Should You Remove Titanium Screws After Rib Fracture Surgery?

Regarding the issue of rib screw removal?

In March, I was involved in a car accident and suffered a rib fracture, which required surgery to insert a plate and screws.
Initially, titanium alloy was chosen for the materials.
Recently, I noticed some discomfort when bending over, so I underwent a CT scan and discovered that one of the screws has slightly migrated.
The surgeon mentioned that this area was difficult to secure properly.
Currently, my condition involves occasional pain when bending, but it is not consistent, and the loosening of the screw is not severe.
Should I consider surgery to remove the screw? What are the risks associated with removing the screw, or is it possible to leave it in place? Thank you for your response, doctor.

Chen Hsuan, 50~59 year old female. Ask Date: 2021/09/27

Dr. Chen Yongxue reply Orthopedics

Hello, regarding the steel nails and plates, since they are foreign objects, I personally recommend removing them once their temporary purpose has been fulfilled.
The removal should ideally take place about a year after surgery, from March until now, as the fracture site should have healed by then.
As for the pain when bending, it may not be directly related to the steel plate.
Thank you.

Reply Date: 2021/09/27

More Info

After undergoing surgery for a rib fracture, the presence of titanium screws can raise concerns about whether they should be removed, especially if there are symptoms such as pain or if the screws appear to be shifting. Here’s a comprehensive overview of the situation, addressing your concerns and providing additional medical insights.

Should You Remove Titanium Screws?
1. Assessment of Symptoms: If you are experiencing intermittent pain when bending, it is essential to evaluate the cause. Pain could be due to several factors, including the positioning of the screws, irritation of surrounding tissues, or even the healing process of the rib itself. If imaging studies, such as a CT scan, show that the screws are indeed shifting or "floating," this could indicate that they are not providing the necessary stability for the fracture site.

2. Risks of Leaving the Screws In: If the screws are not causing significant discomfort and are not compromising the healing process, some surgeons may opt to leave them in place. However, if there is a risk of the screws causing irritation or if they are not securely anchored, this could lead to complications such as infection or further injury to the surrounding tissues.

3. Risks of Removal: The decision to remove screws is not without risks. Surgical removal involves anesthesia and the potential for complications such as infection, bleeding, or damage to surrounding structures. However, if the screws are causing significant discomfort or if there is a risk of them migrating further, removal may be the best option.

4. Timing of Removal: If the screws are to be removed, the timing is crucial. Ideally, they should be removed once the fracture has sufficiently healed, which can take several weeks to months depending on the individual’s healing capacity and the nature of the fracture.

5. Consultation with Your Surgeon: It is vital to have an open discussion with your orthopedic surgeon about your symptoms and the findings from your imaging studies. They can provide personalized advice based on your specific situation, including whether the screws should be removed or if conservative management is appropriate.

Additional Considerations
- Healing Process: Rib fractures typically heal within 6 to 8 weeks, but the timeline can vary based on factors such as age, overall health, and adherence to post-operative care. During this time, it is crucial to monitor for any signs of complications, such as increased pain, swelling, or difficulty breathing.

- Physical Activity: Engaging in activities that put strain on the ribcage should be approached with caution. If bending or twisting causes pain, it may be wise to limit these movements until you have further clarity from your healthcare provider.

- Follow-Up Care: Regular follow-up appointments are essential to monitor the healing process and assess the condition of the screws. If you notice any changes in symptoms or if new symptoms arise, it is important to report these to your healthcare provider promptly.

In conclusion, the decision to remove titanium screws after rib fracture surgery should be made collaboratively with your healthcare provider, taking into account your symptoms, imaging results, and overall healing progress. It is essential to weigh the risks and benefits of both removal and retention of the screws to ensure the best outcome for your recovery.

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