Should You Remove Your Proximal Humerus Plate After Surgery?

Is it necessary to remove the hardware after proximal humerus surgery?

Hello, I had a proximal humerus fracture in a car accident in December 2021, which was fixed with a self-paid titanium alloy plate.
The wound is located on the anterior side (not the lateral side), and the fracture has healed.
Recently, I am considering whether to remove the plate, as there is a significant family history of diabetes, and I currently have insulin resistance, so I feel that leaving it permanently may not be ideal.
However, the surgeon mentioned that removing it could potentially damage the axillary nerve.
I would like to ask: 1.
Is there a high risk of nerve injury due to the wound being on the anterior side? 2.
If nerve damage occurs, is it repairable? How long does it typically take to recover? 3.
How long after surgery should the stitches be removed? 4.
How long should I rest before I can ride a motorcycle? 5.
Will I need rehabilitation after the plate removal? Thank you.

Han, 30~39 year old female. Ask Date: 2023/03/31

Dr. Shi Guozheng reply Orthopedics

If the metal plate does not interfere with the upper arm, there is actually no need to remove the plate.

Reply Date: 2023/03/31

More Info

When considering whether to remove a proximal humerus plate after surgery, there are several factors to take into account, especially given your medical history and current condition. Here’s a comprehensive overview addressing your concerns.

1. Risk of Nerve Injury: The concern about potential injury to the axillary nerve during the removal of the plate is valid. The axillary nerve is responsible for the sensation over the lateral aspect of the shoulder and innervates the deltoid muscle. The risk of nerve injury during plate removal can depend on the surgical approach and the position of the plate. If the incision is made on the anterior aspect of the shoulder, the risk of damaging the axillary nerve may be lower, but it is not negligible. Surgeons typically take precautions to avoid nerve damage, but it is essential to discuss this risk with your surgeon, who can provide insights based on your specific case.

2. Nerve Repair and Recovery: If nerve damage occurs, the prognosis can vary. Some nerve injuries may heal spontaneously, while others might require surgical intervention. The recovery time for nerve injuries can range from weeks to several months, depending on the severity of the injury. If you experience persistent numbness or weakness after surgery, follow-up with a neurologist or a specialist in nerve injuries may be necessary.

3. Suture Removal Timeline: The timeline for suture removal typically depends on the healing process. Generally, sutures are removed about 7 to 14 days post-surgery, but this can vary based on the surgeon's assessment of wound healing. Your surgeon will provide specific instructions based on your individual recovery.

4. Return to Activities: Regarding your ability to ride a motorcycle, it is crucial to allow adequate time for healing and rehabilitation. Typically, patients are advised to avoid strenuous activities for at least 6 to 12 weeks post-surgery, depending on the complexity of the fracture and the surgical procedure. Your surgeon will guide you on when it is safe to resume such activities based on your recovery progress.

5. Rehabilitation Post-Plate Removal: If you decide to have the plate removed, rehabilitation may still be necessary. Physical therapy can help restore range of motion, strength, and function in the shoulder. The extent and duration of rehabilitation will depend on how well you heal after the surgery and your pre-existing condition.

6. Long-term Considerations: Given your family history of severe diabetes and your current insulin resistance, it is understandable to be concerned about the long-term implications of having a foreign object in your body. While many patients live comfortably with plates and screws, there is a theoretical risk of complications, such as infection or irritation, particularly in individuals with metabolic conditions. Discussing these concerns with your surgeon can help you weigh the risks and benefits of leaving the plate in versus removing it.

In conclusion, the decision to remove the proximal humerus plate should be made collaboratively with your orthopedic surgeon, considering the risks of nerve injury, your healing progress, and your overall health. It is essential to have an open dialogue with your healthcare provider to ensure that you make an informed decision that aligns with your health goals and lifestyle.

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