Ankle Fractures: Should Plates and Screws Be Removed?

Q: Ankle Fractures: Should Plates and Screws Be Removed?

Hello： In response to your question, previously there was only one type of internal fixation material (stainless steel, with a steel core and a cobalt or copper electroplated surface), so it is not recommended to leave it in the body for a long time, as these metals can be absorb

The doctor said that the steel plate inserted for the ankle fracture from the car accident does not need to be removed?

I was in a car accident in the U.S.
at the end of April, and it seems I have a comminuted fracture in my ankle.
I have already had a steel plate and screws inserted, and I am currently using an external fixator with pins.
The doctor said that the plate and screws do not need to be removed and that it is better to leave them in.
I don't understand why, as I found on Taiwanese websites that it is best to remove them.
Should I consider going back to Taiwan to consult another doctor? Will the doctors in Taiwan be able to assess my condition even though they are not my primary physician in the U.S.? Can they access my medical records from the U.S.? Also, after recovering from an ankle fracture, is it possible to wear high heels? Lastly, is it true that everyone who has had a fracture will have that area become a "weather station"? How can this be avoided? Thank you for patiently reading my questions.

Gang Ding Jiao, 20~29 year old female. Ask Date: 2006/06/05

Dr. Li Wenlin reply Orthopedics

Hello: In response to your question, previously there was only one type of internal fixation material (stainless steel, with a steel core and a cobalt or copper electroplated surface), so it is not recommended to leave it in the body for a long time, as these metals can be absorbed by the human body.
In rare cases, the body may have adverse reactions to these metal ions (such as the formation of granulation tissue or malignant tumors, etc.), but such occurrences are very uncommon.
Another reason for removing internal fixation is that steel nails and plates can cause osteoporosis in the bone, or metal fatigue may lead to deformation or fracture of the implant.
Therefore, in most cases, it is advisable to remove the implant.
However, with advancements in technology, most materials now use titanium or some absorbable materials (biodegradable screws).
If there are no other concerns (such as the aforementioned osteoporosis or metal fatigue), these implants may not need to be removed.
So, it is not wrong to leave them in; the decision is yours.
If you decide to have them removed, you can request your operating surgeon to do so.
If they are unwilling, you can certainly find another physician who is willing to perform the procedure (this is available in Taiwan, but not in the U.S.).
Additionally, the standard of orthopedic care in Taiwan is quite good.
Once you return to the country, a consultation and X-ray can provide a lot of information.
If rehabilitation after an ankle fracture surgery is good, you can still wear high heels, although it is not recommended to wear them for long periods or to wear shoes that are too high (greater than two inches).
Ankle fractures can affect the articular cartilage, joint capsule, and ligaments, potentially leading to post-traumatic arthritis.
If you are very concerned about this in the future, proper rehabilitation, wearing ankle braces, and avoiding uneven surfaces should help minimize these sequelae.

Reply Date: 2006/06/05

More Info

When it comes to ankle fractures, particularly those that are complex or comminuted, the decision to remove plates and screws after healing is a nuanced one. In your case, you experienced a significant injury that required surgical intervention, including the placement of plates and screws to stabilize the fracture. Your current physician in the United States has advised against the removal of these implants, suggesting that they can remain in place without causing issues. This recommendation is based on several factors, including the materials used for the implants, the nature of your fracture, and your overall healing progress.

Historically, the removal of internal fixation devices (like plates and screws) was more common, primarily due to concerns about potential complications such as irritation, pain, or the risk of future fractures at the site of the hardware. However, advancements in surgical techniques and materials—such as the use of titanium, which is biocompatible and less likely to cause adverse reactions—have led many orthopedic surgeons to adopt a more conservative approach. If the hardware is not causing pain or discomfort and is not interfering with your mobility or daily activities, many surgeons now prefer to leave it in place.

Regarding your question about seeking a second opinion in Taiwan, it is certainly within your rights to do so. Physicians in Taiwan can review your medical history and imaging studies, such as X-rays, to assess your condition. They may not have direct access to your medical records from the U.S., but you can provide them with copies of your X-rays and any relevant documentation. This will help them understand your situation better and offer informed advice.

As for wearing high heels after recovering from an ankle fracture, it is generally possible, but with caution. High heels can place additional stress on the ankle joint and may not be advisable, especially if you have experienced significant trauma. If you do choose to wear them, opt for lower heels and ensure that your ankle is fully healed and stable. Consulting with your physical therapist or orthopedic surgeon about your specific case is crucial before making any decisions regarding footwear.

Lastly, the phenomenon of becoming a "weather vane" after a fracture—where individuals experience sensitivity to weather changes in the affected area—is not uncommon. This is often attributed to changes in the joint or surrounding tissues, which can become more sensitive after injury. While there is no guaranteed way to prevent this sensitivity, maintaining a healthy lifestyle, engaging in regular physical therapy, and ensuring proper rehabilitation can help minimize long-term discomfort and improve joint function.

In summary, the decision to remove plates and screws after an ankle fracture is individualized and should be based on your specific circumstances. It is advisable to have open discussions with your healthcare providers, whether in the U.S. or Taiwan, to ensure that you are comfortable with your treatment plan and understand the rationale behind their recommendations.

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