Post-Fracture Follow-Up Concerns for Leg Injury Recovery

Follow-up concerns after recovery from a comminuted fracture of the lower leg?

Hello, Dr.
Shih.
In August 2018, I accidentally had a car accident that resulted in a comminuted fracture of my left calf.
I underwent surgery at Taipei Veterans General Hospital, where a 22 cm titanium alloy plate and 12 screws were implanted, along with a small piece of donated bone.
My attending physician advised me that after healing, there would be no need for another surgery to remove the titanium plate.

During my follow-up appointment in January 2019, my physician confirmed that I had healed and suggested I return for follow-up in six months to a year.
However, I have been working in Thailand for an extended period, and due to the impact of COVID-19, I have been unable to return to Taiwan and am uncertain when I will be able to do so.
It has now been a year and a half since my last follow-up appointment.
I would like to ask if it is acceptable not to have followed up as scheduled.
Currently, my calf feels normal, and there are no unusual symptoms.
Additionally, I have been experiencing tooth pain and will be seeing a dentist in Thailand, where I may need to take antibiotics or anti-inflammatory medications.
Given that I still have the titanium alloy plate in my calf, are there any contraindications regarding medication I should be aware of?
I appreciate your time and assistance in addressing my concerns.
Thank you!

Luffy Liu, 40~49 year old female. Ask Date: 2020/06/02

Dr. Shi Guozheng reply Orthopedics

1.
Not returning for a follow-up appointment on time is not a major concern for the moment.

2.
If there are metal objects in the body, it is advisable to take some antibiotics as a precaution before seeing a dentist.

3.
There are no contraindications for the medication.

Reply Date: 2020/06/02

More Info

Hello! Thank you for reaching out with your concerns regarding your recovery after a complex leg fracture. It sounds like you have been through a significant ordeal, and it's understandable to have questions about your ongoing recovery and any potential complications.

Firstly, regarding your follow-up appointments, it is generally recommended to have regular check-ups after a fracture, especially one as severe as a comminuted fracture that required surgical intervention. These follow-ups allow your orthopedic surgeon to monitor the healing process, assess the alignment of the bones, and ensure that there are no complications such as non-union or malunion. However, if you feel that your leg is functioning normally and you are not experiencing any pain, swelling, or other unusual symptoms, it may be acceptable to wait until you can return to your home country for a check-up. That said, if you notice any changes in your condition, such as increased pain, swelling, or difficulty in movement, it would be wise to seek medical attention sooner.

As for your concerns about taking antibiotics or anti-inflammatory medications while having a titanium plate and screws in your leg, there are generally no specific contraindications for using these medications in patients with metal implants. Titanium is biocompatible, meaning it is generally well-tolerated by the body, and it does not typically react adversely with medications. However, it is always best to inform your dentist or healthcare provider about your medical history, including the presence of the titanium hardware, so they can make informed decisions about your treatment.

When taking antibiotics, it is important to follow the prescribed dosage and duration to avoid complications such as antibiotic resistance. If you are prescribed anti-inflammatory medications, be cautious about potential side effects, especially if you have any underlying health conditions or are taking other medications. Always consult with your healthcare provider before starting any new medication.

In terms of your recovery, it is crucial to continue monitoring your leg for any signs of complications. If you experience any discomfort, changes in sensation, or difficulty with mobility, it would be advisable to seek medical attention. Additionally, maintaining a healthy lifestyle, including a balanced diet rich in calcium and vitamin D, can support bone health and recovery.

Lastly, if you have any concerns about the long-term effects of having a titanium plate in your leg, such as the potential for pain or discomfort in the future, it is worth discussing these with your orthopedic surgeon during your next visit. They can provide you with personalized advice based on your specific situation.

In summary, while it is generally acceptable to delay follow-up appointments if you are not experiencing any issues, it is essential to remain vigilant about your leg's condition. When it comes to medications, there are typically no significant concerns with taking antibiotics or anti-inflammatory drugs with a titanium implant, but always consult your healthcare provider for personalized advice. Wishing you a smooth recovery and good health!

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