Should You Remove Screws After Ankle Fracture Surgery? Expert Insights

Is it necessary to remove the steel pins for a closed fracture of the right lateral malleolus and fibula?

Hello Dr.
Lee,
About two months ago, I sustained an injury to my right foot, resulting in a closed fracture of the right fibula near the lateral malleolus with displacement, as well as a crack at the distal end of the tibia close to the heel.
I underwent surgery where steel pins and plates were used for fixation.
However, I have been researching whether or not the steel pins need to be removed, and I found that opinions among doctors vary.
Some advocate for removal to avoid potential local complications in the long term, such as bone loss or heavy metal deposition, suggesting that it is better to remove them if one is young (I am currently 25 years old).
Others believe that if there are no specific discomforts, there is no need for another surgery to remove them.
Currently, I can only walk a few steps without feeling any significant discomfort, although my heel feels slightly more prominent than my uninjured foot.
My doctor mentioned that removal is optional, but if I choose to do so, it would be best to decide soon, ideally within one to two years.
I am concerned that if I do not remove them, I might experience the aforementioned issues as I age, and then it could be difficult to remove them later.

Dr.
Lee, given my age and situation, which option would be better: to remove the pins or to leave them in? Thank you for your response.

Vivian, 20~29 year old female. Ask Date: 2017/12/17

Dr. Li Yongheng reply Orthopedics

Hello, due to the thin soft tissue around the lateral malleolus of the fibula, it is possible to palpate the bone screw through the skin.
Wearing shoes that are too tight can easily cause discomfort.
Therefore, I recommend removal after one year.

Reply Date: 2017/12/17

More Info

When it comes to the decision of whether to remove screws after ankle fracture surgery, there are several factors to consider, especially given your age and current condition. Based on your description, you are a 25-year-old who underwent surgery for a fibula fracture with the use of screws and plates for fixation. Here are some insights into the considerations surrounding the removal of hardware after such surgeries.

Understanding the Purpose of Hardware
The primary purpose of screws and plates in orthopedic surgery is to stabilize the fracture and allow for proper healing of the bone. Once the bone has healed sufficiently, the hardware may no longer be necessary. However, some patients experience discomfort or complications related to the hardware, which can lead to the consideration of removal.

Potential Risks of Leaving Hardware in Place
1. Local Symptoms: Some patients report discomfort, pain, or irritation at the site of the hardware, especially during activities that put stress on the ankle. In your case, you mentioned that your heel feels slightly more prominent than the other foot, which could be a sign of hardware-related issues.

2. Long-term Complications: There are concerns about potential long-term complications from leaving hardware in place, such as:
- Bone Density Loss: Some studies suggest that the presence of metal implants can lead to localized bone density changes, although this is not universally accepted.

- Metal Sensitivity: In rare cases, patients may develop sensitivity to the metal used in the implants, leading to inflammation or other reactions.

- Infection: While rare, there is a risk of infection associated with retained hardware, especially if the skin integrity is compromised.

Arguments for Removal
1. Age Consideration: At 25 years old, you are still relatively young, and if you are considering a physically active lifestyle, removing the hardware may be beneficial to prevent potential future complications.
2. Symptom Management: If you begin to experience pain or discomfort that you attribute to the hardware, removal may be warranted.
3. Preventive Measure: Some orthopedic surgeons advocate for the removal of hardware as a preventive measure against potential long-term issues, especially in younger patients.

Arguments Against Removal
1. Surgical Risks: Every surgical procedure carries risks, including infection, bleeding, and complications related to anesthesia. If you are not experiencing significant discomfort, the risks of a second surgery may outweigh the benefits.

2. Healing Considerations: If the bone has healed well and you are able to walk without pain, it may be reasonable to leave the hardware in place.
3. Individual Variability: Each patient's situation is unique. Some individuals tolerate hardware well and do not experience any long-term issues, while others may have persistent discomfort.

Conclusion
In your specific case, since you are currently not experiencing significant discomfort and your doctor has indicated that removal is optional, it may be prudent to monitor your situation closely. If you begin to experience pain or other symptoms that you believe are related to the hardware, you can then reassess the need for removal.
Ultimately, the decision should be made in consultation with your orthopedic surgeon, who can provide personalized advice based on your healing progress, activity level, and any symptoms you may experience. It’s essential to weigh the potential benefits of removal against the risks of another surgery, especially considering your current stability and lack of significant discomfort.

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