Risks of Removing Intramedullary Plates in Young Adults: A Medical Insight

Remove the steel plate?

My son is in his twenties and had a car accident nearly a year ago, resulting in a hip joint fracture that required the implantation of an interlocking plate.
He has been wanting to have the plate removed, but the doctor mentioned that due to the plate being implanted deeply, there is a risk of injuring the sciatic nerve.
Given the current medical standards, how high is this risk? If the sciatic nerve is injured, what would be the consequences?

Niming, 50~59 year old female. Ask Date: 2021/11/20

Dr. Chen Bochen reply Orthopedics

Hello, in the case of a hip fracture treated with a locking plate, if there are no specific issues with the plate, such as loosening or screws penetrating the joint, it is generally not recommended to perform a removal surgery due to the significant risks involved.
There is a risk of damaging the sciatic nerve and blood vessels.
Injury to the sciatic nerve can lead to long-term symptoms of numbness, pain, and weakness.

Reply Date: 2021/11/20

More Info

When considering the removal of intramedullary plates, particularly in young adults who have sustained significant injuries such as hip joint fractures, it is essential to weigh the potential risks against the benefits. In your son's case, the decision to remove the interlocking plate should be approached with caution, especially given the concerns regarding the proximity of the plate to the sciatic nerve.

Risks of Removal
1. Nerve Injury: One of the most significant risks associated with the removal of intramedullary plates is the potential for nerve injury, particularly to the sciatic nerve. The sciatic nerve runs close to the hip joint and can be affected if the surgical procedure is not performed with precision. Damage to this nerve can lead to long-term complications, including pain, numbness, and weakness in the leg. In some cases, patients may experience chronic pain syndromes or difficulties with mobility.

2. Infection: Any surgical procedure carries a risk of infection. The presence of foreign material in the body can increase this risk, particularly if the surgery is performed in an area that has already been compromised by trauma.

3. Blood Vessel Injury: Similar to nerve injury, there is a risk of damaging blood vessels during the removal of the plate. This could lead to complications such as hematoma formation or even vascular insufficiency.

4. Delayed Healing: If the plate is removed, the bone may take time to heal properly, especially if there are screw holes left behind. These holes can weaken the bone temporarily, making it more susceptible to fractures if the patient engages in high-impact activities too soon after surgery.

5. Scar Tissue Formation: Surgical removal can lead to the formation of scar tissue, which may cause adhesions and further complications in the surrounding tissues.

Consequences of Sciatic Nerve Injury
If the sciatic nerve is injured during the removal process, the consequences can be significant:
- Motor Function Loss: The sciatic nerve is responsible for innervating muscles in the posterior thigh, lower leg, and foot. Injury could lead to weakness or paralysis of these muscles, affecting the ability to walk or perform daily activities.

- Sensory Loss: Patients may experience numbness or tingling in the leg or foot, which can be distressing and impact quality of life.

- Chronic Pain: Nerve injuries can lead to chronic pain conditions, such as neuropathic pain, which can be challenging to manage and may require long-term treatment.

Current Medical Standards
With advancements in surgical techniques and imaging, the risks associated with the removal of intramedullary plates have been somewhat mitigated. However, the decision to proceed with such a surgery should be made collaboratively between the patient, their family, and the orthopedic surgeon. It is crucial to consider the following:
- Indications for Removal: If the plate is not causing any discomfort, complications, or functional limitations, many surgeons recommend leaving it in place. The risks associated with removal may outweigh the benefits.

- Surgeon's Experience: The skill and experience of the surgeon play a critical role in minimizing risks. A surgeon who is familiar with the anatomy and potential complications associated with the procedure can help reduce the likelihood of nerve or vascular injury.

- Patient's Overall Health: The patient's age, overall health, and activity level should also be considered. Young adults often heal more quickly and may have a lower risk of complications compared to older patients.

In conclusion, while the desire to remove the intramedullary plate is understandable, it is essential to have a thorough discussion with the orthopedic surgeon regarding the risks involved, particularly concerning the sciatic nerve. If the plate is functioning well and not causing any issues, it may be advisable to leave it in place, especially considering the potential for serious complications associated with its removal.

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