Tibial IM rod Removal

[Orthoski]

Wasatchback - interesting, and a quick search did reveal case reports of a supposed reaction to the orange dye (see link below). They do make clear chlorhexadine and perhaps they can use that as a precaution. I'm not sure whether the same dye is present in betadine, however - they only insert the dye so that a surgeon can tell exactly which area was prepped, and in betadine I always assumed it was just the iodine that gave it that color. Best of luck with the surgery!

http://archderm.jamanetwork.com/arti...icleid=1105302

[Dieterdde]

Hey everybody,

I had an accident in March 2009, with both Tibia & Fibula fractured in my left leg, just above the ankle. They inserted an IM rod in the Tibia, and also put a plate against my Fibula.

In December 2010, I got my second surgery because my Tibia never properly healed and there was a hole in it that didn't close. We dediced to do a bone graft from the hip to the leg, and simultaneously take out the plate against the Fibula, which did heal nicely.

I have started running this year, getting upto 6km in one session, but was struggling too much with pain from the screws near the ankle, and also pain at the knee, which I never had before the accident. Also, when travelling to cold countries, I would often have problems with random pain flaring up. Therefore, decided to ask the doctor to get the screws & rod removed. I could have decided just to get the screws out, but I'm also worried what would happen if I'd fall again with still having that rod in it. Gives me shivers thinking about a bent rod sticking out of my leg...

Anyways, I'm going in for surgery tomorrow, so I'll report out how it was. The doctors reassure me that it's a minor operation, but I know from past operations that I've always had to stay longer in the hospital because I'm severely weakened from either the surgery, the full anesthesia, or likely the combination of both.

Therefore, I've opted for local anesthesia (never experienced this), although they did say the doctor may still decide to do full anesthesia if he believes that is recommended. We'll see.

Hopefully, I'll get to keep the rim, they let me have the other plate that they took out in 2010 so I have high hopes

My main goal is to be able to run without the pain at the ankle from the screws (i'm very optimistic that this pain will be gone), but especially that the knee pain will be gone. It always feel like it's rubbing off of something, whether it's the screw heads or bone buildup around the screw head, I don't know. Fingers crossed.

Cheers to all,
Dieter

[LightRanger]

Yo Dieter,

You probably won't see this in time, but if I was you, I'd go full under. I had a spinal when they put it in (I think because I had so much morphine on board already) and it was quite unpleasant. Pulling it out isn't as bad, but still.

I got mine pulled on December 6. I was walking within three days. I'm still walking in a boot, but that's to protect my foot due to z-lengthening of the FHL tendon, and doesn't have anything to do with pulling the nail.

So, if my experience is any indicator, you'll at least be hobbling after a couple of days. Knee is still weak and hurts when you bend it certain ways though. My nail was put in "old school," just to the outside of the patellar tendon on the front, so they had to pull it out that way. My current ortho (who happens to post here) said the newer way of doing it involves going in from a different direction and saves your knee from being so sore.

I'll post up some x-ray photos at some point.

[teleposeur]

LB,
Thanks for the thread and the pics! I'm 3 weeks out from surgery for a tib-fib break. I just realized for the first time after looking at your photos, then my xrays, that there is actually a rod in my leg. Stupid maybe, but surgery and the run-up was such a drugged out wirlwind that I thought it was one of those long skinny plates on the face of the bone, which was all I'd seen before. I've already given a lot of though about having the hardware out eventually, but now its pretty much a definate, reinjury, or even just a solid hit with that thing in there wouldn't be plesant.

Do still have a plate in the wrist form 4/5years back, meh.

Also Deiter, why did they plate your fibula? was it a mess? Mine is well a truely broken but they're just letting it float, and I can fell it working around in there. I'm a bit concerned in might heal ugly and suck being in a boot

[hiplainsdrifter]

What a great thread! I am 10 months out from my tibia fracture (yes, just the tibia). It was a pretty big spiral fracture and I have a titanium rod. I am suprised to read that so many people have them out. I asked several doctors about the risk of driving that rod through something in another bad break, and they seemed to think that risk was negligible. It causes me no pain, so for now I am not really even considering having it out. My leg does ache during significant low pressure systems, as mentioned by others. I am seriously considering trying to do some mellow skiing this storm cycle, but I suspect that would be premature. I can run 3 miles no problem, and can do several hundred pounds on the hip sled, but I am not sure that means I am ready to ski. How have other people decided when to try to get back into skiing?

[Jax]

19 months, still have the rod and 3 screws in. Skiing is vastly improved from this time last year (break was May 5, 2011). However, my leg is always sore, tender around the Fx site. I have a nice large lump of calcification on top of shin bone. The screws in my ankle are problematic. Needless to say it takes awhile sometimes to dial in the boots in the morning.

I still get cold syndrome and once in awhile a shock-like feel that runs through the leg. Certain areas, if I touch or massage them, still make me want to puke. Running long distances is just not possible with this thing in my leg. I'm thinking it may be time.

Stupid question, but does insurance cover this in most cases? It's a quality of life thing. I'm just sick of the lingering pain.







edited to add: ^^The initial reduction turned out amazing, considering the amount of displacement from the spiral. I highly recommend Dr. Mitchel Robinson from Panorama Orthopedic in Golden, CO. His father, Walter, is also an ortho there.

[LightRanger]

However, my leg is always sore, tender around the Fx site. I have a nice large lump of calcification on top of shin bone. The screws in my ankle are problematic.

Me too. Pain got worse for me over the years. I think because the calcification continued to grow/reform and pressed on the metal. Feels a million times better when you get it out.

I still get cold syndrome and once in awhile a shock-like feel that runs through the leg. Certain areas, if I touch or massage them, still make me want to puke. Running long distances is just not possible with this thing in my leg.

I know how that feels too.

I'm thinking it may be time.

Yep. Get it done.

Stupid question, but does insurance cover this in most cases? It's a quality of life thing. I'm just sick of the lingering pain.

Not stupid. Yes, it'll be covered. My ortho I was seeing on an HMO plan when I lived in Orange County said he would take it out, and I got mine out on a different plan (Kaiser). No questions or issues. The guy who took mine out also happens to post here. You'll feel so much better with it out. I remember people saying that before I got mine out in December (after almost four years), but it really is a big difference. No more pain from the fracture site is sick.

[Jax]

^^Good to know, muchas gracias

[tlt4679]

I'm a 29 year old female and just had a rod put in my tibia jan 6, 2016 and am really glad to find this thread!

Being 6 weeks out, I was actually looking for information on how long the knee pain would last. I can not kneel at all. I can put some pressure on my knee on a soft couch or bed, but it is still uncomfortable - and if I move fast, forget it. I have great range of motion in the knee, but still get swelling and this pain is really bothering me!

...on another note, I was anticipating needing to wait a few years to get the rod out, this is a little encouraging if I can get it out safely within the first year - get it all over with since I have met my deductible this year!

Do people still have the same swelling issues post rod removal?

Any runners on here? I trail run, and am anticipating that is going to be quite painful this summer. Any comments pre / post rod removal on that?

Tracy

[LightRanger]

Hey Tracy,

The pain in the patellar tendon area lasted quite a while for me. Probably over a year, but it definitely fades in severity. Even today it still seems slightly more tender than the other knee if I'm kneeling, but not really noticeable. It'll hurt again when it comes out, assuming you get it out. When I got mine out the patellar pain wasn't nearly as bad, not sure if that was because the tendon had been stretched so much putting it in, better surgeon, or what.

I think, you should be fine running as long as you don't have any other complications. I was running 7-8 months post injury (ex-college XC runner) and I had a pretty gnarly high energy spiral fracture. No pain from the fracture, but I had additional complications with leg length shortening and toe deformity from tendon shortening.

On that last point, not sure where your fracture is--eg close to ankle or high--but especially if it's low, make sure to do your best with ankle and foot ROM stuff as early as they'll let you.

[gregorys]

@Tracy

Mine was done mid Dec 2015. Knee was quite sore, and have a spot of really numb/no real feeling. But I'm now at week 9.5. The last week the tendon pain bloomed quite a lot - but I went out riding two days, just over a week ago. Nothing smashing - a 10 mile ride on the mountain bike - mostly on the road, but a little trail and climbing. [Mt Tabor in PDX OR]. Then a 20mi ride on my road bike.

Two days later, the tendon really went pretty crazy. [6-7/10 on a pain scale.] Not sure if it was riding related, but I can't connect anything else to it.

But a PT friend of mine suggested a patellar tendon strap. Mine's from Amazon. Donjoy, I think. But they have super cheap ones that I suspect are nearly as good for $3-5 on ebay. Mine was $20 from Amazon. But even at $20 it was worth every penny. The reduction in pain, for me at least, was shocking. [One would practically say it's magical.]

Had a very hot water bottle on it today too, for several hours, and that helped quite a lot.

My guess is that I'll feel it quite a bit for 4-6 more months. I've already had Patellar tendinitis in that knee, so I'm not very surprised at the intensity so far.

However, I'll say that I think I'm in the <%5 crew - as I was pretty functional, mostly normal gait by around 7.5 weeks - and I wasn't allowed to bear any weight until 6 weeks. I'm essentially off pain meds, even tylenol/ibuprofen for the last week or so. [If I have a strong flare-up, I'll take 200-400mg ibuprofen.]

I'm on the other side of the deductible fence - since mine was the last three weeks of Dec. I'll probably try to get into 2017 before doing anything, if it's a problem.

[I've already had my ski boots back on, and while I've certainly not spent a day cranking away, I don't think I'll have any issues I can't solve with a little DIY boot-fitting. In fact, they seem pretty good right now, with no changes at all. (Knock on wood.) ]

-Greg

[MsShasta]

I had four tib/fib breaks an had a rod put in July '14 - have had two separate surgeries to remove top and bottom screws, and have been dealing with a TON of pain in my shin since removal of top screws. Got out skiing after removal of bottoms, was in tears after first run a month after removal of top screws because of pain in shin. Some interesting responses here...

- Shasta

[LightRanger]

Shasta, I couldn't ski until I got the nail (rod) out. Including some, yes, tearful days trying. When it came out, the coating was rubbed off at the fracture site--as in the bone was physically contacting the metal. Explained the pain. Seems possible that you may have similar issues. Nail came out almost four years after injury, but got screws out about 10 months after injury.

[kootenayskier]

My 11mm tibial nail has been in for 14 years. I experience full function with constant minor irritation, but all the advice and studies I've read advise against removal - statistically removal has a roughly 3 way outcome split between improvement, stasis, and degradation.

[wasatchback]

Spiral fractured my tibia into about 10 pieces 2/2011. Bone graft 10/2011 = zero skiing for 2011/2012 season. Skied 11/2012 and early December then had the rod removed mid December. Didn't ski until March of 2013.

Man I was psyched to get the rod out! Leg felt soooo much better once it was removed and my leg was seriously messed up. I had a two inch section of my shin where there was virtually no bone until the bone graft. Basically a non union.

If you can get it out I would recommend it. My leg was pretty screwed up and felt so much better with the rod out.

Best part was one of the screws backing itself out. Doc originally thought it was "scar tissue" which I told him it wasn't. Next day I text him a pic and he told me I needed to come in.... No shit!

[MsShasta]

Well. I'm scheduled to visit a new ortho. Definitely going to discuss removal of the rod. Thanks guys!!! Feeling far more optimistic!

[LightRanger]

Good luck.

[wboarder]

Ok I have had my rod in my right leg roughly 5.5 years and I think it time to loose the rod. I have had 2 CT scans and got a second opinion as first doc said let's try to remove the bottom screws to relieve the pain. The second ortho said he would want no skiing for 3 months but can bike and run no prob.


I'm gonna push this sucker done ASAP so I can get some late turns in...

Wish me luck~
WB

[LightRanger]

I bet you'll be skiing in sooner than three months if the only procedure you're having done is pulling the rod. Your patellar tendon will be sore like it was when they put it in. Other than that, it's wound care for 2-2.5ish weeks and getting the sutures out. I'd think 4-6 weeks...

[wasatchback]

I waited three months when I had mine taken out. I had some serious structural issues as well though (non union, bone grafts) and it was only in there for 1.5 years.

[wboarder]

I bet you'll be skiing in sooner than three months if the only procedure you're having done is pulling the rod. Your patellar tendon will be sore like it was when they put it in. Other than that, it's wound care for 2-2.5ish weeks and getting the sutures out. I'd think 4-6 weeks...

I assume you can be up on it right away just don't get crazy. How long were you on crutches? I hope not long - I hate those things. I just broke the news to my ski patrol coordinator.. yeah they weren't stoked- I'm the newb that's gets the not so great tasks on the hill.

[LightRanger]

Been almost four years and I've had multiple procedures with crutches (five since early 2009), so it's hard to remember. I also had a z-plasty at the midfoot for my Checkrein Deformity I developed, so more than just getting the rod pulled. Surgery was December 2012 and I remember skiing in March, but if I recall correctly it was due to the foot surgery more than the rod removal. Thinking... 2-3 weeks for crutches? But again, I had sutures in my instep too. No difference in weight bearing for rod removal, it's really just the wounds and sensitive patellar tendon.

[wboarder]

Been almost four years and I've had multiple procedures with crutches (five since early 2009), so it's hard to remember. I also had a z-plasty at the midfoot for my Checkrein Deformity I developed, so more than just getting the rod pulled. Surgery was December 2012 and I remember skiing in March, but if I recall correctly it was due to the foot surgery more than the rod removal. Thinking... 2-3 weeks for crutches? But again, I had sutures in my instep too. No difference in weight bearing for rod removal, it's really just the wounds and sensitive patellar tendon.

Ok thanks Yeah that what a figured on the crutches . I suppose the good news is that I already got the ankle screws removed 3 months ago. So that part is done

[gregorys]

@WB
Woah cowboy!
I've written up my story from this past year, but am somewhat apprehensive to post it.

TLDR version;
I skied after a very substantial Tib/Fib [Compound,displaced, comminuted, spiral - but not open - Tib nailed w/ 8mm nail. Fib left alone] after 11 weeks. [I'm in my late 40's and reasonably fit and healthy - so it's not some 23yo miracle recovery story either.] The big bummer is it was the first full week of the season here.

I skied really gently for the first 4-5 weeks, and as pain really went away kept turning up the volume. As spinal tap says - "it goes to eleven!" And while I know I was pushing about as hard as it would be possible to do, I don't think I was totally foolish, and simply lucky, either. [I also know that virtually every situation has items that make it unique. So, my (or anyone else's) experience may not apply to you.]

In any case, I salvaged a good portion of the season. I can't imagine, if you can recover from the patellar [or barring other unusual issues] that you can't ski about as soon as it's not too painful - for simply nail removal.



-Greg

[gregorys]

Oh, I'll add this: The neoprene patellar tendon straps were totally like magic for me. Massive reduction in patellar pain. [They're used for Osgood-Schlatter disease.]

They're cheap - like $20-25 on Amazon, or cheap knock-offs on ebay for half that.

Did I mention - they were totally like magic. I was completely blown away. Seriously. Like 80% pain reduction. If someone had claimed that kind of result before hand, I'd have said they were smoking the good stuff - 'cause that just seemed so unlikely. [As far as I can tell, there's no good idea in the medical literature as to why they work either. Perhaps some change in the angle of attack/pull on the tendon is the most likely I've seen.]

Anyway - for super cheap, it's worth it to try. Heck, I'll send you mine, if you like.

-Greg