Convincing Your Doctor to Remove Intramedullary Nails After Surgery

Removal of metal pins issues

Hello Doctor, I was in a car accident in December 2022, resulting in a comminuted fracture of my thigh.
After surgery, I was fortunate to recover.
It has been almost two years now, and I would like to have the metal screws removed.
However, when I inquired about the possibility of removal during my follow-up appointment a year after the accident, my attending physician advised against it, stating that they are fine as they are.
I have expressed my concerns multiple times about wanting to remove the screws because I worry that they may become a burden as I age.
I fear that as my legs become thinner, the screws may become more prominent and uncomfortable.
Could you provide me with some arguments or points that I can use to successfully persuade my attending physician to assist me in having the screws removed? Thank you for your response, Doctor.

Zhang Feng, 30~39 year old female. Ask Date: 2024/07/01

Dr. Zhan Xian reply Orthopedics

Whether to remove the metal pins is not definitive; if the patient experiences discomfort or if the pins are protruding, they need to be addressed.
Metal pins are considered foreign objects in the body.
If the patient is relatively young and in good health, it may be worth discussing the possibility of removal with the attending physician.
If the situation described in the letter is not progressing well, seeking a second opinion from another physician may be advisable.
Thank you.

Reply Date: 2024/07/01

More Info

When it comes to the removal of intramedullary nails after surgery, it's essential to approach the conversation with your doctor thoughtfully and with a clear understanding of both your concerns and the medical rationale behind their recommendations. Here are some points to consider that may help you in discussing this with your physician.

Understanding the Rationale for Keeping Intramedullary Nails
1. Healing and Stability: Intramedullary nails are often left in place because they provide ongoing stability to the bone, especially in cases of complex fractures. Your doctor may believe that the nail is still serving a purpose in maintaining the integrity of your bone structure.

2. Risk of Surgery: Any surgical procedure carries risks, including infection, complications from anesthesia, and the potential for further injury. Your doctor may weigh these risks against the benefits of removing the nail, especially if you are currently asymptomatic.

3. Long-term Outcomes: Research indicates that many patients live with intramedullary nails without significant issues. Your doctor may have experience or data suggesting that the long-term outcomes for patients with retained hardware are generally positive.

Articulating Your Concerns
1. Discomfort and Aesthetic Concerns: You mentioned concerns about the nail becoming a burden as you age, particularly if your leg muscles atrophy. It’s important to express these concerns clearly. You might say, "I understand that the nail provides stability, but I am worried about potential discomfort or visibility as I age. I would like to discuss the possibility of removal to alleviate these concerns."
2. Personal Experience and Research: If you have done any research or have spoken to other patients who have had their nails removed, share those experiences. You might say, "I’ve spoken to others who have had their intramedullary nails removed and felt a significant improvement in their comfort and mobility afterward."
3. Desire for a Second Opinion: If your doctor remains hesitant, you could express your desire for a second opinion. This can be framed positively, such as, "I respect your opinion, but I would like to explore all options. Would you recommend a specialist who could provide further insight into the necessity of keeping the nail?"

Preparing for the Conversation
1. Documentation: Bring any relevant medical records, imaging studies, or notes from previous consultations that support your case. This can help your doctor understand your history better.

2. Questions to Ask: Prepare a list of questions to ask your doctor. For example:
- What are the risks associated with removing the nail?
- How would my recovery process look if I decided to proceed with the removal?
- Are there any specific indicators that would warrant the removal of the nail?
3. Be Open to Dialogue: Approach the conversation with an open mind. Your doctor may provide insights that you hadn’t considered, and being receptive to their expertise can foster a more productive discussion.

Conclusion
Ultimately, the decision to remove intramedullary nails should be a collaborative one between you and your healthcare provider. By clearly articulating your concerns, demonstrating your understanding of the risks and benefits, and being open to dialogue, you can create an environment conducive to discussing your desire for nail removal. Remember, your health and comfort are paramount, and advocating for yourself is an important part of the healthcare process.

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