Should Kidney Disease Patients Remove Ankle Screws and Plates?

Is it advisable to remove ankle screws and plates in patients with kidney disease?

Hello, doctor.
I accidentally fractured my ankle last December and underwent surgery.
Due to the anesthesia, my kidney condition worsened.
Initially, I had self-paid for the insertion of non-removable screws and plates.
However, since the surgery, the area has been experiencing persistent pain.
The original physician mentioned that the hardware could be removed after one year, but I am very concerned that undergoing anesthesia again might exacerbate my condition to the point of needing dialysis.
This dilemma has left me unsure of what to do, and I worry that this pain might continue for the rest of my life.
Therefore, I would like to ask for your advice.
Generally speaking, in such situations, do you recommend that patients have the hardware removed, or are there other methods to alleviate the pain?

Amei, 50~59 year old female. Ask Date: 2023/05/01

Dr. You Dianqi reply Orthopedics

Hello, it is recommended to schedule an earlier follow-up consultation to discuss your concerns directly with the physician.
Thank you.

Reply Date: 2023/05/01

More Info

When considering whether kidney disease patients should remove ankle screws and plates after surgery, several factors must be taken into account. It is essential to weigh the risks and benefits of the procedure, especially in the context of existing kidney issues.

Firstly, it is important to understand the implications of anesthesia on kidney function. Anesthesia can indeed pose risks for patients with pre-existing kidney disease, particularly if the kidneys are already compromised. The concern is that certain anesthetic agents can lead to further deterioration of kidney function, potentially resulting in the need for dialysis. Therefore, if the removal of screws and plates is deemed necessary, it is crucial to discuss with your healthcare provider the type of anesthesia that will be used and its potential impact on your kidney health.

In your case, since you have been experiencing ongoing pain at the surgical site, it is essential to address this discomfort. Chronic pain can significantly affect your quality of life, and if the pain is due to the hardware, removal might be a reasonable option. However, if the pain is manageable and does not interfere with your daily activities, you might consider conservative management strategies before opting for surgery. These could include physical therapy, pain management techniques, or medications that do not adversely affect kidney function.

Moreover, the decision to remove the hardware should also consider the potential for complications. Surgical removal carries risks, including infection, bleeding, and the possibility of further injury to the surrounding tissues. If the screws and plates are not causing significant issues, some orthopedic surgeons may recommend leaving them in place, especially if they are not causing any functional impairment.

It is also advisable to consult with both your nephrologist and orthopedic surgeon. Your nephrologist can provide insights into your current kidney function and the risks associated with anesthesia, while your orthopedic surgeon can assess the necessity of hardware removal based on your symptoms and the condition of your ankle.

In summary, the decision to remove ankle screws and plates in kidney disease patients should be individualized. It requires a thorough evaluation of the patient's overall health, kidney function, and the severity of symptoms related to the hardware. Engaging in a detailed discussion with your healthcare team will help you make an informed decision that balances the need for pain relief with the risks associated with surgery and anesthesia. If removal is not immediately necessary, exploring non-invasive pain management options may be beneficial. Always prioritize open communication with your medical team to ensure that your concerns are addressed and that you receive the best possible care tailored to your specific situation.

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