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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
Prefer reading?

Please continue…

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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Wouldn’t it be great if you had a roadmap to complete healing of your injury?

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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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29 Comments

  1. Maya I have followed your broken ankle orif surgery lectures somewhat. I’m in 18 weeks, 72 years old, very healthy and will be checked again by my doctor on 21st Sept…….I still have the numbness top of foot and gets sleepy or numb as I leave it down extended times…..still do the necesssary flexology exercises and stretch daily…..can walk nearly 1.75 miles per day on a trail…..I hiked here in Red Rock park some twenty years before this accident happened. My ankle fibilia at ankle had to have small plate and two screws in it for the patch work. Stiff I’m afraid it will always be at my age. Life could be worse so I handle it pretty good….was so very active and has slowed me down. If you have anymore advise you can ad for me please do “email”
    Pat Stutts

    1. Pat, congrats on the distance you already manage! This is really good and I’m so happy for you. I also got your email.
      I’m glad you’re handling this so well and that you’re taking a good care of yourself.
      Numbness can happen because of the swelling. You said it gets numb when you leave it down for a longer period of time. That’s when all the blood rushes down your leg, causes extra pressure and also affects your nerves.
      Keep working on the exercises and you know, sometimes it really just takes time to heal completely. And don’t forget that the body achieves what the mind believes. Love xx

    2. I was shot 7 times had full metal screws plates and huge rod for 3 years the bullet shattered my Humer. Recently I just had surgery to remove the metal doc said it was healed to take out but nope now my arm is dislocated not connected hurts like hell saying I need another Surgery more metal idk what to do anymore idk how I still even have a arm

  2. Surgery April 29th, 2018, bi malleolar dislocated right ankle from auto accident. 2 Plates, one each on medial tib and laterial fib, plus many screws. Next surgeon appt scheduled for Nov 16, 2018. Saw him last, on Aug 16, 2018. Been going 3 times a week, to physical therapy. Main problem is limited ROM with dorsiflexion. Safety tripping issue; front of foot can catch on floor, due to limited upward angle of heel strike. Therapist says could be hardware and/or muscle weakness of Anterior Tib. Also a lot of soreness. Is surgeon likely to tell me hardware removal is his decision? Or will he leave it up to me? No guarantees. Thought of more surgery makes me queasy. Appreciate your mindful input.

    1. Arlene, I’m glad that you find this video helpful. Please know that YOU can always decline any treatment if you don’t feel comfortable with it. Much love xx

  3. Hi maya I was reading your story and was wondering what type of advice you can give me I had surgery in 2016 to lift my arch on my left foot the doctor broke it in four places and lifted the arch he also had to use two screws I had a lot of pain an discomfort it was hard to walk but I manage to deal with the pain and try to walk I did therapy for several months and I thought it was doing better yet instead I still had problems walking side ways and up hills the pain was very unbearable and when I walk it feel as if I’m off balanced but I was trying to deal with it then the swelling stopped and it would ache every now and then so 2017 became a year and it was doing ok I felt better about it but then October 25 2017 i tripped on my steps outside my home and before I hit the rest of the step I heard a pop on the same left foot and I continue to fall down the steps and I was in so much pain I tried to get up and when I lift my left foot it just dangled so I knew it had to be broke so I felt the swelling the ambulance rushed to get me I was in to much pain to get up this was the worse pain ever so they said we have to remove your shoe and there it was very big and swollen around the ankle area I screamed cause of the pain when we arrived at the hospital they said my ankle was dislocated and I broke my tib and my fib so they said they had to set it and line it back up they didn’t use any medicine I felt I was treated so wrong I screamed so loud that all the doctors ran in there they twist it so hard to set it in place and then they sent me home because they said I had to have surgery so the next week in a half it was time for surgery they had to set it again cause the doctor said it wasn’t set right so that was pain all over again but they performed surgery when I woke up I didn’t know where I was I was highly sedated but once I started feeling better they explained to me what they had to do so he said that he had to put a plate with 12 screws in it and two pins now that leaves me with 14 screw one plate and two pins a lot of metal so I was sent home to heal I came back three weeks later they put a different cast on it and sent me home to do more healing to make a long story short next month will be a year I cant walk a hour without swelling and uncontrollable pain it still feel like the first day of surgery I cry because of the aches and pain I can’t walk up hills I can walk side ways I find myself walking backwards to get more comfort I limp very bad and I still feel unbalanced the doctor told me therapy wasn’t going to help because I don’t have any rotation movement I can only move my foot up and down because my bones have been fused together I have to go back to my knee scooter every day my ankle brace isn’t working I can’t work out in the gym cause every time I do the pain get worse and I can barely walk out of the gym after a workout I really need help it’s emotionally taking over my life do you think i should remove the screws cause I feel that this could be a big part of the problem I went to the doctor this Wednesday sept 26 2018 and he told me that the pain could be a bad case of arthritis but I told him I wanted to get the screws out he said maybe the first of the year 2019 but that’s way to long to continue to deal with the pain I need answers please help if you can thanks

    1. I really hope you are painfree now. 10 months ago I had a nasty fall on a kerb and broke my femur directly above my knee. Sheer agony. The surgen put in a plate,rod and several screws to hold my fracture in place while it mended. This took a week in hospital. After two weeks at home I had an appt for an xray and complained that I had sever pain and needed more painkillers. Xray showed the screws were too big so my knee could not bend. So SIX WEEKS LATER I had another opp to replace the screws. Three months later, after 4 weeks of intensive phisical therapy,I still could not bend my knee more than 60 %. Back to surgeon, another xray showed the plate was too big. My surgeon said everything needs to be removed and as the femour was healed I would be fine by using crutches for a month after this opp.
      Well, yes. After three opps and tons of tummy injections for circulation I can now bed my knee 90% I am going to attend another PT course next week again and hope to get to 100 or 110 bend so as I get get up steps. Full bend is 130. Its slow, painful, but I’m a 69 year old woman with two renewed hip replacements. Please keep a positive attitude and keep moving.It’s very true. Move it or lose it.
      All the best.

  4. I had an SI Joint Fusion back in August 2016. For about the last year the pain has gotten worse. I have had many different injections and have seen several doctors nothing is helping not even pain medication. I go see my surgeon Wednesday and I think I am going to have him remove the hardware.

  5. I was hit by a drunk driver while riding on the back of boyfriends bike. I had pilon fracture and now have 2 plates and 13 screws. I know we are extremely lucky overall. Its been 8 months since accident. I can’t decide if I should get hardware removed.

    I just wanted to thank you for your video. I’ve been researching hardware removal for several months, you answered all my questions and brought up some things I hadn’t thought of.

    Just wanted to let you know your information was very helpful!

    1. Tera, you are very welcome. So good to hear that this advice is helping you with the decision what to do with the hardware. ❤ Love and healing xx

  6. Hi Maya I am 12 weeks after breaking ankle tibia and fibula- had a plate and couple of pins. I am walking without crutches but still very painful and swollen at the end of the day. Is this normal? Also surgeon recommends removing a screw but I’m terrified of another op. He says it up to me but I worry because he recommends it- I don’t like being put to sleep, would it be feasible to stay awake?
    Jo

  7. I stepped off a curb in Dec 2018 broke my rt. Fibula and Tibet. I had to have surgery and the Anesthesiologists discussed different medications to put me to sleep he gave me Catopril which was a hallucinogenic an I was seeing horrible things coming at me at terrifying speeds. I was very frightened. They put in a plate and seven screws. In March I started having severe pain. Xrays showed two of the screws were broken off. I have to see a surgeon for a second opinion. How can they remove a screw when it is broken off. Would it be better to leave it and put additional screws in the plate? This is very painful. I have to wear a boot on my foot that is difficult to put on and off.

  8. Hi Maya, I had an ORIF ankle surgery a year ago. Actually I had 3 surgeries, screws /plates for fibula and tibia bones( both were broken) – fixing the ankle – ligament reconstruction. Anyways, my achilles started to heal after 8 months and my ankle started clicking. Its loud and annoying. Also, I noticed some malalignment.
    I went for another x-ray after a year and it showed 2 long screws were broken, anether one was too long – so tthe long one is producing some pain. The gp sent me back to the hospital, but my orthopedic surgeon said, its ok, we dont need another surgery, just live with it, as it is. He said “try not to click it on purpose”. What should I do now? Thank you for your time!

    1. hey Erika
      Does you ankle still crack/click? Mine does it all the time now and only ever since I broke my tibia. Its like it slightly locks and cracks. My knee use to do it also when I had the hardware in but that has stopped.
      They did wonder if i had broken my ankle and it was never picked up cos the focus was on my tibia, so I’ll never know.
      But its bloody annoying!
      Hope you stopped clicking

  9. Christie McKinnon

    Hi all. I had a right tibial plateau fracture 27 may 2017. A plate and 9 screws were put in my leg. I had ongoing pain, the plate stuck out and I constantly knocked it on things. I had limited ROM and bad flexibility. On 24 June 2019, just Over three weeks ago I had it all taken out and I feel amazing. I can actually grab my ankle and pull my leg up. I can walk down stairs. And NO pain! I’m still a bit bruised and wound is still healing but it’s amazing how great I feel. And mentally, it’s been a god send. I feel happier and can’t wait to start jogging again. For anyone contemplating hardware removal, if it’s safe to do so, DO IT!!

    1. Hi Chistie. Thank you for posting. I am wondering what to expect for healing from the hardware removal. I had ORIF surgery July of 2019 and have minor hardware pain but want the 14 pins and one plate removed. I am a massage therapist and am wondering how long I need to be off work to recoverand what recovery is like.
      Thank you.

      1. Hi Carol
        The hardware removal was a far easier healing and recovery process than the insertion of hardware.
        Mine was taken out on the Monday. I kept off my feet fully for the first few days and by day 4 I was walking relatively normally. I took 2 weeks off because my job involved being a travelling sales person, so in and out of a car all day(20 customers a day!). If I had an office job I probably could have had a week off and just been cautious.
        It was sore for maybe 4 days and then no significant pain. The usual aches and pains however. It was more related to the surgical incision though.
        Its been over a year and I do still get aching and burning, my bone aches every now and then and I have numbness around the whole scar etc but as far as mobility goes, it was the best thing I did.
        Take at least a week and make sure you rest first few days for swelling etc and then get moving. But take 2 if you can afford the time off just so you feel confident. I dont care what anyone says, its traumatic having things put in then taken out! Best of luck with it. Please let me know how you go!
        Christie

        1. Thank you for your reply Christie! I was wondering when you were originally injured and when your hardware was removed. Did you have all the hardware removed in one surgery? Did you have numbness and burning before the hardware removal? So many questions! Sorry. I was injured July 4, 2019 and had the syndesmotic screw removed after 4 months. That made a HUGE difference in my pain. My surgeon said I had to wait a year to have the other 13 screws and plate removed. My mobility is great but I have hardware pain. Don’t really know what to do. I was hit by a drunk driver and my lawyer said I need to make this decision soon or the insurance will not cover the surgery. Go figure!

      2. Hi Carol
        I can’t find your newest post to reply to!
        I broke my leg May 27th 2017. Surgery 2 days later.
        They said the metal work would stay in unless it caused me grief which it did but that it needed to be in for a minimum of a year.
        I use to get stabbing pains right where the plate was, my leg ached where the screws were especially at the tips. On the xray one appeared to be just protruding out past the bone and i use to get a painful flicking sensation on the inner calf in the vicinity of the screws when i swung my knee back and forth. It use to burn all the time where the incision was and my plate use to stick out of my knee, especially when I sat down. So of course id knock it on everything. When a year passed I booked back in to see the surgeons and by the time consults etc happened it was June 24th 2019 that it was all taken out. The whole lot.
        Now i only get minor niggles and I have full mobility. I would get it removed asap if it is giving you grief. Best thing I did especially for my mental health. The pain and mobility issues made me miserable.
        Hope that info helps.

  10. Hi. Had a metatarsal joint fusion surgery 5 years ago. Have had stabbing/ sharp pain once in awhile when I walk. Sometimes my big toe goes numb. Wondering if anyone else has had this type of pain? Anyone had hardware removal to remove the screws? Suggestions/comments? Would appreciate any feedback! Thanks

  11. I broke my fibula in 10/2019 & had a plate and 7 screws put in (ORIF) a week later. I healed great and was in PT and walking in Dec 2019. I have great ROM, but that ankle pops/clicks a LOT – now I’m wondering if I need to go back to the Orthopedist to find out why. The popping does cause minor pain but it’s not horrible. Just concerning. Any thoughts?

    1. Hi H. My ankle has been the same ever since my tibia plateau fracture. My ankle cracks when I flex it even if I’ve been standing idle.
      Must just be a common thing. I mentioned it to surgeons back in the day but other than wondering if is too had been broken and not picked up at the time, not much was thought about it.
      Just one of those things.
      Christie

  12. Is there a time limit as to when you can get hardware removed? I had my surgery 11-9-16 and have had issues ever since. One of my screws backed out limiting me to shoes I can wear and pressure that can be put on that side of my ankle. I also have thin skin and can feel the plate. At this point it’s causing more and more pain. I’m also having trouble finding a doctor to take them out as the doctor who did them in the hospital doesn’t take my insurance, at the time he was the on call hospital doctor so it was covered but he does not take it in his private practice.

  13. Hey maya my name is Skyler smith I was in a bad car accident 5 years ago I am in constant pain still even after the surgery where they attached my shoulder and arm bone back together I have three deck screw looking screws right through my arm and through the eyes of an X-ray they look long as if they are sticking into my flesh !!!, I can’t sleep properly I’m always in pain I can’t lay certain ways , even lifting stuff and holding my baby for long periods of time causes it to hurt worse I don’t know if taking the screws out would help or not , ic had a rough go with fighting and falls and slips .., my arm may be damaged more but I’m still using it to get by with my day to day chores and work that I do …, any advice on if I should get them removed I feel like the time I would loose will hurt me and my family financially and emotionally as I am a needed asset of our family ..,please let me know your advice please and thank you ?

  14. Great informative video!! I’d like to share my story in that it helps others. I broke my femur (leg) just above the knee (distal) comminuted spiral fracture & had a titanium plate & screws via ORIF the length of my leg in 2018. It healed great but every time I flexed knee it would kinda lock & grab & apparently IT band was rubbing on plate, my knee would crackle & crunch (crepitation) every time it was flexed, it drove me crazy. I tried to get it removed twice by my surgeon, who stated it was too risky & did not want to remove it. I sought another orthopaedic’s opinion who stated plate was very big for my slim leg & he could see that the plate was causing mechanical issues, particularly where it cupped at the distal part of leg near knee & he was more than happy to take it out. So took it out he did (2020) & surgery went super well & it’s the best thing I could have done, no more clicking, crunching, crepitation, it just glides now & I have full flexion. When seeking the second opinion this surgeon was so confident & assuring which gave me confidence & the outcome could not be any better.

  15. Hello Dr.Maya Novak.

    I was hit by A pick up truck not too long ago while riding my bike in the morning to work and broke my fibula towards my ankle.

    I had surgery and got about seven screws put in and the plate. The surgery went well and I healed with a cast for about three months Then starting to wear a boot and walk again.Four months after the surgery I was walking Pretty good on my own five months after the surgery I was walking great and riding a bike again. I no longer have pain just a little bit of swelling here and there.

    The problem that I’m having is with mobility to my foot because of the two larger screws in my leg towards the bottom near my ankle. The dr. advises me to remove the screws because I am 24 years old, and he says I should remove them so I can gain my mobility back.

    I have a question for you about my decision, I want to have the second surgery which is scheduled for next week. But I have an incredible job offer which I can handle and pays well. It’s been two months since I’ve healed. I was thinking about prolonging the surgery for a few months because of the job offer and the money that can be made.

    #My question is if there would be any problems with me having this surgery in a few months versus me getting this surgery next week???? ////i’ve had the cast off and bone healed for two months now.

    1. Hi Alberto. Firstly, congrats on your recovery progress and your job offer! It’s great to hear that your healing has been going so well and I can understand why prolonging the surgery might seem like a good thing right now.

      I’d suggest you call your doctor and ask them about what you’ve shared with me. They know your medical history and have all the x-rays so they will be able to advise you best on this.

      This is a big decision for you to make right now and I can imagine that it might feel like a difficult one. What we all have to remember is that we are responsible for our life and our healing and however we decide we’ll have to live with the result of those decisions.

      What are your heart and body telling you? When getting the answer from your doctor, take the answer from your heart and body into consideration as well. Is it possible that you might already have the answer but are afraid to admit it to yourself? I’m rooting for you, Alberto. 🎉❤

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