To cut a long story short, in separate incidents this year I had a broken femur and broken clavicle surgically repaired.
Both breaks healed quite well and I was back to training and competing quickly. Unfortunately, I suspect that the hardware in my femur is causing some irritation that causes a constant, low level of pain that is, quite frankly, just making me miserable. (I’ve been working with doctors and other therapists and have rule things out like bursitis…we can’t guarantee removal of the hardware will cause the pain to go away, but it is the best guess at this point.)
Anyway, the rod in my femur has a max diameter of 17mm…pretty large. The hole will backfill, as will the holes in my clavicle.
Is there anything I can do toro mote bone regrowth/optimal healing?
I am otherwise healthy and have been told the recovery from the removal is easier than the installation (I was on a trainer within 48h of each surgery, training outdoors within weeks and racing within the month)…and in each case I was recovering from a pretty big trauma that caused the injury. My doctor has told me that with the removal I will have no restrictions that common sense and/or pain would not define.
Any comments/suggestions? Any questions I should be asking specifically about bone growth? Any diet/supplement tips?
Thanks for the help. I’m not excited about another surgery and another recovery, but I am encouraged that there’s a chance this will stop the chronic pain and that the recovery might be easier than the others.
I had my clavicle plated 2.5 years ago and have not had the plate removed. I have been toying with the idea but have been put off since:
not sure I want another surgery
have finally regained most of the feeling in the skin area around the last surgery
risk of re-break
The last one is a big one. Yes, the holes will backfill and you will be up and operational very quickly but in the meantime… your clavicle is swiss cheese (7 holes for me) and is very susceptible to breaking during even a minor fall for the 4-6 weeks post surgery (maybe +/-) while the holes in fill. For me even in an off-season surgery that would been those 4 weeks just riding indoors or being super careful to reduce the risk of a random freak fall resulting in another break (and subsequent re-plating!).
I had my clavicle plated 2.5 years ago and have not had the plate removed. I have been toying with the idea but have been put off since:
not sure I want another surgery
have finally regained most of the feeling in the skin area around the last surgery
risk of re-break
The last one is a big one. Yes, the holes will backfill and you will be up and operational very quickly but in the meantime… your clavicle is swiss cheese (7 holes for me) and is very susceptible to breaking during even a minor fall for the 4-6 weeks post surgery (maybe +/-) while the holes in fill. For me even in an off-season surgery that would been those 4 weeks just riding indoors or being super careful to reduce the risk of a random freak fall resulting in another break (and subsequent re-plating!).
Thanks. I should mention that the hardware in the femur is the impetus for the surgery, and the clavicle hardware is going to be removed because I will already be under.
I race my bike and am at risk for rebreaking my clavicle, so I’d rather not have the hardware in there if that happens.
In any event, I know the bone will backfill…the question is what, if anything, I can do to encourage that growth.
I’m a skier (alpine and Nordic)…it’s a daily habit, and I understand I won’t have any restrictions. I was told it would take a pretty large wreck to rebreaking my femur, even with the hole in it.
Odd that you posted this…just recovering from Taiwan Ironman 70.3 and the joy of punching my ticket to Austria this summer…and now sitting in front of my computer waiting for my wife to get ready and go to the hospital to have three 5mm screws removed from my tibia.
I exhausted all possible medical excuses to avoid this. I don’t have any pain from this at all in terms of triathlon…but any later movements or when I carry heavy objects…I can certainly feel the pins in the bone…hard to describe, but it feels as though the bone is “soft.” The decider on this, however, is that one of the screws is VERY close to the IT band attachment point on the tibia…and that has caused constant irritation and swelling…a very pronounced “horn” like bump…so that is the primary concern and the reason they are coming out. Like you, I’m much more inclined to leave things as they are as the injury has not prevented me from doing anything I truly love…but medical advice says if I don’t do something now…the IT band problem will come back to bite me in a much bigger way…so…a longer than I wished for recovery period of a few weeks is in order…
Best of luck in making your decision…I struggled with that choice for a long time…even though every bone surgeon, therapist, and rehab doctor unanimously agreed in my case the hardware needs to come out. By the way, they were inserted January 24 of this year…so just about 10 months.
I broke my femur in 1986 and had a rod put in and two floating pieces wired to the rod. Two years later I had the rod removed as the Dr. recommended to avoid long term complications. No issues and no regrets. Rod still resides in my sock drawer.
Take it out. You’ll be fine. I’ve cut big holes in cadaver bones (25mm is the largest) and essentially hollowed it out- they can still bear really large loads with no problem. What I would recommend is that you cut down on running during the recovery period- We’ve found that fatigue failure may be a concern for this sort of thing. also avoid any sort of activity where you receive sharp sudden knocks perpendicular to your bones ( hockey, contact sports) sor the time being. bone is not equally strong in all directions.
Don’t completely lay off exercise though. Bone regrows according to how much load you put it under, ( google wolffs law of bone remodelling) , so bone that is stressed slightly grows back stronger. I’d suggest some gym work.
Take it out. You’ll be fine. I’ve cut big holes in cadaver bones (25mm is the largest) and essentially hollowed it out- they can still bear really large loads with no problem. What I would recommend is that you cut down on running during the recovery period- We’ve found that fatigue failure may be a concern for this sort of thing. also avoid any sort of activity where you receive sharp sudden knocks perpendicular to your bones ( hockey, contact sports) sor the time being. bone is not equally strong in all directions.
Don’t completely lay off exercise though. Bone regrows according to how much load you put it under, ( google wolffs law of bone remodelling) , so bone that is stressed slightly grows back stronger. I’d suggest some gym work.
thanks. i’m committed to the removal. mostly concerned with the cutting of the muscle to get at the nail in the femur–dealt with it for insertion of the nail and understand more muscle has to be sliced for the removal.
i’ll be on my trainer soon after surgery (was on it the day after waking up from the insertion, and there was a lot more trauma preceding that surgery) and alpine skiing daily ASAP (within a week?). will hope to do some nordic and backcountry soon. that’s my outdoor gym.
I’d go slowly with the skiing, maybe give it about 2-3 weeks before trying any of the serious stuff. the last thing you want to do is take a tumble and break that femur.
I’d go slowly with the skiing, maybe give it about 2-3 weeks before trying any of the serious stuff. the last thing you want to do is take a tumble and break that femur.
duly noted. for me, skiing is like walking. i ski between 120 & 200 days a year, depending on the year. it’s pretty natural.
(i’m not into doing stupid things; of course there is risk in every activity, but i’m told that even when hollow the bone has quite a bit of strength and would take more than an incidental impact to break.)
I rode my bike 6 hours after I left the recovery room yesterday…having taken 3 5mm pins out of my tibia. But no muscle issues and doctor appreciated I have skinny legs. I had same advice on recovery…exercise and use it…but don’t bang it or sports that require sudden changes of direction.
Absolutely remove any hardware put in, it’s a foreign object and it will always eventually cause a reaction or detriment.
I’ve broken my left leg twice (slow learner) once a compound fracture, tibia fibia with two plates and ten screws. It itched and surface bled during exercise until I had it removed. After removal, I gained some increased range of motion too.
Second time, tibia plateau fracture, a chip and some powdering (ah the joy of motorcycles). I insisted on having it removed; the orthopedic surgeon said he generally didn’t recommend removal so close to the knee cap, but he did it and later agreed that it was a good idea. I would never be able to run at all if I hadn’t had that operation. Of course, I’m still turtle slow, and continuing to rehab and strengthen that knee–it will only take forever.
Also, remove the hardware as soon as you can; first orthopedic surgeon relayed horror stories, if you wait too long the bone will calcify over the hardware and then they have to chip and saw away just to get to the screws, truly orthopedics are the carpenters of the MDs!
As for healing, if you’re doing endurance stuff you’re probably already watching your magnesium and calcium intake. Rest and exercise helps, but there’s no substitute for time. Being clavicle/center of body, you may have more blood flow to encourage growth, whereas at the extremities, cracks start to mend only after about 8 weeks!
I broke my femur at the end of June and have a ti rod through the centre of pinned at either end of it, progress is going well, with lot’s of swimming and spinning on the wind trainer. Racing this weekend as a swimmer in a team at a half ironman. My initial talks with the Consultant, is they would leave it in unless there was any infection then they would remove it.
Certainly would be interested to hear how everyone gets on, please post your results.
Traditional teaching and studies show that removal of hardware helps improve pain about 75% (25% pain completely alleviated, 50% it is improves), but 25% it is no better. I don’t recommend to remove hardware for the sake of just removing it as there are risks with all surgeries. That being said, if it is seriously thought that your pain may be due to the hardware and then it makes sense to remove it and hope for improvement.
I would be very careful with skiing in the first 4-6 weeks due to the clavicle.
Make sure your are getting adequate levels of calcium and Vit D.
I am an orthopedic surgeon who has hardware in my left shoulder from a break 8 years ago an plan to die with the hardware in place. Doesn’t bother me one bit.
Traditional teaching and studies show that removal of hardware helps improve pain about 75% (25% pain completely alleviated, 50% it is improves), but 25% it is no better. I don’t recommend to remove hardware for the sake of just removing it as there are risks with all surgeries. That being said, if it is seriously thought that your pain may be due to the hardware and then it makes sense to remove it and hope for improvement.
I would be very careful with skiing in the first 4-6 weeks due to the clavicle.
Make sure your are getting adequate levels of calcium and Vit D.
I am an orthopedic surgeon who has hardware in my left shoulder from a break 8 years ago an plan to die with the hardware in place. Doesn’t bother me one bit.
thanks for the comments. i do not take any surgery lightly and despite hearing much feedback otherwise (“remove at all costs!”) i would not be considering removal if i were pain-free. the pain in the leg/hip from the nail in my femur causes more of the daily pain, but i can feel the heads of the screws in my clavicle plate when wearing a pack, when giving my son a piggyback ride, sometimes when wearing a seatbelt.
just learned today that, on top of everything, i likely have a torn labrum in my hip. went from having a bit of optimism about the hardware removal returning me to normal (i’m hopeful it will at least lead to reduction in some of my pain) to feeling a bit depressed about the labrum in a span of a few hours.
can’t do an MRI/MRA until the hardware is out so won’t know for sure for a little bit, but all the signs are pointing in that direction.
tetonrider…really sorry to hear about the labrum coming on top of this decision.
As for your hardware removal decision, that makes things possibly easier…as now you have pain and a the MRI issue related to diagnosing another serious injury as reasons to take the hardware out.
I’m so glad the orthopedic surgeon chimed in here too…(sorry I forgot your handle) Every time I mentioned to physicians here in Taiwan that surgery has risks they acted as though I were paranoid. Having said that, only 51 hours into my recovery, I do feel less pain in my leg; I had actually become so accustomed to how my legs felt I thought that was normal, but now that the hardware is gone, it feels much better. Waiting for the wounds to heal up to get back in the water, already walking, stretching and very very light cycling…and looking forward to getting back to running in a week or two.
got a call today with the opportunity to move my surgery up 2 weeks to monday (4 days from now). i jumped at it and am hopeful this will help address at least some of my issues. when the hardware is out i can then proceed with imaging on my hip and lower back.
question: the following week (8 days post-op) i have to take a short trip by plane for a few days. assuming all is normal in the surgery, will this be an issue?
i’m guessing it will not be a problem (guessing any bleeding would have stopped by then). i’m told i’d likely walk out of the hospital without crutches and may only need them the next few days if i feel fatigued…would i generally be OK a week out? probably won’t sling my carry-on / messenger’s bag over my shoulder that just had the plate removed, though.
it’s a trip i need to take, so if it there’s a chance of a problem i’d stick with the original date.
Mine were just pins…but I was walking within 2 hours of leaving recovery…rode my bike to the bike shop that night (1km downhill!) and have been riding pain free all week…so it is probably reasonable that you can travel the next day…
I’m glad this topic came up. I had a high tibial osteonomy exactly a year ago, PT twice a week for a year, dry needling, stretching, etc and I still can’t walk up and down stairs, move laterally very well or run. Seems the pain is coming from where the gracilis attaches to the tibia and that is right where my plate and four screws is currently residing. I was thinking about looking in to removing the hardware, but now I am going to make the appointment.
