Hardware Removal After Surgery - Anybody Done This?

I am 8 months post op on a broken ankle (fibula) and had a plate and 6 screws put in.
Went through all rehab and had a pretty successful cycling season (competitive cyclocross)
and am now seeing that skiing is putting more stress on my ankle then cycling did. Foot is kept
more flat in a cycling pedal stroke vs the angulation required in skiing.
At times I think I can feel the plate in my ankle. I don't know if this is just scar tissue or some swelling
but it is a little unsettling. Some pain and minor swelling associated with it and it feels hingy and stiff.

A 12 months I will meet with my surgeon to discuss removal of the plate and screws. All research
I have done associated with removal does not point to a 100% improvement. It seems to be divided
on weather to have this done - some people feel improvement - others do not.

Wondering from the TGR collective if others have had experience with removal from a skiers point
of view - thanks for any input!

My experience was with an intramedullary rod in my tibia. In for almost four years. Wish I'd gotten it out earlier (screws came out 10 months after the injury). Made a huge difference in pain level. Over time my fracture site started to hurt more and when the rod was pulled, it's coating was rubbed off in the fracture area. E.g. the bone callous was apparently rubbing on it on the inside of my tibia.

Guarantee you that the consensus you're going to get here is to get it out. If you don't, you're going to wonder.

I broke my tib/fib down by my ankle. 9 screws and a plate. I did some grinding in my plug boots and use intuition liners in my touring boots. It can hurt a little in the plug boots from time to time since the liners are super thin but overall its manageable. I didn't want the down time from the surgery to remove the hardwear so I deceided to give it a go and 3 years later I don't have any intentions of removing them. Get some bootwork done and leave them in unless you want a few week recovery and a medical bill.

there are already threads on this subject

IME the HW I left in an ankle on a 1st injury interfered with a 2nd injury so I got all the HW taken out which is a much easier operation with quicker recovery than when I broke the leg

L femur IM nail. Had it removed because IF I broke it again (knock on wood) a bent nail would properly, properly, properly fuck things up. Had it out at 2 years, nice looking souvenir.

I've got wrist and collarbone plates, and still feel them when I rub on things (4 years?). If I had that same sensation in my ski boot, then I would definitely get it out. Apparently the bone can start to grow around the plate and lock it in, which makes removal of the plate extra difficult and painful (grind er down). So my instinct would be to get it earlier than later, but your doc would know better.

Angry - 12 months is a good time frame according to my doc for removal.

I did search on the topic (found a good post from Lawless from 2012) but was
looking for more current info and hopefully fibula specific.
I don't think my boot is rubbing on the plate but I will see a bootfitter this
week to stretch my shell a bit as my ankle is slightly larger now and the fit
does pinch a bit. Cramming my foot into race fit 130 lange has not been fun.

Range of motion is not quite the same either but maybe it never will be. Is a
return to normal even possible? Don't want to risk another surgery and cutting
into tissue (with possibly more scar tissue and loss of sensitivity) without a good
outcome...I guess that's million dollar question/leap of faith.

Standard protocol is to avoid unnecessary surgery, but every situation is different. I'm going on 12 years with an IM nail in my tibia. Had the screws removed within 2 years as they bothered me, but other than mild pressure into the base of my knee capsule, I'm pain free. My wife is planning to have a plate and screws on her femur removed after 2 years, because it continually aggravates her IT band. If it's preventing you from enjoying the things you love, go ahead and deal with it.

I'm piling on the IM rod train here. You can search through my posts for my situation - LR was a big help for me in sharing his experience.

I had my screws out in October, which was 8 months post op, and the quickest the surgeon was willing to remove them. I notice a huge difference - I couldn't run at all prior to removal, was running within 3 weeks. I've been skiing for the last two months, have no pain in my ankle at the screw sites and I can say definitively that I would have had pain in boots, because the screw heads were protruding slightly beneath the skin. If you think you can feel the plate, you very well may be able to feel the plate.

For removing the IM rod entirely - I also hit my surgeon really hard to remove it because I was scared of a break and then having a bent nail or shattered shin to deal with. He said he wouldn't do it. I spoke with two other surgeons in two different practices, their thought was titanium is made to flex with the bone, although the biomechanics will never be as great as bone - but the risk for a break and bent nail was significantly less than additional nerve, bone and scar tissue damage from another major surgery.

Not that this is entirely your scenario - but I would say if it isn't extremely invasive for removal and there is already a psychosomatic component to the hardware for you, you'll be happy with it out.

Subscribed.

Looking to get my collar bone plate and screws out. It randomly feels crazy itchy like there's a ball of damp hair under my skin, and the screw's scrape pretty good when anything is resting on it (backpack, skis, etc...). Plus if I touch this one spot, an electric stabbing pain shoots to the end of my shoulder (ac joint).

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Originally Posted by SlugInfinite

I'm piling on the IM rod train here. You can search through my posts for my situation - LR was a big help for me in sharing his experience.

I had my screws out in October, which was 8 months post op, and the quickest the surgeon was willing to remove them. I notice a huge difference - I couldn't run at all prior to removal, was running within 3 weeks. I've been skiing for the last two months, have no pain in my ankle at the screw sites and I can say definitively that I would have had pain in boots, because the screw heads were protruding slightly beneath the skin. If you think you can feel the plate, you very well may be able to feel the plate.

For removing the IM rod entirely - I also hit my surgeon really hard to remove it because I was scared of a break and then having a bent nail or shattered shin to deal with. He said he wouldn't do it. I spoke with two other surgeons in two different practices, their thought was titanium is made to flex with the bone, although the biomechanics will never be as great as bone - but the risk for a break and bent nail was significantly less than additional nerve, bone and scar tissue damage from another major surgery.

Not that this is entirely your scenario - but I would say if it isn't extremely invasive for removal and there is already a psychosomatic component to the hardware for you, you'll be happy with it out.

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That's great that the screw removal helped so much. Interesting that he straight up refused to remove the rod. I think I saw a total of six orthos (and two podiatrists) over the course of dealing with my issues. The orthos were really divided on IM rod removal. The guys who would (and did) do it were the younger more sports-oriented guys. The surgeon who removed mine actually posts on this board. By the time he removed it, though, it was fairly apparent that it was problematic for me.

I had a blade plate and screws in my femur... removed 14 months post surgery. Took away all residual pain.

The issues with removal of hardware include, 1) additional surgery and associated risks and, 2) risk of still not feel better after having the hardware removed (e.g., any joint can have a baseline ache after a fracture, especially a severe one). That being said, there are certain findings on exam that would push me to remove the hardware. For example, in thin people the screws can be quite prominent and if the pain can be recreated by pushing on the screw heads. Another example is that someone describes that a healed ankle fracture doesn't hurt when in regular shoes but in hiking or ski boots the pushing on the plate hurts. You get the idea.

Intramedullary (IM) rods are their own category. Honestly, one of the biggest hesitancy to removing IM rods is that it can be quite challenging to do so and you can potentially cause damage in the process. Trying to get the insertion handle to lock into the nail often involves scraping away substantial bone that grew into the rod and, even once the handle is attached, you can sometimes mallet it quite hard and the nail doesn't always budge, etc. Furthermore, issues such as knee pain after insertion of a tibial nail may be inherent to its insertion, not the hardware. That being said, some people feel much better after removal, and because it's hard to predict, it can be hard to do a cost-benefit analysis.

As with most things in this forum, much of these considerations should be discussed directly with the surgeon, ideally the one that performed the original surgery.

Best of luck to you!

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Originally Posted by Orthoski

For example, in thin people the screws can be quite prominent and if the pain can be recreated by pushing on the screw heads.

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Pressure on a couple of the screws in my collar bone turn me into a little girl, who pulls away like a cat in a bathtub.

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Originally Posted by Orthoski

Intramedullary (IM) rods are their own category. Honestly, one of the biggest hesitancy to removing IM rods is that it can be quite challenging to do so and you can potentially cause damage in the process. Trying to get the insertion handle to lock into the nail often involves scraping away substantial bone that grew into the rod

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My femoral IM nail took 4.5 hours to remove for this reason, it was a very slow, very delicate operation.

Had hardware removed from hip after one year. Second surgery no picnic, and second summer on crutches no bonus, but turned out fine and seems worthwhile now.

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Originally Posted by Orthoski

Intramedullary (IM) rods are their own category. Honestly, one of the biggest hesitancy to removing IM rods is that it can be quite challenging to do so and you can potentially cause damage in the process. Trying to get the insertion handle to lock into the nail often involves scraping away substantial bone that grew into the rod and, even once the handle is attached, you can sometimes mallet it quite hard and the nail doesn't always budge, etc. Furthermore, issues such as knee pain after insertion of a tibial nail may be inherent to its insertion, not the hardware. That being said, some people feel much better after removal, and because it's hard to predict, it can be hard to do a cost-benefit analysis.

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I should have expanded earlier upon my response after LR responded; but this is basically what my ortho told me. They needed to remove a decent amount of material in the tibial canal to fit the rod down into my leg. The ortho was/is concerned about bone regrowth into the rod, coupled with potential/further damage done to the patellar tendon in a removal attempt. The initial procedure was supposed to take 4 hours and wound up closer to 6 because of the circumstances surrounding my knee and the bone in my tibia.

All of that being said - the ortho also told me I would need to be at a year to hit the baseline for healing from the injury, and if I really got into hard activity the following year and found it bothered me, we could revisit it. A year will be the end of February this year - and while I've been running, biking and skiing without pain, I certainly haven't been pushing it like I would have prior to the injury. As someone mentioned above, I can feel a little bit of an odd pressure internally just below my knee - I assume it is the tip of the rod pressing against the top of the cavity in the tibia. I think this next summer will really be the true test for me in how hard I'm going to be on the leg - but to my original point as it relates to the OP, the screws were definitely my big issue because of the proximity to the surface of the skin.

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Originally Posted by iscariot

Pressure on a couple of the screws in my collar bone turn me into a little girl, who pulls away like a cat in a bathtub.

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Had the hardware in my collarbone removed for just that reason. It would hurt SO badly if someone grabbed it playing soccer, etc. Dunno if your plate was countersunk/bored so the screws could sit flush, but mine wasn't.

Recovery was a little worse than I expected (it's like a mini surgery), but no complaints other than that. Be warned though: it feels better, but still hurts if grabbed hard or hit with a soccer ball.

Happy to answer any other questions, if I can.

I had a rod installed in my tibia in 1989, and had it removed a year later. I suspect that leg is stronger than the unbroken one now. I have alway wondered if the rod could carry too much of the intended load for a given bone, resulting in decalcification. Anyway, my doc recommended removal if I was to continue skiing, mtn biking, moto riding. I'd hate to break the leg again and bend the rod

Went ahead and had the ankle hardware removal surgery a week ago. Couldn't live with
"What if" I removed it thoughts and chronic stiffness and lack of flexability. Hoping for the
best because I have heard positive results from others.

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Originally Posted by gforce

Went ahead and had the ankle hardware removal surgery a week ago. Couldn't live with
"What if" I removed it thoughts and chronic stiffness and lack of flexability. Hoping for the
best because I have heard positive results from others.

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Keep us posted on how this pans out. I have a plate and four screws on the outside of my fibula from an injury five or six years ago. I may have to reconsider having them removed

I have had two plates and 8 screws on my radius and ulna when I was sixteen. Im thirty now and havent had a problem

Last year I had 2 plates and 13 screws installed on my tibial plateau. Didn't have any problems with them and would probably have left them in but they were removed to make room for a rod in my tibia and a plate and 4 screws on my fibula last March. Haven't had issues with any of it yet. My general outlook is to keep them in unless chronic pain becomes an issue. Good luck!

I am now almost 8 weeks post op for the removal of the fibula hardware. Ankle is feeling more fluid and better range of motion.
It is also hardly sore after hard efforts on the bike. So far - happy I made the effort to remove the hardware. Hopefully return to
normal eventually.

I had a tibia rod and screws removed after a year and no regrets.
A friends smashed his hand real good and had lots of metal added to his hand. He was miserable for years and eventually they rebuilt it with plastic - huge improvement for him.

My verdict is always get foreign parts removed if things have healed. They will just cause problems years later. The older you get the less likely you will be able to convince a doc to do so.. Get that stuff out! Demand it unless seriously warned otherwise!

This.

Got my plate and screws out ASAP.

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Originally Posted by lodopo

My verdict is always get foreign parts removed if things have healed. They will just cause problems years later. Get that stuff out! Demand it unless seriously warned otherwise!

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Humbly disagree with this. While some pain is definitely hardware related (pressure from boots over an ankle plate, etc), don't forget that a fracture itself, especially if into a joint, can have long term consequences. Case in point, how many people on this forum have had bad ankle sprains and found that, while functional, their ankle was never quite the same? Hardware removal is always a conversation to be had with your surgeon about hopes, expectations, and risks. For some it's worth it, for others not so much. Ultimately, the majority of patients have their hardware left in place and do fine. Not to mention, it gives the TSA screeners at the airport something to admire.

^^^ Fair point. The bone callous on my lower shin can still be a bit tender after a day of skiing pretty hard in less than ideal conditions. Far far worse before I got it out though (I couldn't ski from the pain). It also took a season or two post-fracture for the callous to develop enough that the nail was rubbing (we assume from the marks on it when it came out and the type of pain) and causing that much pain, so there's that. I was also quite concerned that with time it would be harder to pull. That was me. Nail didn't set off the detectors though. :D