Pros and Cons of removing pins/screws from formerly broken bones

Triathlon Forum
1

I snapped both my Tibia AND my Fibula in a poorly executed jump from a dock into shallow water a few years ago. Orthopedic surgeon scared the living bejeezus out of me with doom & gloom talk, but 11 pins and 2 plates later, it healed up just fine. I completed PT to my therapist’s satisfaction and have been swimming, running, riding, Crossfitting, kicking walls in frustration, etc. for about a year and a half. The surgeon mentioned that the hardware was completely safe to leave in forever but that a certain percentage of cases have a second operation to remove it due to discomfort or pins breaking. He also mentioned that the surgery to remove the hardware would require a similar recovery period as the original operation in order for the bones to build back up where the metal was. Again, guy was a total pessimist (told me I was guaranteed to have arthritis by age 40) so I try not to let him freak me out too much, but my job (aviation) requires certain physical capability, plus I honestly don’t know if I could mentally handle another 3 months without exercise, so I have been living in constant fear that something will happen with my bionic ankle.

Specifically, it weirds me out that I can press against the skin of my ankle and feel the head of the screws. The whole ankle also feels stiff a lot of the time which is annoying but not interfering with training. Again, I am extremely opposed to dealing with any more surgery, so I’m hoping for some good news here.

Anyone with similar hardware stuck onto their bones have an experience to share?

Docs, what’s your prognosis on something like this? Is surgery and/or arthritis likely to be in my future?

2

I’m sure you will hear from others more qualified than me, but I had some hardware in my collar bone - plate and 4 screws. I had the plate taken out - it was uncomfortable and the screws were coming out on their own anyway. After a few weeks of recovery I was cleared to run. But your recovery may be longer.

I did not like having hardware in my and have been fine since its been out. If you think you will want the hardware out eventually, might as well do it sooner than later.

3

I had a plate and screws installed on a broken fibula in Jan 2004 and have had no side effects through many years of hard training.

I’m 60 now, no signs of arthritis in the ankle, and I figure the hardware is there to stay.

4

I have plates and / or screws in my foot, neck and shoulder. No problems. Also in aviation

5

Had a shattered kneecap that was reassembled with a wire mesh and some pins. Doc said it could be fine, or it could come out. But six months in, during a routine follow-up, an x-ray showed I’d broken the pins and the doc said it all had to come out … And right away before it all decided to go walkabout inside my leg. The second rehab was nowhere near as bad as the first and now, 15 years later, doc says I’m way better off having had it done. But this is a knee, obviously. A few years later I got creamed by a car. My femoral head was nearly severed and my ankle was shattered. I have a number of screws, but no plates. I never had them removed. Like you, I can feel the heads of the screws in my ankle and it sometimes feels like a tendon gets off the track, runs over the screw heads and gets irritated. But the doc never said anything about removing any of this hardware. She did, however, say that, if I ever got into running, I could count on a hip replacement and possibly a knee replacement sooner rather than later. So I don’t run. I race TTs and do lots of tri relays and I savor having a good excuse not to run (I always hated it anyway).

Aside from the little tendon issue I mentioned, I don’t really have any lingering issues. I’m 57 with a history of arthritis in my family, but I have no issues with it in my hip, knee or ankle (all left side). I did also suffer a compression fracture of the spine. That’s essentially untreatable and it gives me lots of trouble.

I ride about 250 to 300 miles a week year-round and I’m generally at or near the top of my age group when I race (depending on who shows up).

Good luck with your decision. It’s a tough one. Keep in mind that most docs are used to dealing with very sedentary people. I beat all the timelines my doc gave me by months.

.

6

Sounds like I had just about exactly the same break and plates/screws as you experienced. I was on a group ride and a guy in front of me took my front wheel out from under me. Went down and broke my ankle, both the tibia and fibula. Had surgery about six hours later to install the two plates and eleven screws. My doc told me the surgery to remove the hardware would be much less difficult than the installation and the recovery would be fairly short, like maybe a week or so? I didn’t get into a lot of detail at the time with respect to how long it would take to return to cycling, but he didn’t give me the impression that I would be off the bike for an extended period. So, sounds like your doc is setting expectations really low, or there is something unique about your situation. BTW, I am 56 YO, so I suspect you are younger and would heal faster. I still don’t feel comfortable running.

My break and surgery happened on Oct. 28th, and I am seriously considering having the hardware removed sooner rather than later. Over time, your bone will actually begin to grow around the plates and make them even more difficult to remove. I don’t want to get to that point and the possible side effects that could present themselves 10 years from now when having a surgery for something like that at 66 YO may not be possible for some reason.

JMHO,
Greg

7

If it bothers you , get it removed.

I had a 8" long plate in my thigh. It caused some pain, but mostly annoyed me. I had it out. I don’t miss it. (It set off metal detectors. Without it I get less hassle.)

8

i had a tri malleolar fracture in 2005 (at age 47) stepping off a surfboard into a hole. got the hardware, pins and a plate. before the surgery, the doc told me they would remove the hardware. 9 months later he waffled, gave a similar story to yours (risks, rehab, arthritis etc). i wanted the pins out (they poked out on the side).
it did take some months, because your bone will be like swiss cheese when the pins come out and you are at risk.
i took the time. rehab took a very long time, the foot and ankle hurt every morning when i walked down the stairs.
i took up running and after 2 months i proved the doctor wrong. i am 55 now and doing great.

9

I had my femoral nail removed and it was the best thing ever, screws were driving me crazy.

Sorry cant really comment on recovery but it was not that bad

10

I shattered my tib/fib skiing back in 2005. Ended up with compartment syndrome, four compartment fasciotomy, 12"x3" skin graft, plus a rod and 6 screws in my tibia. After about six months one of the screws in my ankle began bothering me so the Doc pulled it out with nothing more than a shot of Lidocaine and an Allen wrench. It was a pretty quick and simple procedure.

I still have 5 screws in my knee/ankle and the rod in my tibia but ill leave them in there as long as they don’t cause any issues. The rod is in there permanently but the screws will come out if they ever cause any issues.

11

Unless the hardware is causing actual problems I’d just leave it in.

This September will be the 10 year anniversary of my tib/fib and I haven’t had anything removed. I did a 4:05 half Ironman last week. The only time I ever even think about the metal in my leg is when I’m trying to get through security at an airport or replying to one of these threads.

12

Unless the hardware is causing actual problems I’d just leave it in.

This September will be the 10 year anniversary of my tib/fib and I haven’t had anything removed. I did a 4:05 half Ironman last week. The only time I ever even think about the metal in my leg is when I’m trying to get through security at an airport or replying to one of these threads.

Too funny. +1 on everything…except the 4:05 HIM :slight_smile:

13

Had pretty much the same type of injury as you. Although mine happened on New Year’s Eve in 1988 so lets say that it was not sports related. Anyway I have had the pins, plates and screws in there since that time. My surgeon said the same thing that there was no reason to take them out unless you have issues. So for the last 25 years I have had this gear in my leg and been running, biking, skiing and other activities. One thing that is cool is that I can feel the heads of the screws under my skin quite easily. I would not worry it unless it comes time you have to. By the way I have never had any arthritis issues either.

Steve

14

I broke my tibia many years ago and still have a plate and some pins in there, which x-ray shows are all broken! Tried to remove them once not too long after healing, and had the operation started but not finished as planned. Was told that removing the hardware would weaken the bone too much and so the surgeon sewed me back up without retrieving anything. I feel a little soreness down there sometimes when the weather changes, but not always and its really not a big deal. Now I’ve been living with those metal parts longer than without, I don’t see them ever getting taken out, as I don’t really want to deal with the downtime and potential for re-fracture, although the idea still appeals.

15

A close friend of mine works in product education for Synthes, the premier maker of surgical hardware (and the same stuff that I have in my collarbone and face).

Pros:

  • no hardware

Cons:

  • requires another surgery, which always involves risks
  • the bones are VERY fragile after the hardware is removed because there are large holes where they were formerly steel/titanium screws. So your bone is basically swiss cheese. How long it takes for these holes to fill in is individual, but until the bone fully heals, you are at a much higher risk of breakage. That sucks.
  • you can no longer play cool tricks with metal detectors.

I plan to leave mine in. With that said, the ankle seems to be the one joint where people really, really, really are much happier having the stuff taken out.

16

I have had a plate and about 6 screws in my fibula since 2001 due to a basketball injury that broke both my fibula and my ankle and tore all the ligaments. there was a long screw in my ankle for a few weeks but th was removed. The plate on the fibula stayed. It only bothers me if I hit something against the plate since that has the effect of spidering to the entire length of the plate on the bone, but not sure if hitting the straight bone would feel much better anyway. I can physically feel the screws on the outside of my fibula, makes for a cool story and freaks people out when I tell them to feel them, haha.

I think my running gait was affected since it didn’t heal completely normal, my right foot pronates a bit more than my left, but other than that I don’t really have any other side effects.

17

I broke my ulna in half. I have a plate and six screws in my right arm. It’s been there since 2003. I don’t even notice it so I am not having it removed.

18

I am 16 weeks post-op from HWR from my distal femur. Plate and nine screws. I had to wait three full years before my surgeon would allow removal. Most people DO get along just fine with hardware, and I never wanted to take mine out unless it was really problematic.

The issue was, the more active I became, the more of an issue it was. Again, I stress this isn’t all that common. I didn’t mind that I could FEEL my hardware, or that it was cold sensitive, or anything else. In fact, I rather liked having it there. My problem was the IT band was so scarred and shortened, it started getting stuck on the anterior edge of the plate, so sometimes I’d fall while running or on stairs, etc. Occasionally, I’d have to unstick it manually. It was mildly amusing at first, as It looked gross and was a nice party trick, but eventually it hampered not only my training, but also my daily life. I could have dealt with chronic pain, but its not working right just wouldn’t fly.

I went thru a year of pt and soft tissue manipulation but it didn’t help, so at just over three years post op, I had it removed.

My initial recovery from putting the plate in was looong for a couple of reasons/complication (included two months of bed rest, 4+ on crutches, six months until easy riding, 15+ months until I started running a bit). So the HW removal recovery hasn’t been quite that bad, but it definitely hasn’t been short. It’s an open procedure for that much metal, and removing a plate/scews is more involved and slower to heal than removing a rod. I did have a bone graft to fill in the holes, as well as the divot left (the plate was pretty well entrenched.

Like I said, I am at 17 weeks, just about. I’m riding fine, but have just now started run/walking again, so this season of duathlons is a wash.

Also, they cut the muscles and IT band AGAIN, and the scarring and nerve damage only gets worse. Still…it works now, so I got that going for me.

Long story long, if it is really impeding function, and you’ve waited the full healing time and tried everything else, have it out. If you can live with it in…try to do that.

Oh, and if you DO have it out–try and have the same surgeon do it. Or, at the very least, find out EXACTLY what type/brand/size of HW you have, b/c the tools differ.

19

I shattered both Tibia’s and both tibial plateaus in a ski accident. Also a shattered Femur! I am 20 months post op from the accident. 3 months in wheelchair with another follow up osteotomy to straighten the left Femur, I am 11 months post op from that. Tuesday I am having 2 pounds of hardware removed from 3 different leg bones. I am nervous. All things I have read about removal has been very positive. I hope things go well. I want my life back. Any suggestions?
J

20

I recently took a biomedical course as an engineer. They said the main problem with plates is that the bone in between gets week. It is not just full of holes, the remaining bone gets weaker.

If you stop and think about it. Bone gets stronger when it repeatedly experiences loading. The area between the plates and the outermost screws sees almost no loading. In parallel loading the stiffer part carries the load. This will always be the plate.

This is why they don’t like removing plates. You have soft weak bone full of holes that suddenly has to weight bear again.

Far to many people re-hurt themselves by pushing for performance before they should. You are not just regrowing the bone. You have to slowly restrengthen the entire area.

Now to beat the dead horse.
You have to slowly restrengthen the whole bone.
Slowly.

Did I mention slowly?

Best of luck.