Should Facial and Foot Fracture Hardware Be Removed After Surgery?

Do facial and foot fractures need to be removed?

Hello, doctor.
Recently, I was involved in a car accident and suffered fractures in my right face and right thigh, which were treated with screws and plates by different doctors.
The doctor who treated my foot mentioned that since I am still young (21 years old), he is concerned about potential long-term effects on my body, so he recommends removing the hardware from my foot after more than a year.
However, the doctor who treated my face said that the facial hardware does not need to be removed.
I would like to know if leaving the facial screws and plates in place could have any future effects or problems.
Would it be better for me to have them removed? I have seen the X-rays of my face, and it appears that there is one screw in the lateral brow bone and another near the lower eye area.
Both of these look similar.

A-Rong, 20~29 year old female. Ask Date: 2024/03/07

Dr. Chen Yongxue reply Orthopedics

Hello, metal nails and plates are considered foreign objects.
In principle, they should be removed after the completion of staged tasks (bone healing).
The reason is that several years later, if the body's resistance is low (such as in cases of dialysis or diabetes), there is a risk of bacterial infection, and bacteria can easily thrive around foreign objects.
Therefore, the general principle is to remove the metal plates from the limbs.
However, the facial area has good blood circulation, making it difficult for bacteria to linger, and due to aesthetic concerns related to scarring, removal may not be necessary.
Thank you.

Reply Date: 2024/03/07

More Info

When it comes to the removal of hardware such as plates and screws after facial and foot fractures, there are several factors to consider, including the type of fracture, the location of the hardware, the patient's age, and the potential for future complications.

In your case, you mentioned that you suffered fractures in both your face and foot due to a car accident, and that different surgeons have recommended different approaches regarding the removal of the hardware. The foot surgeon suggested that, due to your young age (21 years), it would be prudent to remove the hardware after about a year to prevent any long-term complications. On the other hand, the facial surgeon indicated that the hardware in your face does not need to be removed.

Considerations for Hardware Removal
1. Location and Type of Hardware:
- Facial Hardware: In many cases, facial hardware, such as plates and screws, can remain in place without causing issues. The facial bones have a good blood supply and can heal well, and the hardware is often placed in a way that minimizes irritation to surrounding tissues. However, if the hardware is prominent or causes discomfort, removal may be considered.

- Foot Hardware: In contrast, foot hardware may be more likely to cause complications if left in place, especially if it interferes with normal foot mechanics or if there is a risk of infection or irritation.
2. Potential Complications:
- Leaving hardware in place can sometimes lead to complications such as infection, irritation, or even hardware failure. In your case, the foot surgeon's recommendation to remove the hardware may be based on the potential for these issues, especially considering your age and activity level.

- For facial hardware, complications are less common, but there is still a risk of issues such as infection or discomfort, particularly if the hardware is located near sensitive areas like the eyes or mouth.

3. Future Considerations:
- If you choose to leave the facial hardware in place, it is important to have regular follow-ups with your healthcare provider to monitor for any potential issues. If you experience pain, swelling, or other symptoms, further evaluation may be necessary.

- If you opt for removal of the facial hardware, it is generally a straightforward procedure, but it does involve some risks, including the possibility of scarring or complications from surgery.

4. Personal Factors:
- Your lifestyle and activity level can also influence the decision. If you are highly active or involved in contact sports, the risk of hardware-related complications may be higher, and removal may be advisable.

- Additionally, psychological factors, such as concerns about appearance or comfort, should also be taken into account.

Conclusion
Ultimately, the decision to remove hardware should be made in consultation with your healthcare providers, considering the specific circumstances of your injuries, your overall health, and your personal preferences. It may be beneficial to seek a second opinion from an orthopedic surgeon or a facial plastic surgeon who specializes in trauma to get a comprehensive understanding of the risks and benefits associated with leaving the hardware in place versus removing it.

In summary, while the facial hardware may not need to be removed and can often be left in place without issues, the foot hardware may warrant removal to prevent potential complications. Regular follow-ups and open communication with your healthcare team will be essential in making the best decision for your recovery and future health.

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