Should You Remove Titanium Screws After Fifth Metatarsal Fracture?

Does the titanium alloy screw for the fifth metatarsal fracture need to be removed?

The recommendation for removal is based on the fact that the patient would have to live with the bone screws and plates for the next 50-60 years, which could introduce additional uncertainties.
Since the lower extremities bear significant weight, there is a possibility of developing a "stress shielding effect." Removal is not advised because the original bone structure is occupied by the screws, making it more susceptible to secondary fractures.
Additionally, there is a concern regarding osteoporosis.
If the screws are removed, the original screw sites may become voids.

Could you please clarify the advantages and disadvantages, as well as the risks associated with both removal and non-removal?

ROC, 30~39 year old female. Ask Date: 2023/08/08

Dr. Shi Guozheng reply Orthopedics

1.
It is possible.
2.
There is no increased risk of fractures because continued walking makes it less likely to develop osteoporosis.
There may be temporary cavities, but over time, the bone will regenerate and fill in.
3.
Removing it requires another surgery, which carries its own risks.
Not removing it may sometimes lead to a sensation of foreign body presence or tenderness.

Reply Date: 2023/08/08

More Info

When considering whether to remove titanium screws after a fifth metatarsal fracture, it's essential to weigh the pros and cons of both options. Titanium screws are commonly used in orthopedic surgeries due to their biocompatibility and strength. However, the decision to remove them is not straightforward and should be based on individual circumstances, including the patient's age, activity level, and the specific nature of the fracture.

Reasons for Removal
1. Long-term Presence: If titanium screws are left in place, the patient may have to live with them for decades. This can lead to complications such as discomfort, irritation, or even pain, especially if the screws are located near the skin surface or if they cause any mechanical issues with surrounding tissues.

2. Stress Shielding Effect: The presence of screws can lead to a phenomenon known as "stress shielding," where the bone around the screw does not bear the normal load it would if the screw were not present. This can potentially weaken the bone over time, making it more susceptible to future fractures.

3. Potential for Complications: Over time, there is a risk of complications such as infection, screw loosening, or migration. If these issues arise, they may necessitate surgical intervention to remove the screws.

Reasons Against Removal
1. Risk of Re-fracture: Removing screws can create a void in the bone where the screw was anchored. This can lead to instability and increase the risk of re-fracture, particularly if the bone has not fully healed or if the patient has underlying conditions such as osteoporosis.

2. Surgical Risks: Any surgical procedure carries risks, including infection, bleeding, and damage to surrounding tissues or nerves. The potential complications of surgery may outweigh the benefits of removing the screws.

3. Bone Healing: In some cases, the bone may have healed around the screws, making their removal unnecessary. The screws can provide additional stability to the fracture site, especially in the early stages of healing.

Conclusion
Ultimately, the decision to remove titanium screws after a fifth metatarsal fracture should be made collaboratively between the patient and their orthopedic surgeon. Factors to consider include the patient's age, activity level, and any symptoms they may be experiencing related to the screws.
If the screws are causing significant discomfort or if there are concerns about long-term complications, removal may be warranted. Conversely, if the screws are well-tolerated and the fracture has healed adequately, it may be advisable to leave them in place.
Regular follow-ups with imaging studies, such as X-rays, can help monitor the condition of the bone and the screws, guiding the decision-making process. It's also important for patients to engage in rehabilitation and strengthening exercises to support bone health and prevent future fractures, regardless of whether the screws are removed.
In summary, both options have their advantages and disadvantages, and the best course of action will depend on the individual patient's situation.

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