Impact of Retained Bone Pins on Older Adults: What You Need to Know

Q: Impact of Retained Bone Pins on Older Adults: What You Need to Know

SAM： After internal fixation with steel nails following a fracture, it is generally best to remove them after one to one and a half years once the fracture has healed. <br>However, if the patient is older or has other considerations, not removing them will not affect health. <br>

Does leaving a fracture fixation nail in the body have any effects on health?

Hello Dr.
Hong,
My mother was in a car accident in July of this year, resulting in a fracture of her tibia (with a steel nail implanted that needs to be surgically removed).
During her follow-up appointment this month, the doctor mentioned to my brother that he is considering whether to remove the steel nail.
My mother is 54 years old and has hypertension, so we are quite concerned about the burden of another surgery on her body.
I would like to ask the doctor: Generally speaking, do physicians recommend removing the steel nail for younger patients, while it is less of a concern for older individuals? What is the reasoning behind this? Additionally, since the steel nail is a foreign object, if it remains in the body for an extended period without removal, could it have any effects on my mother's leg, such as causing discomfort or potentially leading to complications? Since her next appointment is at the end of January next year, I would like to understand this in advance.
Thank you!

sam, 20~29 year old female. Ask Date: 2005/12/27

Dr. Hong Ximing reply Orthopedics

SAM: After internal fixation with steel nails following a fracture, it is generally best to remove them after one to one and a half years once the fracture has healed.
However, if the patient is older or has other considerations, not removing them will not affect health.
Moreover, with current medical advancements, controlling hypertension is not an issue.
Your mother is only 54 years old, which is not considered elderly.
Okay, let's stay in touch.

Reply Date: 2005/12/27

More Info

When it comes to the impact of retained bone pins in older adults, there are several important considerations to keep in mind, particularly regarding the potential risks and benefits of leaving these devices in place versus opting for surgical removal.

Firstly, it is essential to understand that bone pins, or internal fixation devices, are often used to stabilize fractures and promote healing. In younger patients, the recommendation to remove these pins is typically based on the idea that their bones are still growing and changing, and the presence of foreign objects can sometimes interfere with this process. Additionally, younger individuals generally have a higher capacity for recovery from surgery, making the risks associated with removal more acceptable.

In contrast, older adults, such as your mother, may have different considerations. As we age, our bones become more fragile, and the risks associated with surgery can increase significantly. Factors such as pre-existing conditions (like hypertension in your mother's case), overall health status, and the potential for complications during and after surgery must be carefully evaluated. For older adults, the decision to remove bone pins is often made on a case-by-case basis, weighing the risks of surgery against the potential benefits of removal.

Regarding the long-term presence of bone pins, there are several factors to consider. While many individuals tolerate retained pins without significant issues, there can be complications. These may include:
1. Infection: The presence of foreign material can increase the risk of infection, particularly if the skin over the pin becomes compromised.

2. Pain or Discomfort: Some patients report chronic pain or discomfort associated with retained hardware, which can affect mobility and quality of life.

3. Bone Healing: In some cases, the presence of pins may interfere with the natural remodeling of bone, particularly if the pins are not well integrated into the bone structure.

4. Potential for Migration: Although rare, there is a possibility that retained pins can shift or migrate over time, leading to additional complications.

5. Long-term Effects: There is ongoing debate in the medical community about whether retained hardware can lead to long-term complications, including the potential for osteoarthritis or other degenerative changes in the joint or surrounding tissues.

Given your mother's age and health status, it is crucial to have a thorough discussion with her orthopedic surgeon. They can provide insights based on her specific case, including the type of fracture, the nature of the pins, and her overall health. It may also be beneficial to seek a second opinion if there are uncertainties about the best course of action.

In conclusion, while the decision to remove bone pins in older adults is often more conservative than in younger patients, it is essential to consider the individual circumstances. Monitoring for any signs of complications, such as increased pain, swelling, or signs of infection, is crucial. Regular follow-ups with her healthcare provider will help ensure that any potential issues are addressed promptly, allowing for the best possible outcome for her recovery and overall health.

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