Should You Remove a Broken Tibial Nail After an Injury?

Does a broken tibial nail need to be removed?

Hello, I had a tibial fracture from a car accident in early January this year, and I underwent surgery to have a titanium alloy plate and locking screws inserted.
In mid-May, I returned to the hospital for an X-ray and discovered that one of the screws near my ankle had broken.
I consulted my attending physician, who advised that I need surgery to remove the broken part.
I also asked other doctors, and they suggested that it could be removed a year later.
I am currently experiencing pain while walking, but it is gradually improving.
Should I have the screw removed or leave it in place?

SAN, 50~59 year old female. Ask Date: 2023/05/26

Dr. Li Wenhong reply Orthopedics

You can visit the outpatient clinic for an evaluation and have an X-ray taken.

Reply Date: 2023/05/26

More Info

When dealing with a broken tibial nail, especially after an injury such as a car accident, it is crucial to consider several factors before deciding whether to remove the broken nail. The situation you described involves a tibial nail that has broken and is causing pain, which can complicate your recovery process.
First, it is essential to understand the purpose of the tibial nail. Tibial nails are used to stabilize fractures in the tibia (shinbone) and allow for proper healing. If the nail is functioning correctly and the fracture is healing, the presence of the nail is generally beneficial. However, if the nail is broken and causing pain, it may indicate that it is no longer serving its intended purpose.

In your case, since the broken nail is located near the ankle and you are experiencing pain while walking, it is advisable to follow up closely with your orthopedic surgeon. The fact that you have already consulted multiple doctors is a good practice, as it provides you with different perspectives on your condition. Here are some considerations to help you make an informed decision:
1. Pain Management: If the broken nail is causing significant pain, it may be a sign that it is irritating surrounding tissues or not providing adequate stabilization. Pain can hinder your rehabilitation and affect your mobility. If the pain persists or worsens, it may be necessary to remove the nail sooner rather than later.

2. Healing Process: If your fracture is healing well and the broken nail is not causing any complications, some surgeons may recommend leaving it in place for a period of time. However, if the nail is broken and not contributing positively to your recovery, removal may be the best option.

3. Risk of Complications: A broken nail can lead to complications such as infection, irritation of surrounding tissues, or even migration of the nail into adjacent structures. If there is a risk of these complications, timely removal is warranted.

4. Timing of Surgery: If your surgeon suggests waiting a year to remove the nail, it may be based on the assessment that your fracture is healing adequately and that the risks of surgery outweigh the benefits at this time. However, if you are experiencing ongoing pain, it is essential to communicate this with your surgeon and discuss the possibility of earlier intervention.

5. Consultation with a Specialist: If you are uncertain about the recommendations you have received, consider seeking a second opinion from a specialist in orthopedic surgery or a sports medicine physician. They can provide further insights into your specific case and help you weigh the pros and cons of nail removal.

In summary, the decision to remove a broken tibial nail should be based on your current symptoms, the status of your fracture healing, and the potential risks associated with leaving the nail in place. Open communication with your healthcare providers is key to ensuring that you receive the best possible care tailored to your needs. If pain persists or worsens, do not hesitate to advocate for further evaluation and potential removal of the broken nail. Your health and comfort should always be the priority.

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