Should You Remove Surgical Plates After Orthopedic Surgery?

Should the steel plate be removed?

Hello doctor, my father is 69 years old, has diabetes mellitus, and has a coronary stent.
He was hit by a motorcycle on January 9th of this year, resulting in a comminuted fracture of his left lower leg and left ankle.
He has undergone external fixation by the physician and it has been a week.
He is scheduled for internal fixation surgery next Monday.
Since he is opting for a self-paid plate costing nearly 80,000 NTD, it can remain in place, but there is also a suggestion that it should be removed.
I am a bit confused about whether it should be removed or not.
Thank you.

Miss Lin, 40~49 year old female. Ask Date: 2017/01/15

Dr. Shi Guozheng reply Orthopedics

After a fracture has healed, if the plate does not irritate the surrounding tissue, it may not be necessary to remove the plate.
If any irritation occurs, it can be removed at that time.

Reply Date: 2017/01/15

More Info

When it comes to the question of whether surgical plates should be removed after orthopedic surgery, there are several factors to consider. In your father's case, he has undergone a significant injury with a comminuted fracture of the left lower leg and ankle, which necessitated both external fixation and an upcoming internal fixation surgery. Given his age and medical history, including diabetes mellitus (DM) and a history of cardiac intervention, careful consideration is essential.

Reasons for Keeping the Plate
1. Healing and Stability: After a fracture, the primary goal is to ensure that the bone heals properly. Plates and screws provide stability, allowing the bone to heal in the correct position. If the fracture has healed adequately, the plate may no longer be necessary, but it can still provide additional support during the healing process.

2. Risk of Surgery: Removing the plate involves another surgical procedure, which carries risks such as infection, anesthesia complications, and the potential for further injury to the bone or surrounding tissues. For an older patient, especially one with diabetes, these risks can be more pronounced.

3. Current Technology: Modern orthopedic implants, such as titanium plates, are designed to be biocompatible and can often remain in the body without causing issues. Many surgeons now adopt a "leave it in" philosophy unless there are specific complications.

Reasons for Removing the Plate
1. Discomfort or Pain: If the plate causes discomfort or pain, it may be advisable to remove it. Some patients report that they can feel the hardware, especially if they are thin or have less soft tissue coverage over the implant.

2. Future Complications: In some cases, plates can lead to complications such as irritation of surrounding tissues or even fracture at the screw holes if the bone is subjected to stress before it is fully healed. If there is a risk of these complications, removal may be warranted.

3. Activity Level: If your father plans to return to high-impact activities or sports, it may be beneficial to remove the plate to reduce the risk of re-injury or complications associated with the hardware.

Recommendations
Given your father's situation, it is crucial to have a thorough discussion with his orthopedic surgeon. The surgeon will consider factors such as:
- The extent of the healing process.

- Any symptoms your father may be experiencing related to the plate.

- His overall health and any comorbidities that may affect surgical risk.

In many cases, if the fracture has healed well and there are no complications, the surgeon may recommend leaving the plate in place. If your father is asymptomatic and the plate does not pose any risk of complications, it may be best to avoid the additional surgery.

Conclusion
Ultimately, the decision to remove or retain surgical plates after orthopedic surgery should be made collaboratively between the patient and the healthcare provider, taking into account the specific circumstances of the injury, the healing process, and the patient's overall health. Regular follow-up appointments and imaging studies can help monitor the healing process and guide the decision-making regarding the surgical hardware.

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