?

    • One cause of non-union of bone is infection. Removal of implanted metal may be necessary in the management of this infection. However the trade-off might be increased vulnerability of the bone, which is frequently weakened by immobility and other factors. If so that bone will need to be protected whilst healing processes continue. The decision as to whether to remove metal in these circumstances is best made by a skilled and experienced surgeon in attendance.

  222. I am from Nigeria but resides in Denmark. I do like to ask about the effect of cold and hot weather on my health due to the presence of the metal plate inside my tibia. I am considering returning to spend the winter at home if there will be added discomforts during winter.

  223. I broke my femur just below the hip joint 15 months ago. The doctor put in a plate and a screw that went through the neck of the femur. It has healed well. I am now having a little pain in that area. Should I have the plate and screws removed?

    • Hip plates, such as yours, can cause pain which can be managed by removing the plate.
      However the pain in your hip could also be the result of a variety of causes and might not be caused by the plate.
      A diagnosis, by your orthopaedic surgeon, as to the cause of the pain should be made.
      Best Wishes.

  224. I dislocated my ankle by severely twisting it . Both bones broke at the end into several pieces. There is one plate on the outside bone, and the smaller one has several screws. Dr. said the bone looked perfect and was completely healed in only 4 months. Some times I have stabbing pains from this hardware and if I bump it, it is excruciatingly painful. When it gets cool it really hurts, like my replaced knee does. I want it out.

    What happens to the holes? My ankle is still swollen and wont go down even when I put a tight bandage on it. Why is that and will it ever go away?

    • As you are aware your injury is a common one, seen daily in most busy orthopaedic practices.
      It is possible to get good union of bone in four months, but the soft tissue physiology might take up to a year to settle. Hence the persistent swelling. One year would probably be the best time to remove the plate and screws.
      The holes tend to fill by your own natural healing. However, even if they do not, the adjacent bone will strengthen sufficiently for safety. Leaving the plate and screws in place will weaken the bone.
      Walking will help the swelling to go and you would be wise to get into the habit of walking daily, up to three kilometers.
      Below-knee elastic stockings will help. There are many on the market, and expertise should be recruited for the choice.

  225. I had a rotational fracture of the tib/fib 1 year ago with 5 distal breaks and needed plates on the tib and fib plate and 17 screws. A stubborn fracture of the tibia required a bone graft and is now healed. The tibia plate causes pain with every step. My questions are:
    I have 4 screws in the medial ankle bone which appear to take up a lot of space. What happens there when all screws are out? Is there enough bone to support this area? What signs should I look for of possible infection of the bone. I thought once it all healed, the risk of infection was no longer present.

    • The risk of infection remains as long as “foreign” material or dead bone remains.

      • I have never heard that there remains a risk of infection as long as “foreign” material remains. I have a distal tibial plate and 8 screws from a tobogganing accident 2 years ago. I thought that if there were no signs of any infection after 2 years, that there would be no risk at this point. I’m still trying to decide if I want to have surgery to remove all of the metal because I’m not sure that it bothers me enough yet to go through with surgery and being laid up again. However, if there is still risk of infection from the metal remaining I’d really like to know more about that!

        • Now you know. However after some years the risk is small and, in itself, not a reason to remove non-symptomatic implants

  226. In Middle School I had a plate put into my left radius to make sure the break would heal straight .

    I’m 20 years old. It hasn’t bothered me much over the years, just stiffness and very minor pain when the weather turns from hot to cold quickly.

    I’m concerned that I missed the opportunity for easy removal. Is it too late to remove easily? Will removing cause more problems? I ask because over the last month I’ve been noticing my wrist is acting up. It feels like a weakling wrist. I hardly use or work out this wrist, now it hurts and feels weak. I instinctively think it’s my surgical plate, but logicality kicks in and see’s no relation between my wrist and the plate screwed into my radius.

    • You do not say where in the radius is the plate. Send a jpg x-ray if possible.

      You also do not say how old you were at the time of insertion of the plate. If you were past your adolescent growth spurt, then the plate is unlikely to be buried, and can probably be removed relatively easily. One proviso is that should the plate is near the elbow there is an increased risk of damaging the radial nerve when the plate is removed. In any event if it is near the elbow it is less likely to be affecting the wrist.

      One way that wrist weakness could be caused (if the plate is not close to the wrist) is by the abrasion of the tendons which control wrist or finger movements, as those tendons pass over the plate or the screws in the arm. This point of abrasion could be some distance from the wrist, but nevertheless influence wrist function.

  227. I am a 42 year old female. Broke my tib & fib 11 years ago. I originally had a nail & screws but the nail broke after 2 mos of walking on it. ( I only weigh 120 lbs so weight wouldn’t be an issure) They removed all the broken hardware, did a bone graft from my hip and used the old fashioned plate and screws method.

    I am having the plate & screws removed in two days. I am frightened to death and hope that I have made the right decision. I do not want this to hold me up.

    A few times a year the pain would be excrutiating at the top of the plate and would be red and inflammed.

    Wish me luck!

    • Plates on the leg are those most often removed.

      One reason is that there is little “flesh” over the leg bones, and symptoms are frequent, These include the “cold syndrome”, and pain on knocking the tibia (which is frequent in all people). When the tibial is knocked it can produce a bruise which lifts the skin off the plate (because the plate has no blood supply, and does not supply the normal, healthy base to the skin). This is particularly so in the elderly – which you will be eventually.

      The reason for the delayed union which you had was probably damage to the internal (medullary) blood supply to the tibia. This would make you a little more prone to infection (even late infection, years down the line) and screws further enhance the risk of infection. The periodic painful redness is probably a low grade infection, a good reason in itself to remove the metal.
      If the tibia is united, which you can be sure it is if your orthopaedist has decided to remove the plate, you have nothing to fear in terms of a re-break.

      Don’t play contact sport for a year, while the tibia regains its maximal strength.

      • I had my plate and 6 screws removed from my tibia last Friday. Just a simple day surgery. Felt fine afterwards. Spent that day on crutches but tossed them away the next day.

        Surgeon prescribed anitbiotics for me to start taking right away. Not sure if this is a precautionary thing or ….

        I’m up and around and am back to work. The swelling hasn’t been bad at all. A lot of bruising in the arch area of my foot and when I’ve been off it for awhile it will feel tight when I first get up on it. Once I get going though it is fine.

        I won’t be back to see the surgeon for a week and a half.

      • It has been almost six months since I had a metal plate and screws removed from a break in my tib 11 years ago. Best thing I ever did! I’ve had no pain or irritation in it since.

  228. I think the opinion stated by the orthopedist in regards to routinely remove orthopedic implants is contrary to the opinions held by the majority of the orthopedic community and great consideration should be used before taking out a plate or rod for no reason. Just a thought…

    • “Routine” removal of metal implants was not the message of the post. It was designed to counter the often routine tendency to leave implants in place when there are , at times, good reasons for their removal.

  229. Hi, I broke my tib and fib some thirty years ago. When I asked the surgeon when they would come out he said never because the removal would weaken the leg too much. I have a plate and thirteen scews in the main bone. It broke into three pieces so one screw was driven right through to hold it in place.
    I have just been told after an xray that I have a screw loose (yes, I know, the jokes are hilarious). This accounts for the pain and swelling I have had. Anti-biotics have reduced the infection. I personally think that a screw has broken rather than come loose. I imagine the screw will be extracted but should I ask for the rest of it to be taken out in light of your piece above? I am 55 and broke the leg when I was 25 and my health is not too good right now. I have high blood pressure and a recent xray shows an enlarged heart.

    • The belief that a plate should not be removed from a healed bone “because it will weaken the bone if removed” is simplistic and a naive analogy with inert structural repairs. Bones are biologically responsive to changing loads, with extraordinary compensatory qualities.
      The screw may have loosened as a result of an adjacent infection which had destroyed to purchase of the screw into the bone. If this is the case a first principle of treating infection, if the infection is related to a foreign body, is to remove that foreign object.
      This also illustrates one of the long term dangers of all implanted non-absorbables (infection) from root canal fillings to total joint replacements, and could be one reason for pre-emptive removal.
      Low grade infections adjacent to implants (perhaps unrecognised) may affect general health in many ways. Screws which extrude might interfere with other anatomical structures, and might cause significant log term damage. Examples include abrasion of tendons or penetration into blood vessels.
      If it is planned to remove your screw under general anaesthesia, you should give consideration to using that anaesthetic to remove the entire implant, particularly if it is associated with infection.

      • Hi, I had the plate and screws removed two weeks ago and all seems well though I have been put on a course of anti-biotics as a precaution. 50% weight bearing for two weeks and eight weeks before I can drive or do anything remotely manual. Many thanks for your advice.

  230. Well I had them removed. Had to go to a different doc. My scars are horrible and crooked like it was a free for all, I’m totally numb on the inner portion of my leg. Quite honestly, my leg looked better after the initial surgery. Wish I had waited it out, now I’m this way for life

    • I am sorry that you are less happy now. What factors merited the removal of your plates? The point which I wanted to emphasise in my web-site was that the answer to the question as to whether plates should be removed is not a binary “Yes” or “No”. There are many variables which are best interpreted by discussions which encompass the wisdom of an experienced orthopaedic surgeon. Your experience also demonstrates is that there is a broad spectrum of capabilities amongst orthopaedic surgeons.

      • I am 48 yr old woman who had ORIF surgery in a primitive hospital in a primitive country in south america. You can’t imagine how scary that was. Surgeon did an amazing job. 9 or 10 weeks later back in US I had syndesmotic screw removed. 11 months after initial operation I had the final 5 screws and plate removed by another surgeon. The screws were sticking out and hurting and the cold factor was terrible. Still have joint stiffness. After three surgeries in a year to be expected. Scar is lovely considering all involved. No regrets.

  231. I am 23 years old, I fractured my ankle in about 10 places and shattered my tibia and fibula in a skiing accident about six months ago and had it fixed with metal plates and screws, however the screws in my ankle are protruding. My doctor has said that he doesn’t like to remove plates but he will remove them if they are causing a problem. I am confused as I don’t know whether to leave the plates and screws in there and hope they don’t cause me any trouble in the future or have them removed, however I have been told it will be a very difficult operation, is there any advice you can give me?

    • The purpose of the plates and screws is to hold the bones in place until they heal. Thereafter they have no purpose and may cause difficulties. It is usually not difficult to remove tibial plates and screws, although this might be difficult in some (unusual) circumstances. If the screws are protruding they will be superficial (and the plate likewise) and therefore those should be relatively easy to remove.

  232. Well, it seems everybody has a different opinion about this. I broke my tib and fib in 5 places total, its been over a year and the plates are KILLING ME!!!! I can’t see the point of them being left in, doesn’t the bone have some sort of flexion that is impeeded by the plate?

    • There is, or ought to be, a clear rationale for removing implanted metal. I have tried to explain some of these in the post. Where differences of opinion occur it is because there are different injuries, different ways of stabilisation, and different patient contexts – such as the varied symptoms, ages, and healthcare structures.

      • I was relieved to find that someone like yourself that has expert advice concerning implant removal. I am 53 years old with a 6 inch plate secured by 4 screws to my fibula. The implant was installed 30 years ago with no complications until 7 months ago. After new low impact exercises, the area surrounding the implant began to swell and cause pain. A bone scan revealed a suspect hairline fracture midway down the plate on my fibula.

        I had opinion from three orthopedic surgeons. The first declared a definite stress fracture, the second said “not a stress fracture”, and the third said maybe. (The second surgeon suggested bursitis may be the cause of the inflammation but I’m not aware of bursas in that area). After a few weeks of no exercise, the inflammation subsided but has returned a few times since then. I’m not sure what is really going on in there but I think it’s related to the implanted hardware.

        I’m weighing the risks against benefits as to whether I should have the implants removed.

        I’m not sure about the risks. The screws could break off making it very difficult to remove, the fibula could break … and I’m not sure if that is such a big deal since I’ll be in a cast anyway, and of course there is the possibility of infection.

        Can you add any other risk factors to my list?

        Any advice will be very much appreciated!

        • Diagnosis first. If you had a radio-isotope uptake scan (because MRI would be distorted by the metal, and CT gives anatomy but no physiological information) any increased uptake in the bone would be non-specific. That means there is an accelerated reaction from the bone, but the cause would not be revealed. This might be why the opinions varied, since low grade infection and a stress fracture could give similar scan appearance. However the new variable was exercise and one must ponder how that caused your symptoms. The muscles adjacent to the plate might have been adherent to the plate, and a new range of movement might have caused some tearing and bleeding about the adhesions. Similarly any protrusion of the plate or screws might have caused abrasive irritation on the moving structures.
          Thus far you do not have a diagnosis. However what you do know (in probability) is that the metal is involved. If your symptoms intrude significantly, plate removal is warranted.
          Now the potential complications: These are rare. Even if there is a “stress fracture” you would not need a cast. The sutures would normally be removed after about ten days. The major downside is therefore the costs and the day of hospitalisation.

      • 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 think that you probably do not have a true “foot drop” but more likely an inhibition of rhythm. Five months is still relatively early jn a convalescence for a severe ankle injury. It may be that you have adhesions (or abbutment) about the peroneal tendons. If there is still swelling of the joint you should be using an elasticized below knee stocking. My suggestion is to continue with the rehabilitation for a year from this injury, avoiding surgical removal until then. Ultrasonography of the peroneal tendons should be done. A caveat: Is there a “diastalsis screw” between the tibia and fibula? If so this screw might be too tight. In any event such screws should be removed inside two months, since they inevitably break if left longer.

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