Post-Surgery Concerns After Steel Nail Removal: What to Expect

Post-operative issues after nail removal surgery?

Hello Dr.
Chen! Last year, I had a femoral neck fracture in my right leg and had three steel pins implanted for stabilization.
After a year of recovery, my doctor assessed that the bone had healed well, and on August 25 of this year, the pins were removed.
Due to my osteoporosis, I was concerned about incomplete bone healing, so I asked my doctor to fill the bone defect with BMP (Bone Morphogenetic Protein) to promote proper bone growth.
After the stitches were removed, the doctor informed me that there was no need for further follow-up appointments.

I would like to know if the addition of this material means I no longer need to worry about the healing of the defect.
However, for the past month since the surgery, I have been experiencing persistent pain around the wound area, with mild pain when sitting or walking for extended periods.
I am uncertain if this discomfort is related to the BMP material or if it is a rejection response from my own bone.
Is this a normal reaction? I would prefer not to rely on pain medication continuously.
If I wish to schedule a follow-up appointment, how long would you recommend waiting? Thank you!

Chen, 30~39 year old female. Ask Date: 2023/09/30

Dr. Chen Bochen reply Orthopedics

Hello, there won't be any rejection issues with the BMP.
I recommend getting an X-ray follow-up in two months.

Reply Date: 2023/09/30

More Info

Post-surgery concerns after the removal of steel nails, particularly in the context of a femoral neck fracture, are quite common and can be multifaceted. Given your situation, where you had three steel nails implanted for fixation and subsequently removed after a year due to good healing, it’s essential to understand what to expect during your recovery phase.

Firstly, the use of Bone Morphogenetic Protein (BMP) is a well-established method to enhance bone healing, especially in cases where there is a concern about bone density, such as in osteoporosis. BMPs are known to stimulate the formation of new bone and can significantly aid in filling bone defects. Since your doctor has indicated that the healing process is progressing well, the use of BMP should ideally mitigate concerns regarding the healing of the bone defect left by the removed nails.

However, it is not uncommon to experience pain around the surgical site after the removal of hardware. This pain can be attributed to several factors:
1. Soft Tissue Healing: After the removal of the steel nails, the surrounding soft tissues, including muscles, tendons, and ligaments, need time to heal. This healing process can lead to discomfort, especially with increased activity.

2. Bone Remodeling: The bone itself undergoes a remodeling process after the removal of the hardware. This process can cause temporary discomfort as the bone adjusts and strengthens in response to the absence of the nails.

3. BMP Reaction: While BMP is generally well-tolerated, some individuals may experience localized pain or discomfort as the body integrates this material. However, significant adverse reactions are rare.

4. Activity Level: Increased activity, such as prolonged sitting or walking, can exacerbate discomfort as the muscles and joints adapt to the changes post-surgery.

Regarding your concern about whether this pain is a normal reaction, it is indeed common to experience some discomfort in the weeks following the removal of hardware. However, if the pain persists or worsens, or if you experience swelling, redness, or any other concerning symptoms, it would be prudent to consult your healthcare provider.

As for follow-up appointments, it is generally advisable to have a check-up around 6 to 8 weeks post-surgery, especially if you are experiencing ongoing pain. This timeframe allows your doctor to assess the healing process and determine if any further intervention is necessary. If you feel that your pain is not improving or if you have any new symptoms, you should not hesitate to reach out to your physician sooner.

In summary, while some discomfort after the removal of steel nails is expected, it is important to monitor your symptoms closely. The use of BMP should aid in the healing process, but if you have concerns about your recovery, a follow-up visit is always a good idea. Your health and comfort should be the priority, and your doctor can provide the best guidance tailored to your specific situation.

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