Should You Remove Titanium Intramedullary Nail After Humerus Fracture?

Hello, doctor?

Currently, I have a spiral fracture of the left humerus that has been treated with a titanium intramedullary nail.
However, I am experiencing discomfort and a foreign body sensation, and I plan to have it removed after one year (which will be in August this year).
My doctor advised against removing the nail, stating that my arm could fracture again at the original injury site due to lifting heavy objects or falling.
Is this accurate?

Lin, 20~29 year old female. Ask Date: 2022/06/23

Dr. Chen Yongxue reply Orthopedics

In fact, bone screws are not part of the body's original tissue, and they should ideally be removed after the staged tasks are completed.
However, there is a risk of injuring the radial nerve when removing the plate at the site of a humeral fracture.
Thank you.

Reply Date: 2022/06/23

More Info

When it comes to the question of whether to remove a titanium intramedullary nail after a humeral fracture, there are several factors to consider. Titanium nails are commonly used in orthopedic surgery due to their strength, lightweight nature, and biocompatibility. They are designed to provide stability to the fractured bone while it heals. However, the decision to remove them is not always straightforward and can depend on various individual circumstances.

1. Healing and Stability: After a humeral fracture, the bone typically takes several months to heal. Once the fracture has healed adequately, the intramedullary nail may no longer be necessary for stability. However, the risk of re-fracture at the site of the original injury can be a concern, especially if the bone has not regained full strength. Your doctor’s recommendation against removing the nail may be based on the assessment that the risk of re-injury outweighs the discomfort you are experiencing.

2. Discomfort and Foreign Body Sensation: It is not uncommon for patients to experience discomfort or a foreign body sensation from the intramedullary nail. This can be due to the nail's presence, irritation of surrounding tissues, or even nerve involvement. If the discomfort is significant and affects your quality of life, it is worth discussing with your orthopedic surgeon. They may consider imaging studies to evaluate the healing process and determine if removal is warranted.

3. Risks of Removal: The removal of an intramedullary nail is a surgical procedure that carries its own risks, including infection, nerve damage, and complications related to anesthesia. Additionally, there is a possibility that the bone may not heal as well after the nail is removed, especially if the bone is still in the process of remodeling. Your doctor may be concerned that removing the nail could lead to instability and increase the risk of re-fracture, particularly if you engage in activities that place stress on the arm.

4. Timing of Removal: Many surgeons recommend waiting at least a year after the initial surgery before considering the removal of hardware, as this allows sufficient time for the bone to heal and remodel. If you are approaching the one-year mark and still experiencing significant discomfort, it may be beneficial to seek a second opinion or discuss alternative pain management strategies with your healthcare provider.

5. Long-term Considerations: If you decide to keep the nail, it is essential to monitor for any signs of complications, such as infection or changes in pain levels. Regular follow-ups with your orthopedic surgeon can help ensure that your recovery is progressing as expected. If you experience any new symptoms or changes, be sure to report these to your doctor promptly.

In conclusion, the decision to remove a titanium intramedullary nail after a humeral fracture should be made collaboratively with your orthopedic surgeon, taking into account the healing status of the bone, the level of discomfort you are experiencing, and the potential risks associated with both removal and retention of the nail. Open communication with your healthcare provider is crucial to ensure that your concerns are addressed and that you receive the best possible care tailored to your individual needs.

Similar Q&A

Concerns About Titanium Intramedullary Nail Removal After Humerus Fracture

I have a distal humeral fracture that was stabilized with a titanium intramedullary nail. I sometimes feel a foreign body sensation, which is quite uncomfortable, and it has affected the flexibility and range of motion of my arm. I hope to have the intramedullary nail removed in ...

Dr. You Dianqi reply Orthopedics
Hello: If this is your recent X-ray, the removal is not an option yet since your bone has not fully healed. If you wish to have it removed later, as you mentioned, it will indeed be technically more challenging due to the intramedullary nail being more embedded, but it is certain...

Should You Remove Intramedullary Nails After Fracture Healing?

Hello, I suffered a closed femoral fracture on the left side due to a car accident a year ago (November 2022). At that time, I was treated with intramedullary nailing. My recovery has been relatively good, and I can walk freely, although running still feels somewhat unnatural. Du...

Dr. You Dianqi reply Orthopedics
Each individual's condition and recovery process varies, so it is recommended to consult with an orthopedic specialist for personalized advice. Thank you.

Post-Tibial Screw Removal: Essential Care Tips and Precautions

Hello, I would like to ask what precautions should be taken after removing the tibial screws. If I accidentally bump into the bone, will it break? Thank you.

Dr. Chen Bochen reply Orthopedics
Hello, whether or not to remove the intramedullary nail and the associated risks can only be accurately assessed with a physical examination and X-rays. However, I can share some general information: 1. Intramedullary nails in the tibia can typically be removed after the fracture...

Should You Remove Intramedullary Nails After Bone Healing?

Several years ago, my mother suffered a comminuted fracture of the femur and had a steel rod implanted in her thigh bone. She has undergone several surgeries to remove it, but they were unsuccessful due to a drop in blood pressure that required emergency cessation. As the rod is ...

Dr. Zhang Jiahao reply Orthopedics
Hello: Generally speaking, metal screws do not have a specific lifespan. If there are no other symptoms and the surgical risks are too high, it may be considered not to remove them. It is advisable to discuss this further with your attending physician and make a decision after ev...