When to Remove Surgical Rods After Fracture Surgery?

When should the metal rod be removed after a fracture surgery?

Dr.
Chen: Hello.
My older sister is 52 years old.
Three years ago, she suffered an open fracture of the right tibia and fibula, which led to osteomyelitis.
She underwent surgery and had a metal rod implanted (from just below the knee joint to near the ankle).
After being discharged, she received rehabilitation for one to two years.
To this day, if she stands for a while, she experiences lower back pain, ankle swelling, and knee pain (the rod seems to be too long and protrudes below the knee joint).
I would like to ask: 1.
How long should the rod be kept in place before it is advisable to remove it? 2.
How long does the surgery take? How many days of hospitalization are required? 3.
How many days after the surgery can she get out of bed and walk? 4.
How long will it take for her to be able to go up and down stairs? (She lives on the 4th floor of an apartment building.) 5.
Her bone density is -2; is there any risk or potential complications after the rod is removed? 6.
Are there any other considerations she should be aware of? I truly admire your ability to take time out of your busy schedule to assist online users.
Thank you in advance, and I wish you a Happy New Year! Sincerely, Zheng Shuhua, 12/28/91.

Zheng, 40~49 year old female. Ask Date: 2002/12/28

Dr. Chen Xingyuan reply Orthopedics

Dear Ms.
Chen,
The complication of fracture with osteomyelitis is quite a troublesome issue, as osteomyelitis is difficult to control and can affect the healing of the bone.
Whether the steel pin can be removed depends on confirming if the fracture has healed, which can be determined through X-ray examination.
If the bone is confirmed to be healed, the removal of the steel pin can be considered.
Generally, this takes about a year, but if osteomyelitis is present, it may delay bone healing or even lead to nonunion.
If it is simply a pin removal surgery, the procedure typically takes about 30 minutes to an hour, with a hospital stay of 3 to 4 days.
Patients can usually get out of bed and walk the day after surgery.
Initially, climbing stairs may be somewhat challenging, but with assistance or the use of a cane, it should not pose a problem.
After the pin is removed, the support of the bone will decrease, and the greatest risk is the possibility of re-fracture.
However, if you avoid vigorous or weight-bearing activities for three months post-removal, the chance of re-fracture will be quite low.
I recommend that you follow up with the orthopedic outpatient clinic to check if the osteomyelitis has been adequately controlled and if the fracture has healed.
The pin removal is a minor procedure, so there is no need to worry excessively.
Wishing you health and safety!
Sincerely,
Dr.
Chen

Reply Date: 2002/12/28

More Info

When it comes to the removal of surgical rods after fracture surgery, several factors need to be considered, including the type of fracture, the healing process, and the patient's overall health. In your sister's case, she has had a significant history of an open fracture of the tibia and fibula, complicated by osteomyelitis, which can affect the healing and stability of the bone.

1. Duration for Keeping the Rods: Generally, surgical rods or plates are kept in place until the bone has healed sufficiently. This can vary widely depending on the individual case, but typically, rods are removed anywhere from 6 months to 2 years after surgery. In your sister's case, given her history of complications, it would be prudent to consult with her orthopedic surgeon to evaluate the current state of her bone healing and whether the rod is still necessary. If she is experiencing discomfort due to the rod, it may be a sign that removal should be considered sooner rather than later.

2. Surgical Time and Hospital Stay: The surgery to remove the rods is usually less complex than the initial surgery to insert them. It typically takes about 1 to 2 hours, depending on the complexity of the case. The length of hospital stay can vary, but many patients are able to go home the same day or after an overnight stay, assuming there are no complications.

3. Walking After Surgery: Most patients are encouraged to start walking as soon as they feel comfortable after surgery, often within a day or two. However, your sister's specific situation may require a tailored approach based on her pain levels and the surgeon's recommendations.

4. Stair Climbing: The ability to navigate stairs post-surgery can vary. Generally, patients can start practicing stair climbing within a few weeks after surgery, but this should be done under the guidance of a physical therapist to ensure safety and proper technique.

5. Bone Density Concerns: Your sister's bone density of -2 indicates osteopenia, which can increase the risk of fractures. After the removal of the rods, there is a potential for increased risk of refracture, especially if the bone has not fully healed or if there are underlying issues with bone density. It is essential to discuss these concerns with her healthcare provider, who may recommend bone density improvement strategies, such as weight-bearing exercises, dietary changes, or medications to enhance bone health.

6. Other Considerations: Post-operative care is crucial. Your sister should be monitored for signs of infection, especially given her history of osteomyelitis. Regular follow-ups with her orthopedic surgeon will help ensure that her recovery is on track. Additionally, physical therapy may be beneficial to strengthen the muscles around the knee and ankle, improve mobility, and reduce pain.

In summary, the decision to remove surgical rods should be made in consultation with her orthopedic surgeon, taking into account her healing progress and any discomfort she is experiencing. The recovery process can vary, and it is essential to follow medical advice closely to ensure the best possible outcome.

Similar Q&A

Recovery After Steel Nail Removal: What to Expect Post-Surgery

Hello, doctor. I would like to ask a question. Last January, I had an open fracture of the tibia and fibula due to a car accident. The attending physician inserted a metal rod at that time, and now, after a year, the doctor has suggested that it can be removed. I would like to kn...

Dr. Shi Guozheng reply Orthopedics
If an intramedullary nail is placed in the tibia, normal walking can resume one week after its removal. However, if a plate and screws are used for fixation, protection is required for three months post-removal, and vigorous activities should be avoided during this period.

Should You Remove Plates and Screws After Arm Fracture Surgery?

Hello, I sustained a closed fracture of the right humerus while throwing a baseball on February 27 of this year, and I underwent surgery in early March. I have mostly recovered now and would like to know if there is a necessity to remove the plates and screws in the future. The p...

Dr. Wang Shouji reply Orthopedics
Hello: When removing the plate after a humeral fracture, it is important to consider the risk of injury to the radial nerve. Titanium alloy has less stress shielding effect, and based on my assessment of the risks, I do not recommend removal. Thank you!

How to Remove Surgical Pins After Radius Fracture Recovery?

Hello, Doctor. I sustained a fracture of the radius while playing basketball on April 30. I underwent surgery where two steel pins were inserted to realign the bone. There are two small wounds on the skin surface, and I can see the heads of the pins, but neither of the heads is p...

Dr. Shi Guozheng reply Orthopedics
Typically, bone screws can be removed in about six to eight weeks, but the decision depends on the degree of bone healing as seen on X-rays. If the screws are protruding through the skin, they can be removed directly in the outpatient setting using tools, and anesthesia may not b...

Understanding the Need for Hardware Removal After Arm Fracture Surgery

Hello Doctor, I had surgery on October 27th of last year following a car accident, primarily for a right distal humeral fracture. The current condition, as shown in the photos [link], has improved with ongoing rehabilitation, but I still experience slight differences in the angle...

Dr. Chen Yongxue reply Orthopedics
Each person's recovery varies. Whether or when to remove it should be discussed with your attending physician. Generally, a hospital stay of about 3 to 4 days is required post-surgery, and it is advisable to avoid vigorous exercise for at least 3 months. Thank you.