Misaligned Screws or Plates: What to Do Next?

The steel nail or steel plate is slightly misaligned?

Today, during my follow-up appointment, I had an X-ray taken.
The doctor mentioned that my metal rod or plate (I can't remember which) is slightly misaligned and asked if I had accidentally stepped on it.
I told him that since the surgery, I have never dared to put my foot on the floor.
Before I could ask any further questions, the doctor left in a hurry, and I don't know what he was rushing for.
I would like to know what I should do about the slight misalignment of the metal rod.
Should I be concerned about needing another surgery? I am very certain that I have not put any weight on my foot.
Since the doctor was not very clear, I am feeling anxious about whether this will affect the healing of my bone or if there could be any side effects after it heals.

A-Bao, 20~29 year old female. Ask Date: 2020/10/16

Dr. Chen Bochen reply Orthopedics

Hello, your question actually requires an X-ray for a more accurate answer.
In the case of a lower limb fracture with a steel plate, there are typically 3-4 screws (or bolts) at each end.
If fewer than two screws remain intact, there is a risk that surgery may be needed again.
However, if there are more than three tight screws on one end of the fracture, it is generally not a concern and should not affect recovery.
If you are worried, it’s best to schedule an earlier follow-up appointment to consult with the surgeon who performed your operation.
Wishing you a speedy recovery!

Reply Date: 2020/10/16

More Info

When it comes to orthopedic surgery and the use of plates and screws for bone stabilization, it is understandable to feel anxious about any misalignment or deviation observed in post-operative imaging. In your case, the slight misalignment of the screws or plates can raise concerns about the healing process and the overall stability of the surgical site.
First and foremost, it is important to understand that minor deviations in the positioning of screws or plates are not uncommon in orthopedic procedures. Surgeons aim for optimal alignment during surgery, but factors such as bone quality, the nature of the fracture, and post-operative activities can influence the final positioning of hardware. If your doctor noted that the screws or plates are "a little bit misaligned," it is crucial to assess the degree of this misalignment and its potential implications.

In general, if the misalignment is minimal and the bone is healing well, it may not necessitate any surgical intervention. The body has a remarkable ability to adapt to minor deviations, and as long as there is no significant instability or pain, the healing process can continue without major issues. However, if the misalignment is significant or if you experience increased pain, swelling, or instability, further evaluation may be warranted.

Here are some steps you can take moving forward:
1. Follow-Up Appointment: Schedule a follow-up appointment with your orthopedic surgeon to discuss your concerns in detail. It is essential to have a clear understanding of the implications of the misalignment and what it means for your recovery.

2. Imaging Studies: Your doctor may recommend additional imaging studies, such as X-rays or CT scans, to assess the extent of the misalignment and to ensure that the bone is healing properly. These images can provide valuable information about the stability of the hardware and the healing of the bone.

3. Monitor Symptoms: Keep track of any symptoms you may experience, such as pain, swelling, or changes in mobility. If you notice any worsening of symptoms, it is important to report these to your doctor promptly.

4. Activity Modification: Since you mentioned that you have been cautious about putting weight on your leg, continue to follow your doctor's recommendations regarding weight-bearing activities. Avoid putting excessive stress on the surgical site until you receive further guidance.

5. Physical Therapy: If you are not already engaged in a physical therapy program, consider discussing this option with your doctor. A physical therapist can help you with exercises that promote healing and strengthen the surrounding muscles, which can provide additional support to the surgical site.

6. Stay Informed: Educate yourself about the healing process and what to expect post-surgery. Understanding the normal timeline for recovery and the signs of complications can help alleviate anxiety.

In conclusion, while the misalignment of screws or plates can be concerning, it does not automatically indicate that you will require another surgery. Many patients experience successful recoveries despite minor deviations in hardware placement. Open communication with your healthcare provider is key to addressing your concerns and ensuring a smooth recovery process. Remember, your health and peace of mind are paramount, so do not hesitate to seek clarification and support from your medical team.

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