Screw Displacement in Orthopedic Surgery After Fractures

Screw displacement

Hello Dr.
Lee, I would like to ask about a situation following a car accident where I fractured my tibia and fibula.
I underwent surgery and had an intramedullary nail implanted.
However, after more than two months, an X-ray showed that one of the screws near the knee has protruded slightly.
Why did this happen? Shouldn't the screws be securely tightened?

Mr. Lin, 30~39 year old female. Ask Date: 2019/08/26

Dr. Li Yongheng reply Orthopedics

Hello, as long as the bone screws are not displaced significantly due to activities like walking, there should be no major issues, so please don't worry too much.

Reply Date: 2019/08/26

More Info

Screw displacement after orthopedic surgery, particularly following a fracture, can be a concerning issue for patients. In your case, where a screw has seemingly migrated after the insertion of an intramedullary nail for a tibia-fibula fracture, there are several factors to consider.

Firstly, it is essential to understand that screws and other fixation devices are designed to stabilize fractured bones during the healing process. However, various factors can contribute to screw displacement or migration. These include:
1. Bone Quality: If the bone is osteoporotic or has poor quality due to age, disease, or other factors, it may not provide adequate support for the screws. This can lead to loosening or migration of the screws over time.

2. Surgical Technique: The initial placement of the screws is crucial. If the screws were not properly secured or if there was inadequate fixation due to technical errors during surgery, this could lead to displacement.
3. Mechanical Forces: After surgery, the forces applied to the bone during movement or weight-bearing can affect the stability of the screws. If the patient resumes activities too soon or does not follow post-operative guidelines, this can lead to increased stress on the fixation devices.

4. Infection or Inflammation: Post-operative infections can compromise the integrity of the fixation. Inflammation around the surgical site can also affect healing and stability.

5. Patient Factors: Individual factors such as body weight, activity level, and adherence to rehabilitation protocols can influence the healing process and the stability of the screws.

In your situation, where the screw has migrated slightly, it is crucial to follow up with your orthopedic surgeon. They may recommend imaging studies, such as X-rays or CT scans, to assess the extent of the displacement and the overall healing of the fracture. Depending on the findings, your surgeon may suggest several options:
- Observation: If the screw displacement is minimal and the fracture is healing well, your surgeon may choose to monitor the situation without immediate intervention.

- Reoperation: If the screw displacement is significant or if there are concerns about the stability of the fracture, a surgical revision may be necessary to reposition the screw or to replace the fixation device.

- Rehabilitation Adjustments: Your surgeon may also recommend modifications to your rehabilitation program to ensure that you are not placing undue stress on the healing bone.

In conclusion, screw displacement after orthopedic surgery can occur due to various factors, including bone quality, surgical technique, mechanical forces, and patient-specific factors. It is essential to maintain open communication with your orthopedic surgeon and adhere to their recommendations for follow-up care and rehabilitation. Early intervention can help prevent complications and ensure optimal healing of your fracture.

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