the Risks of Removing Plates and Screws in Osteomyelitis

Removal of bone plates and screws in osteomyelitis?

Hello Doctor, in November 2017, I fractured my right humerus, and in March 2018, I was diagnosed with osteomyelitis.
I received antibiotic treatment and was hospitalized until the end of April.
In October, I underwent debridement and had a portion of my pelvis removed, staying in the hospital for a week.
In November 2018, I had a portion of my pelvis and some synthetic bone implanted into my right arm.
Recently, my attending physician mentioned that if the plate needs to be removed, it should be done as soon as possible, as delaying may reduce the chances of success.
However, the doctor is also concerned about the risk of nerve damage during the removal process, considering the plate has been in my body for nearly three years.
If I do not have it removed, I experience pain at the elbow (especially noticeable during seasonal changes and rainy days), and if I were to injure the same area again in the future, it would be difficult to manage since my right arm already has the plate.
Regardless of whether I choose to have surgery or not, there are risks involved.
I would like to seek your advice or insights on this matter.
Thank you.

Yuan Yuan, 20~29 year old female. Ask Date: 2021/09/12

Dr. Shi Guozheng reply Orthopedics

If the steel plate is affecting your elbow, please have the doctor carefully remove it during surgery, paying close attention to the position of the nerves.

Reply Date: 2021/09/12

More Info

When considering the removal of plates and screws in the context of osteomyelitis, it is essential to weigh the benefits against the potential risks involved in the surgical procedure. Osteomyelitis, an infection of the bone, can complicate the healing process and may necessitate the removal of hardware that has been implanted to stabilize a fracture.
In your case, having undergone a significant surgical history involving the humerus, including the placement of hardware and subsequent treatment for osteomyelitis, it is understandable that you are concerned about the implications of removing the plate. The primary risks associated with the removal of plates and screws include:
1. Infection Risk: Any surgical procedure carries a risk of infection, especially in a patient with a history of osteomyelitis. The presence of hardware can sometimes serve as a nidus for infection, and its removal may exacerbate this risk if not managed properly.

2. Nerve Damage: As you mentioned, there is a concern about potential nerve injury during the removal of the hardware. The longer the hardware remains in place, the more integrated it may become with surrounding tissues, including nerves. This can complicate the removal process and increase the risk of nerve damage.

3. Delayed Healing: If the hardware is removed, there is a possibility that the bone may not heal as expected, particularly if the osteomyelitis has compromised the integrity of the bone. The healing process may be prolonged, and there may be a need for further interventions.

4. Pain Management: You noted that you experience pain in the elbow area, particularly during changes in weather. This could be due to the presence of the hardware or related to the underlying condition. Removing the hardware may alleviate some of this pain, but it is not guaranteed.

5. Future Fracture Risk: If the hardware is not removed, there is a risk that if you sustain another injury to the same area, it may complicate treatment due to the existing hardware. This could lead to more complex surgical interventions in the future.

Given these considerations, it is crucial to have a thorough discussion with your orthopedic surgeon. They can provide insights based on your specific case, including the condition of the bone, the extent of the osteomyelitis, and the potential for recovery post-surgery.
In general, if the hardware is causing significant discomfort or if there is a high likelihood of complications from leaving it in place, removal may be warranted. However, if the risks of surgery outweigh the benefits, and if the hardware is not causing significant issues, it may be advisable to monitor the situation closely.

In conclusion, the decision to remove plates and screws in the context of osteomyelitis should be made collaboratively with your healthcare team, considering all risks and benefits. It is essential to have a clear understanding of your current health status, the potential for recovery, and the implications of both surgical and non-surgical options. Regular follow-ups and imaging studies may also be beneficial in assessing the condition of the bone and the surrounding tissues.

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