Concerns About Long-Term Effects of Bone Plates and Screws After Fracture

What are the issues related to a left humeral fracture with intramedullary nailing?

On March 13 of this year, I was involved in a car accident that resulted in an open fracture of my left humerus.
Last week, I consulted with my doctor regarding the need to remove the metal screws and plates after a year and a half.
The doctor advised against removal, expressing concern that it could damage the nerves, as there was nerve injury initially.
A clamp was used to stabilize the fracture for natural healing, and the plate was positioned beneath the nerve for fixation.
The doctor mentioned that over the year and a half, there is a risk that the nerves and muscles may adhere to the plate, which is why he does not recommend removal.

I am only thirty years old, and I would like to know if the metal plate and screws could undergo any changes or lead to complications.
What is the likelihood of such changes or complications occurring, and what specific complications might arise? Thank you!

elton, 30~39 year old female. Ask Date: 2006/08/01

Dr. Chen Xingyuan reply Orthopedics

Dear Readers,
In principle, temporary fixation devices such as steel plates and screws implanted in the body should be removed as soon as possible after the fracture has healed.
While it is possible to leave these fixation devices in place, there are several considerations:
1.
The use of fixation devices like screws and plates can lead to reduced load-bearing on certain bones, resulting in bone resorption and hindering bone growth.
Prolonged use of these devices may also lead to metal fatigue, compromising their structural integrity.
2.
Protruding fixation devices can cause local irritation and a sensation of foreign body presence.
3.
Trace amounts of metal may dissolve, potentially causing allergic reactions in a small number of individuals.
However, the removal of implants also carries surgical risks:
1.
The underlying condition and the surgery itself may damage surrounding nerves or blood vessels, leading to limb paralysis or ischemic injury to tissues.
2.
There is a risk of fat embolism, which can pose a life-threatening danger to the lungs or brain, with an incidence of approximately 1%.
3.
Surgical site infections or re-fractures may occur, which are related to postoperative care, the patient's constitution, and the original injury.
4.
Some screws or bone materials may break during removal or become encapsulated by new bone, and may not be removed for safety reasons.
In the case of humeral fractures, the removal of implants can be complicated by the radial nerve often crossing over the plate, making it susceptible to injury during surgery, which may lead to nerve palsy.
Although most patients recover, rehabilitation can take up to six months.
Therefore, unless the plate causes significant discomfort, it is sometimes advisable to leave the implant in place to avoid complications.
Thus, after weighing the benefits and risks of surgery, your physician will provide you with the best recommendations.
Wishing you health and safety!
Sincerely,
Dr.
Chen

Reply Date: 2006/08/01

More Info

When it comes to the long-term effects of bone plates and screws after a fracture, there are several important considerations to keep in mind. Your situation, involving an open fracture of the humerus and the use of internal fixation with plates and screws, is not uncommon. The concerns you have about potential complications, such as nerve damage and the possibility of needing to remove the hardware, are valid and warrant a thorough discussion.

Firstly, it is essential to understand that the primary purpose of using plates and screws is to stabilize the fracture and allow for proper healing. In many cases, these devices are left in place indefinitely, especially if they are not causing any discomfort or complications. The decision to remove them often depends on several factors, including the location of the hardware, the presence of any symptoms, and the potential risks associated with removal.

In your case, since the hardware is located near a nerve, your doctor’s recommendation to leave it in place is prudent. Nerve injuries can lead to chronic pain, weakness, or sensory changes, and surgical removal of the hardware could potentially exacerbate these issues if the nerve has adhered to the plate or screws. This is particularly relevant in cases of open fractures where soft tissue damage may have occurred, leading to scar tissue formation.

Regarding the potential for hardware-related complications, there are a few key points to consider:
1. Infection: While the risk of infection is highest immediately after surgery, it can still occur later, particularly if the skin over the hardware becomes compromised. Regular follow-ups with your healthcare provider can help monitor for any signs of infection.

2. Hardware Failure: In some cases, plates and screws can break or loosen over time, especially if the bone has not healed properly. This is less common but can occur, particularly in high-stress areas or in patients who engage in high-impact activities before full recovery.

3. Osteolysis: This is a process where the bone around the hardware begins to break down, which can occur due to stress shielding (where the plate takes on too much load, leading to bone resorption). This can potentially lead to complications, but it is generally more of a concern in older patients or those with certain medical conditions.

4. Chronic Pain: Some patients report ongoing pain or discomfort in the area where the hardware is located, even after the bone has healed. This can be due to irritation of surrounding tissues or nerves.

5. Allergic Reactions: Although rare, some individuals may have allergic reactions to the materials used in the hardware, which could lead to inflammation or other symptoms.

As for the likelihood of these complications, it varies widely based on individual circumstances, including the type of fracture, the surgical technique used, and your overall health. Generally, the risk of significant long-term complications from retained hardware is relatively low, especially if you are asymptomatic.

In conclusion, while there are potential risks associated with the presence of plates and screws, many patients live with them without any issues. Regular follow-up with your orthopedic surgeon is crucial to monitor your healing and address any concerns that may arise. If you experience new symptoms or changes in your condition, it is essential to communicate these with your healthcare provider promptly. Ultimately, the decision to remove hardware should be made collaboratively with your surgeon, weighing the risks and benefits based on your specific situation.

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