Hardware Removal and Recovery – When Is A Good Time And Is It Necessary?

Questions about hardware removal are pretty common and today I’m answering Elizabeth’s.

Elizabeth: “Do you recommend getting the hardware removed when safe to do so? I’ve been told my plate and screws will stay in, but I can feel them and it is uncomfortable.“

After an ORIF surgery (open reduction and internal fixation) a lot of people wonder if it’s necessary to have another operation and if the hardware is gonna cause any extra problems.

Internally fixed hardware can cause some trouble for some people, such as pain, infections, limited range of motion… but there are also others that never have these kinds of problems.

In today’s video, you’ll learn about 11 reasons why another surgery might be necessary and also why you might think twice before you decide to do so.

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Things mentioned in the video:

1. [free online course] 7 Essential Ankle Exercises

Should you remove your plates and pins? Or should you leave them in?

My own doctor’s advice: “If they aren’t giving you any problems, they stay in.”

If your fracture required an ORIF, chances are your fracture was critical.

Since you’re reading this, chances are you had an ORIF open reduction internal fixation surgery. It’s done for more serious fractures – those types that can’t be treated only with a splint or cast on its own. 

Open reduction means a surgeon makes an incision to re-align the bone into the proper position.

And Internal fixation refers to the pins, screws, and plates that help fix a broken bone. This ensures that the fracture is stable enough for it to heal the right way and to prevent infection.

When is hardware removal necessary?

Here are 10 indications for hardware removal after fracture fixation:

Reason #1: IRRITATED TENDONS

If a tendon is in constant contact with a plate, screw, or pin, the constant rubbing can lead to pain and discomfort.

Reason #2: A LOOSE SCREW

Loose screws don’t happen often. But occasionally a screw can back out, unscrew, and irritate tendons or nerves.

Reason #3: BROKEN PLATE OR SCREW

Broken plates or screws don’t happen often either. When they do, it may mean that something went wrong with the way your bones healed. Your surgeon will definitely need to take these out.

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Reason #4: CONTINUED PAIN

If you still experience pain (or are in constant pain) despite a healed fracture, then the hardware could be the reason.  It’s rare in my practice, but it’s a possibility.

Reason #5: METAL ALLERGY / ALLERGIC REACTION TO HARDWARE

Not common but it happens and if that’s your case, you need another operation.

Reason #6: YOU JUST WANT IT OUT

You just don’t want it and that’s fine. A lot of people who can’t stand having a plate attached to their bone wouldn’t let the surgeon operate in the first place. But here you are. Also, if you are constantly thinking that the hardware is causing you pain, then your body will react that way.

Reason #7: INFECTION

Some antibiotics might be enough, but if your surgeon decides that the hardware is better to come out, you’ll have another surgery.

Reason #8:  PAINFUL NON-UNIONS

This happens when bones fail to heal and join properly.

Reason #9: YOU’RE YOUNG

If your bones are still growing, you will need another operation – no questions asked. Otherwise, you face bone and growth problems down the line.

Reason #10: FIXATION ACROSS PELVIC JOINTS IN WOMEN

Fixation across pelvic joints such as the pubis or sacroiliac joints in women may require removal, especially if the female patient plans to get pregnant or prefers to deliver vaginally.

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When is a good time to get this follow-up surgery?

No matter what or how severe your injury is, a good time to take our hardware is when:

• Your fracture has healed; and
• At least three to six months have passed since the original surgery.

Whatever you decide, know that every surgery comes with risks. Moreso with follow-up surgeries. A second surgery to remove hardware carries a slightly higher risk for:

• bleeding,
• blood clots,
• infections,
• a re-fracture of the bone,
• adverse reactions to medicine,
• breathing problems and
• nerve damage.

Further, extra scar tissue over the plate can make dissection slightly more difficult.

With these risks, is it worth it?

An average of 50% of patients report significant improvements after surgery. Statistically, this figure is considered great. Most importantly, recovery time is usually (way) quicker than the original surgery.

So if you experience problems with the range of motion even after doing everything in your power to improve it (check these articles here and here), if you are in constant pain and discomfort (check this article here as well), discuss your concerns with your surgeon. It might be a hardware issue. 

Does this help with your decision?

Love  and  flexibility xx

Dr. Maya

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