Addressing Issues with Distal Humerus Fracture and Hardware Removal

Distal humeral fracture screw removal issues?

Hello Doctor, I was in a car accident on June 2nd of this year, which resulted in a distal humerus fracture in my left arm.
On June 3rd, I underwent surgery where two plates and eight screws were inserted to stabilize my upper arm, and two long intramedullary nails and wires were placed in my elbow and forearm.
During my follow-up appointment last month (September), my attending physician mentioned that I could schedule the removal of one of the screws from the ulna this month (October), while the others would be removed after a year.
I would like to inquire whether removing just this one screw would allow for further improvement in the extension and flexion of my hand.
Currently, I can extend my arm to about 170 degrees, but I can only flex it to about 70-80 degrees.
Additionally, I experience some discomfort when bending for a long time and then suddenly straightening it (and vice versa).
Would the removal of this screw make the movement smoother, or would it be better to wait and remove all of them together in a year? This way, I would only need to undergo surgery once.

Celine, 30~39 year old female. Ask Date: 2020/10/08

Dr. Shi Guozheng reply Orthopedics

After the removal of bone screws, joint mobility may improve slightly, but the sensation of stiffness may not necessarily improve.
If there are two bone plates fixed, removing them simultaneously may sometimes lead to re-fracture; therefore, it is reasonable to perform the removal in two separate procedures.

Reply Date: 2020/10/08

More Info

Addressing issues related to a distal humerus fracture and the subsequent hardware removal can be complex, especially considering the specifics of your case. After your accident on June 2nd, where you sustained a distal humerus fracture, you underwent surgery on June 3rd, which involved the placement of plates and screws for stabilization. It’s understandable that you are eager to regain full functionality of your arm, particularly in terms of extension and flexion.

From your description, it appears that you currently have a range of motion (ROM) of approximately 170 degrees for extension and 70-80 degrees for flexion. This indicates that while your extension is nearly full, your flexion is limited. The sensation of "catching" or pain when moving from a bent to a straight position (and vice versa) is not uncommon after such surgeries, especially when hardware is involved. This can be due to several factors, including scar tissue formation, hardware irritation, or even muscle tightness.

Regarding the removal of the specific hardware (the ulnar screw) this month, it is likely that this procedure could improve your range of motion and alleviate some discomfort. Removing hardware can sometimes relieve pressure on surrounding tissues and joints, potentially leading to improved mobility. However, the extent of improvement can vary from person to person.
Here are some considerations to keep in mind:
1. Timing of Hardware Removal: If your surgeon has recommended removing one of the screws now, it may be because they believe that this particular screw is contributing to your discomfort or limiting your range of motion. If you wait to remove all hardware at once, you may experience prolonged discomfort and limited mobility in the meantime.

2. Post-Operative Rehabilitation: After the removal of the screw, physical therapy will likely be essential. Engaging in a structured rehabilitation program can help you regain strength and flexibility in your arm. Your therapist can guide you through exercises tailored to your specific needs, focusing on improving your flexion and addressing any stiffness.

3. Potential Risks: As with any surgical procedure, there are risks involved in hardware removal, including infection, nerve damage, or complications related to anesthesia. However, if the hardware is causing significant discomfort or impeding your recovery, the benefits may outweigh these risks.

4. Future Surgery Considerations: If you choose to wait a year to remove all hardware, you may have to endure ongoing discomfort and limited mobility during that time. However, if your surgeon believes that the remaining hardware is stable and not causing issues, this may be a reasonable approach.

5. Consultation with Your Surgeon: It’s crucial to have an open dialogue with your orthopedic surgeon about your concerns and goals. They can provide insights based on your specific situation and help you weigh the pros and cons of removing the hardware now versus later.

In conclusion, removing the ulnar screw could potentially enhance your range of motion and reduce discomfort, but it’s essential to discuss your specific situation with your surgeon to make an informed decision. Engaging in physical therapy post-surgery will also be vital for your recovery. Remember, every patient’s healing journey is unique, and your healthcare team is there to support you through this process.

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