Should You Remove Intramedullary Nails After Fracture Surgery?

Is it necessary to remove the intramedullary nail?

Hello Doctor: I was involved in a car accident on July 23, 2023, which resulted in a closed fracture of my right tibia with three segments broken and bone fragmentation.
I underwent an open reduction and internal fixation surgery, which included the insertion of an intramedullary nail, four screws, and artificial bone graft.
It has been nearly 11 months since the surgery, but I still experience numbness around the knee and the surgical site on the ankle (I have been taking Ailokan coated tablets).
There is a prominent screw near the ankle that is visibly sticking out, and I feel a foreign body sensation when I rotate my ankle or walk.
Below the knee, I often feel tightness and notice a difference in skin color (slightly darker than my left foot).
I would like to ask the doctor: 1.
If the intramedullary nail is not removed, will the numbness at the surgical site and the foreign body sensation in the ankle improve over time? 2.
I have consulted with a doctor regarding the removal of the intramedullary nail, and since there is a cavity in the medullary canal, I would need to pay out of pocket for an additional 10cc of artificial bone graft.
3.
The doctor mentioned that I am still young and recommended removing the intramedullary nail to prevent osteoporosis (though I don't consider myself young at this age!).
Approximately 6-7 months post-surgery, X-rays showed good bone healing.
I would appreciate your response and recommendations.
Thank you!

Tseng, 50~59 year old female. Ask Date: 2024/06/13

Dr. Shi Guozheng reply Orthopedics

1.
Intramedullary nails should only be removed after the fracture has healed.
If the nail is protruding, it should be extracted.

2.
Some physicians may not perform bone grafting, and this may not pose any issues.

3.
Leaving the nail in place can cause a foreign body sensation and increase the risk of infection, and it may also contribute to osteoporosis.

Reply Date: 2024/06/13

More Info

When it comes to the decision of whether to remove intramedullary nails after fracture surgery, there are several factors to consider, especially in your case where you have experienced complications such as numbness and a foreign body sensation due to the presence of screws and nails.

1. Long-term Recovery and Symptoms: It is not uncommon for patients to experience numbness and discomfort around the surgical site for an extended period after surgery. This can be due to nerve irritation or damage during the initial procedure, or it may be related to the hardware itself. In many cases, these symptoms may improve over time, but they can also persist indefinitely. The presence of hardware can sometimes lead to chronic discomfort, especially if the hardware is prominent or if there is an inflammatory response in the surrounding tissues. If the symptoms are bothersome and do not improve, it may be worth considering hardware removal.

2. Risks and Benefits of Removal: If you decide to have the intramedullary nails removed, there are both benefits and risks. The primary benefit is the potential alleviation of the discomfort and the foreign body sensation you are experiencing. Additionally, removing the hardware can reduce the risk of complications such as infection or hardware failure. However, surgery carries its own risks, including the potential for further nerve damage, infection, and complications related to anesthesia. The need for additional bone grafting (as you mentioned needing artificial bone powder) is also a consideration, as it can add to the recovery time and complexity of the procedure.

3. Age and Bone Health: Your physician's advice to consider hardware removal due to your age and the risk of osteoporosis is significant. While you may feel that you are not particularly young, the health of your bones is crucial, especially if you have a history of fractures. Removing the hardware may help prevent future complications related to bone density and integrity. If you are concerned about osteoporosis, it may be beneficial to discuss with your doctor about bone health management, including dietary changes, supplements, and weight-bearing exercises.

4. Monitoring and Follow-Up: Given that your X-rays show good healing, it is essential to continue monitoring your recovery. Regular follow-ups with your orthopedic surgeon can help assess whether the symptoms you are experiencing are likely to improve with time or if they warrant surgical intervention. If you choose to keep the hardware, it is crucial to maintain open communication with your healthcare provider about any changes in your symptoms.

5. Physical Therapy and Rehabilitation: Engaging in physical therapy can also be beneficial in managing your symptoms. A physical therapist can provide exercises to strengthen the muscles around your knee and ankle, which may help alleviate some of the tightness and discomfort you are experiencing. They can also guide you in activities that promote healing and improve your overall function.

In conclusion, the decision to remove intramedullary nails should be made after careful consideration of your symptoms, the potential benefits and risks of surgery, and your overall bone health. It is advisable to have a detailed discussion with your orthopedic surgeon to weigh your options and make an informed decision that aligns with your recovery goals.

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