Wire Loosening After Patella Fracture Surgery: Risks and Solutions

Loose wire from patellar fracture fixation?

Dear Dr.
Wang,
I was involved in a car accident on May 1st, resulting in a horizontal fracture of the patella in my left knee, which broke into two pieces.
I underwent internal fixation surgery with two steel pins and wires.
After the surgery, I have been diligently rehabilitating myself, and as of June 29th, I can bend my knee to 120 degrees.
However, due to insufficient quadriceps strength, I am still unable to go up and down stairs, although I can move around quite freely for the most part.
During my follow-up appointment on June 15th, an X-ray revealed that the wire had become loose, having rotated 180 degrees.
The doctor mentioned that if there is no significant foreign body sensation, it is conservatively estimated that the pins and wire could be removed in about six months.
Since I did not experience any obvious foreign body sensation at that time, I felt it was manageable.
However, this week, I have noticed a sensation of something piercing the skin at the inferior edge of the patella, accompanied by a sharp pain that affects the surrounding muscle groups.
This intermittent sharp pain is quite uncomfortable and distressing, impacting my motivation and progress in rehabilitation.
I would like to ask the following questions:
1.
Is loosening of the wire a risk associated with this type of surgery?
2.
Given that it has been two months post-surgery, is it feasible to remove the pins and wire now?
3.
If the wire is not removed, what risks are associated with it continually piercing the skin? Could it lead to inflammation? Would recurrent inflammation cause tissue fibrosis?
4.
Are there any other methods to alleviate my discomfort that would allow me to manage until the surgery in six months?
Thank you.

Sofia, 40~49 year old female. Ask Date: 2022/06/29

Dr. Wang Shouji reply Orthopedics

Hello, the fixation of patellar fractures using steel pins and wires can lead to displacement and malalignment postoperatively, which is not uncommon due to the absence of threads.
The patella connects the quadriceps muscle to the lower leg, and removing the steel pins after just two months may be too early.
Close monitoring of the skin condition is essential; if the pins protrude through the skin, it could lead to wound infection.
High-angle joint movements should be avoided initially to prevent continuous friction that may cause skin damage.
Changhua Hospital cares about your health.
Wang Shou-ji.

Reply Date: 2022/06/29

More Info

After a patella fracture surgery, particularly one involving internal fixation with wires and screws, patients may experience various complications, including wire loosening. Your concerns regarding the discomfort and potential risks associated with the loosening of the wire are valid and warrant careful consideration.

1. Wire Loosening as a Surgical Risk: Yes, wire loosening is indeed a recognized risk following surgeries involving internal fixation. Factors contributing to this may include the patient's activity level, the quality of bone healing, and the mechanical stress placed on the fixation device. In your case, the X-ray findings indicating a 180-degree rotation of the wire suggest that it has not remained securely in place. While some patients may not experience significant discomfort, others, like yourself, may feel pain or discomfort as the wire shifts, especially if it begins to irritate surrounding tissues.

2. Timing for Removal of Hardware: At two months post-surgery, the decision to remove the screws and wires is typically based on the healing progress of the bone and the presence of symptoms. If the bone is healing well and you are experiencing discomfort due to the hardware, it may be feasible to consider removal sooner than the typical six-month period. However, this decision should be made in consultation with your orthopedic surgeon, who can assess the healing through imaging and physical examination.

3. Risks of Not Removing the Wire: If the wire remains in place and continues to irritate the surrounding tissues, there is a risk of developing inflammation. Chronic irritation can lead to a condition known as tenosynovitis, where the tendon sheath becomes inflamed, potentially resulting in pain and limited mobility. Additionally, repeated inflammation can lead to fibrosis, where scar tissue forms, potentially complicating future recovery and rehabilitation. If the wire penetrates the skin, there is also a risk of infection, which could further complicate your recovery.

4. Management Strategies Until Surgery: While waiting for a potential surgical intervention, there are several strategies you can employ to manage your discomfort. First, consider modifying your activities to avoid movements that exacerbate the pain. Gentle range-of-motion exercises may help maintain flexibility without placing undue stress on the knee. Applying ice to the affected area can help reduce inflammation and pain. Over-the-counter pain relievers, such as ibuprofen or acetaminophen, may also provide relief. Additionally, physical therapy can be beneficial in strengthening the quadriceps and improving overall knee function, which may alleviate some of the discomfort associated with the hardware.

In conclusion, while wire loosening is a known risk after patella fracture surgery, your symptoms warrant a thorough evaluation by your orthopedic surgeon. They can provide guidance on whether early removal of the hardware is appropriate and suggest strategies to manage your discomfort in the interim. Maintaining open communication with your healthcare provider is essential to ensure a safe and effective recovery.

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