Should You Remove Titanium Screws After Fifth Metatarsal Fracture Surgery?

Should the titanium alloy screw be removed after a fifth metatarsal fracture?

Hello, on November 14, I suffered a fracture of the fifth metatarsal in my left foot due to a fall.
I visited an orthopedic outpatient clinic nearby, where they advised me to use a brace and undergo rehabilitation.
Concerned about whether this would lead to proper recovery, I returned to the orthopedic outpatient clinic on November 15.
After an X-ray, they indicated that there was displacement and that surgery was necessary.
The following day, I was hospitalized for surgery, during which titanium alloy screws were used.
The doctor mentioned that there would be no need for a second surgery to remove them.
However, I recently came across information suggesting that leaving the screws in place could lead to deterioration of bone quality.
It was also mentioned that titanium alloy screws are not as hard as stainless steel screws, and removal could be difficult, with a risk of breakage.
I am starting to worry.
Should I consider having the titanium alloy screws removed? Thank you for taking the time to answer.

Ms. He, 40~49 year old female. Ask Date: 2018/12/04

Dr. Shi Guozheng reply Orthopedics

If the bone has healed and the bone screws have not shifted, there is no need to remove them.
The deterioration of bone quality typically occurs in long bones (such as the femur or tibia), while in the metatarsal bones of the foot, the screws can often be left in place without removal.

Reply Date: 2018/12/04

More Info

After undergoing surgery for a fifth metatarsal fracture, the question of whether to remove titanium screws is a common concern among patients. Titanium screws are often used in orthopedic surgeries due to their biocompatibility, strength, and resistance to corrosion. However, the decision to remove them or leave them in place can depend on several factors, including the nature of the fracture, the healing process, and the potential risks involved.

Firstly, it is essential to understand that titanium screws are designed to be left in place unless they cause specific problems. In many cases, they do not need to be removed after the bone has healed. The body often encapsulates these screws with fibrous tissue, which can help stabilize the area. This encapsulation process can mitigate any potential issues related to the screws, such as irritation or discomfort.

Regarding your concern about bone quality, there is no substantial evidence to suggest that leaving titanium screws in place will lead to deterioration of bone density or quality. In fact, titanium is known for its favorable properties in promoting bone healing. The concern about screws leading to bone loss is more associated with the mechanical stress and loading on the bone rather than the presence of the screws themselves.

You mentioned that your doctor indicated that the screws do not need to be removed. This is a common recommendation, especially if the screws are not causing pain or complications. However, if you experience persistent pain, discomfort, or any signs of infection, it is crucial to communicate these symptoms to your healthcare provider. They may recommend imaging studies to assess the situation further.

The concern about the difficulty of removing titanium screws is valid. While titanium is a strong material, it can be challenging to remove due to its integration with the bone. In some cases, attempts to remove screws can lead to complications, such as fracture or damage to surrounding tissues. Therefore, if the screws are not causing any issues, many surgeons prefer to leave them in place to avoid unnecessary risks.

In summary, the decision to remove titanium screws after a fifth metatarsal fracture surgery should be made in consultation with your orthopedic surgeon. If the screws are not causing any pain or complications, it is generally advisable to leave them in place. However, if you have concerns or experience any issues, do not hesitate to discuss them with your doctor. They can provide personalized advice based on your specific situation and help you make an informed decision regarding your recovery and long-term health.
Additionally, it is essential to follow your rehabilitation program and any recommendations for weight-bearing activities. Gradual progression in your rehabilitation can help ensure a successful recovery and minimize the risk of complications. Engaging in physical therapy and adhering to your doctor's advice will be crucial in restoring function and strength to your foot.

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