Post-Surgery Complications: Titanium Rod Deformation in Pediatric Fractures

Postoperative heterotopic ossification after fracture surgery?

I would like to inquire about an incident on February 16, where my child fell off a bicycle and suffered a fracture of the left tibia (specifically in the middle of the tibia).
The surgery involved the use of titanium alloy internal fixation (two rods were inserted into the bone).
The stitches were removed a week later, and there was significant improvement after two weeks.
However, on February 29, when I helped my child to the bathroom for the first time and bathed him in the tub, I noticed that the surgical site showed signs of the metal rod protruding (it was visibly close to breaking through the surface).
An X-ray taken yesterday compared to the initial post-operative images indicated that the rod, which was originally bent, had straightened, leading to the protrusion.

I would like to know under what circumstances a metal rod can deform? Could bathing cause this situation? It seems that another surgery is necessary; otherwise, there is a risk of it protruding at any time.
After another surgery, will there still be a risk of deformation? What is the principle behind titanium alloy fixation? Why might it shift or deform? Does this indicate that this method is unsuitable for my child? Are there better alternatives if another surgery is required? Additionally, my child has been complaining of discomfort from the removable cast (pain around the heel area), making it difficult to wear it consistently (he tends to remove it while sleeping or lying down).
Is it normal to experience pain while wearing a cast? When is it advisable to temporarily remove the removable cast post-surgery? Thank you, doctor.

Zhuang Xiaojie, 30~39 year old female. Ask Date: 2020/03/04

Dr. Shi Guozheng reply Orthopedics

1.
The healing of the bone after tibial fracture surgery occurs at a certain rate.

2.
Typically, it takes one to two months for callus formation to begin.

3.
It is necessary to wait until the bone becomes very hard, which usually takes about three to six months.

4.
If the injured leg is overexerted shortly after surgery, it may lead to the displacement of the bone screws.

5.
Undergoing another surgery is a safer approach.

6.
After the surgery, it is essential to properly protect the injured lower leg.

7.
Metal fixation for fractures is aimed at achieving stability at the fracture site, which facilitates proper bone healing.

8.
If a cast is used post-surgery, it serves as an auxiliary fixation and should not be removed casually.
Wearing a cast may cause discomfort, but it is necessary to keep it on.

Reply Date: 2020/03/04

More Info

Post-surgery complications, particularly in pediatric fractures, can be concerning for both parents and healthcare providers. In your case, the child experienced a tibial fracture that was surgically treated with titanium rods. The subsequent deformation of the rods, leading to them protruding from the skin, raises several important questions regarding the healing process, the materials used, and the overall management of the situation.

Understanding Titanium Rod Deformation
1. Causes of Deformation: Titanium rods are generally chosen for their strength and biocompatibility. However, deformation can occur due to several factors:
- Mechanical Stress: If the child puts weight on the injured leg too soon or engages in activities that exert excessive force on the healing bone, it can lead to bending or shifting of the rods.

- Bone Healing Dynamics: The healing process involves the formation of callus (new bone tissue), which can sometimes lead to instability if the fixation is not adequate or if the bone does not heal properly.

- Growth Factors: In children, the bones are still growing, and any premature stress on the healing bone can lead to complications, including rod deformation.

2. Impact of Activities: Bathing or any activity that involves movement can potentially stress the surgical site. However, it is crucial to follow post-operative guidelines regarding weight-bearing and activity restrictions to minimize risks.

3. Surgical Intervention: If the titanium rods are indeed protruding and causing discomfort or risk of infection, a follow-up surgery may be necessary to either reposition or remove the rods. The risk of deformation can persist if the underlying issues (such as premature weight-bearing) are not addressed.

Titanium Alloy Fixation Principles
Titanium alloys are used in orthopedic surgery due to their favorable properties:
- Strength and Lightweight: They provide strong support while being lighter than other metals.

- Biocompatibility: Titanium is well-tolerated by the body, reducing the risk of rejection.

- Corrosion Resistance: This property helps maintain the integrity of the rods over time.

However, the fixation can fail if:
- The bone does not heal adequately.

- There is excessive movement at the fracture site.

- The child engages in activities that exceed the recommended limits during the healing phase.

Future Considerations
1. Re-surgery Risks: If a second surgery is performed, the same risks of deformation could apply unless the underlying issues are resolved. It is essential to ensure that the child follows post-operative care instructions strictly.

2. Alternative Methods: Depending on the specific circumstances, other fixation methods (like external fixation) may be considered, but these come with their own set of risks and benefits. Discussing these options with an orthopedic specialist is crucial.

3. Cast Discomfort: It is not uncommon for children to experience discomfort while wearing a cast, especially if it is too tight or if there is swelling. Regular follow-ups with the healthcare provider can help assess the fit and comfort of the cast. The cast should only be removed or adjusted under medical supervision.

4. When to Remove the Cast: The timing for short breaks from the cast should be guided by the physician. Generally, it is recommended to keep the cast on as much as possible to ensure proper healing, but short periods of removal for hygiene or comfort may be allowed under specific circumstances.

Conclusion
In summary, the deformation of titanium rods post-surgery can be attributed to mechanical stress and the dynamics of bone healing. It is vital to adhere to post-operative care guidelines to minimize risks. If surgery is required again, the orthopedic surgeon will evaluate the situation and recommend the best course of action. Regular follow-ups are essential to monitor healing and address any complications early on. Always consult with the healthcare provider for personalized advice and management strategies tailored to your child's specific needs.

Similar Q&A

Understanding Titanium Alloy Fixation for Pediatric Femur Fractures

Hello Doctor: My 4.5-year-old child has suffered a femoral shaft fracture due to a fall and has had a titanium alloy plate inserted for stabilization. I have several questions to ask you (the child is too young to express clearly): 1. Will there be a sensation of foreign body pre...

Dr. Li Yongheng reply Orthopedics
Hello: 1. There will be no foreign body sensation. 2. The fractured limb may experience overgrowth. 3. It may affect skeletal development. 4. It will not impact mobility. I still recommend that you have the bone plate removed after the fracture has healed.

Post-Surgery Stiffness in Pediatric Humerus Fracture: Seeking Solutions

Dear Doctor, On March 13, just before turning four years old, my child accidentally fell from the bed and sustained a deformity in the left elbow due to a fracture. That evening, we took him to the emergency room for an X-ray, which confirmed a fracture of the left humerus. He u...

Dr. You Dianqi reply Orthopedics
Hello: As a parent myself, I understand your feelings. It truly pains me to hear about your child's condition. Would it be convenient for me to explain this to you in person? I find that written communication often fails to convey the precise information I wish to share with...

Understanding Radial Fractures in 11-Year-Olds: Treatment and Risks

Dear Doctor, An 11-year-old child fell off a bicycle on July 25 and fractured the radius near the wrist. Initial treatment involved closed reduction and casting, with weekly follow-ups. The physician indicated that if there was no displacement, surgery would not be necessary. On...

Dr. Li Wenhong reply Orthopedics
Hello: 1. To prevent deformities, it is essential to provide stable fixation and protect the growth plates from excessive injury. Pediatric fractures are typically stabilized with percutaneous pins and cast immobilization, which is usually sufficient. Proper anesthesia (general a...

Understanding Tibial Fractures: Treatment, Surgery, and Growth Concerns

Hello: My daughter suffered a tibial fracture in a car accident on September 5, 2018. She underwent surgery at that time, where a steel plate was used for fixation. The plate was removed the following July, and upon further observation, it was discovered that she has a leg length...

Dr. Wang Shouji reply Orthopedics
Hello, if a pediatric fracture affects the growth plate, it can sometimes lead to asymmetrical growth. In such cases, it is necessary to suppress the growth on one side to prevent increasing deformity and to correct the malalignment. We will only know if there is still a leg leng...