Complications of Distal Radius Fractures: Nerve Compression and Plate Removal

Distal radioulnar joint dislocation

Hello: I have a displaced fracture of the right radius and ulna, and I underwent surgery to place metal plates and screws (out-of-pocket expenses).
Two months later, I experience numbness in my thumb, index finger, and middle finger (the ring finger near the middle finger also feels numb).
The doctor mentioned that the metal plate might be compressing a nerve in that area.
I asked if removing it would resolve the issue, and the doctor said yes.
However, I am concerned about whether the nerve might be damaged during the removal process, or if I should wait a year to remove it.
By then, could the prolonged compression damage the nerve? Could you please advise if removing the metal plate would resolve my symptoms? Is there a risk of nerve injury during the removal? Is it safe for the nerve to be compressed for such a long time? How soon can the metal plate be removed? Thank you, doctor.

Huang S, 50~59 year old female. Ask Date: 2021/06/20

Dr. Chen Yongxue reply Orthopedics

Hello, regarding your inquiry, it is possible that the median nerve is being compressed.
If the condition of nerve compression gradually improves after surgery, some medications can be used to alleviate nerve discomfort.
However, if there is no improvement in nerve symptoms, it may be necessary to consider the early removal of the implant.

1.
If it becomes necessary to remove the implant, will it damage the nerve during the removal?
Answer: With careful handling, it should not cause damage.

2.
Is it acceptable for the nerve to be compressed for such a long time?
Answer: Generally, prolonged compression should be avoided; of course, it depends on the degree of compression, but it should not exceed three months.

3.
How soon can the metal plate be removed?
Answer: This depends on the extent of the fracture and the rate of bone healing...
It is advisable to follow the recommendations of your treating physician.
Thank you.

Reply Date: 2021/06/20

More Info

Understanding the complications associated with distal radius fractures, particularly regarding nerve compression and the implications of plate removal, is crucial for effective recovery and management of symptoms.
When a distal radius fracture occurs, it often requires surgical intervention, such as the insertion of plates and screws to stabilize the bone. While this is a common and generally effective treatment, complications can arise, particularly with nerve compression. In your case, the symptoms of numbness and tingling in your thumb, index, and middle fingers suggest that the median nerve may be compressed, possibly due to the hardware used in the surgery.

Nerve compression can lead to conditions such as carpal tunnel syndrome, where the median nerve is compressed as it passes through the wrist. This can result in persistent symptoms, including pain, numbness, and weakness in the affected fingers. The fact that your doctor indicated the possibility of the plate compressing the nerve is a valid concern, as hardware can sometimes shift or exert pressure on surrounding tissues, including nerves.

Regarding your question about the timing of plate removal, it is essential to weigh the risks and benefits. If the hardware is indeed causing nerve compression, removing it may alleviate your symptoms. However, there is a risk associated with any surgical procedure, including potential damage to the nerve during removal. Surgeons typically take great care to avoid such injuries, but the risk cannot be entirely eliminated.

The timeline for hardware removal can vary based on several factors, including the degree of healing of the fracture, the presence of symptoms, and the surgeon's assessment. Generally, if the fracture has healed adequately and you are experiencing significant symptoms related to nerve compression, your surgeon may recommend earlier removal of the hardware. It is not uncommon for surgeons to consider hardware removal if symptoms persist for several months post-surgery, especially if conservative measures (like physical therapy or medication) have not provided relief.

In terms of the potential for nerve damage due to prolonged compression, nerves can sometimes recover even after being compressed for an extended period, but this is not guaranteed. The longer the nerve is compressed, the higher the risk of permanent damage. Therefore, it is crucial to communicate openly with your healthcare provider about your symptoms and concerns. They may recommend imaging studies, such as an MRI or ultrasound, to assess the situation further before making a decision about surgery.

In summary, if you are experiencing persistent symptoms that suggest nerve compression, it is advisable to discuss the possibility of hardware removal with your surgeon. They can provide a thorough evaluation and help determine the best course of action based on your specific situation. Early intervention may prevent further complications and promote a better recovery outcome. Always prioritize clear communication with your healthcare team to ensure that your concerns are addressed and that you receive the best possible care.

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