Addressing Complications After Forearm Fracture Surgery: A Patient's Concerns

Issues with steel pins for left distal radius/ulna fractures?

Hello Doctor, I underwent internal fixation surgery for a distal radius and scaphoid fracture on May 11 of this year (I was injured on April 9, and the surgery was delayed for various reasons).
I have been in rehabilitation since then, but I still cannot perform passive pronation movements; the physical therapist is unable to move my elbow at all.
Recently, I had further examinations including a CT scan, and I consulted several doctors.
Some believe that the screws are too long and are causing a blockage, while others think the screws are of appropriate length.
The CT scan also revealed soft tissue calcification and fragmented bone proliferation, which may be related to the shockwave therapy I received immediately after the sutures were removed, as per the clinic's recommendation.
I am very proactive in my rehabilitation, but there has been no progress with the pronation movement, and I am quite worried.
I would like to ask the doctor: 1.
Can I undergo surgery now to replace the screws with shorter ones? (The surgeon is willing to help me replace them with shorter screws) or should I wait until a year after the surgery to remove the plate and screws together? 2.
Will undergoing surgery now increase the risk of nonunion? 3.
What are the pros and cons that I should be aware of? Thank you, Doctor!

Jo, 30~39 year old female. Ask Date: 2022/08/31

Dr. Shi Guozheng reply Orthopedics

1.
It may be more appropriate to use shorter screws.

2.
It should not be a problem.

3.
You should ask your attending physician for the most accurate information.

Reply Date: 2022/08/31

More Info

Dear Patient,
Thank you for sharing your concerns regarding your forearm fracture surgery and the complications you are experiencing. It’s understandable to feel anxious when recovery does not progress as expected, especially after undergoing surgery. Let’s address your questions and provide some insights based on the information you provided.

1. Surgical Consideration for Shorter Screws: If your surgeon is willing to replace the longer screws with shorter ones, this could potentially alleviate the issue if the screws are indeed impeding your range of motion. However, it’s essential to weigh the risks and benefits. Surgery carries inherent risks, including infection, bleeding, and the possibility of further complications. If the screws are not confirmed to be the cause of your limited pronation, it may be prudent to explore other non-surgical options first, such as continued physical therapy or alternative treatments like corticosteroid injections to reduce inflammation.

2. Risk of Nonunion: Any additional surgery does carry a risk of nonunion, especially if the bone has not fully healed. The stress of a second surgery could disrupt the healing process. If your fracture has not shown signs of healing on imaging studies, it may be wise to wait until you have a clearer understanding of the healing status before proceeding with another operation. Consulting with your orthopedic surgeon about the current state of your fracture healing is crucial.

3. Pros and Cons of Surgery:
- Pros: If the screws are indeed too long and causing mechanical blockage, replacing them could restore your range of motion and alleviate discomfort. A successful revision surgery could lead to improved function and quality of life.

- Cons: As mentioned, the risks associated with surgery include infection, delayed healing, and the potential for additional complications. Moreover, if the screws are not the primary issue, surgery may not yield the desired improvement in function.

In addition to these considerations, it’s important to continue with your rehabilitation program. Sometimes, recovery can be slow, and progress may not be linear. Engaging with a skilled physical therapist who can tailor a program to your specific needs is vital. They can also provide modalities such as ultrasound therapy or electrical stimulation, which may help in reducing pain and improving function.

Furthermore, the presence of soft tissue calcification and bone fragments noted on your CT scan may indicate that there is ongoing healing or inflammation that could be contributing to your symptoms. These findings should be discussed with your orthopedic surgeon, as they may suggest a need for further intervention or a change in your rehabilitation strategy.

In conclusion, while the option to revise your surgical hardware is available, it’s essential to consider the timing and necessity of such a procedure carefully. A thorough discussion with your orthopedic surgeon, possibly involving a second opinion, may provide additional clarity on the best course of action. Your proactive approach to recovery is commendable, and I encourage you to keep advocating for your health and well-being.

Wishing you a smooth recovery and improved function in the near future.

Best regards.

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