Impact of Misaligned Screws After Calcaneus Fracture Surgery

Nail orientation

I have a comminuted fracture of the left calcaneus and underwent surgery where two metal screws were inserted.
After returning home to rest, I noticed that one of the exposed screws has rotated 90 degrees while changing the dressing.
I'm unsure if this will have any impact.
Should I return for a follow-up appointment?

Younger Teeth, 30~39 year old female. Ask Date: 2019/03/19

Dr. Shi Guozheng reply Orthopedics

The metal pin may be a bit loose, which could cause it to shift.
If there is any discharge from the wound, it is important to monitor for signs of inflammation and to return for a follow-up appointment to check if there is any displacement of the fracture.

Reply Date: 2019/03/19

More Info

After undergoing surgery for a calcaneus (heel bone) fracture, it is crucial to monitor the condition of the surgical site and the hardware used for stabilization, such as screws or pins. In your case, you mentioned that two screws were inserted during the procedure, and you have noticed that one of them has rotated 90 degrees. This situation raises valid concerns about the potential impact on your recovery and the healing process.

First and foremost, the alignment and stability of the screws are essential for proper bone healing. Misalignment of screws can lead to several complications, including:
1. Bone Healing Complications: If the screws are not properly aligned, they may not provide adequate stabilization to the fractured bone. This could result in delayed union (the bone taking longer to heal) or nonunion (the bone not healing at all). Both conditions can lead to persistent pain and functional limitations.

2. Increased Pain and Discomfort: Misaligned screws may cause irritation to the surrounding tissues, leading to increased pain, swelling, or discomfort. If the screws are pressing against nerves or other structures, this could result in additional symptoms such as tingling or numbness.

3. Risk of Hardware Failure: If the screws are not securely positioned, there is a risk that they could loosen or break, which may necessitate further surgical intervention to correct the issue.

4. Potential for Malalignment of the Bone: If the screws are not holding the bone fragments in the correct position, this could lead to malunion, where the bone heals in an improper alignment. This can result in long-term functional issues and may require corrective surgery.

Given these potential complications, it is advisable to return to your orthopedic surgeon for an evaluation. They may perform imaging studies, such as X-rays, to assess the position of the screws and the status of the fracture healing. This will help determine if any intervention is necessary.

In the meantime, it is essential to follow your surgeon's post-operative care instructions closely. Avoid putting weight on the affected foot until you receive guidance from your healthcare provider. If you experience any worsening symptoms, such as increased pain, swelling, or changes in sensation, seek medical attention promptly.

In summary, the misalignment of screws after calcaneus fracture surgery can have significant implications for your recovery. It is crucial to consult with your orthopedic surgeon to assess the situation and ensure that your healing process is on track. Early intervention can help prevent complications and promote optimal recovery.

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