Should You Remove Metal Plates After Bone Surgery? Risks and Recovery Explained

Will there be any sequelae after the removal of the metal plate?

Hello, Dr.
Chen! I had surgery for a right humeral fracture (with plates and screws) nearly two years ago.
I've been considering whether I should have the hardware removed, but I'm concerned about potential complications.
I've heard that delaying removal could lead to adhesions; is this true? Will removing the hardware cause nerve damage in my hand? Additionally, I understand that extensive rehabilitation is necessary, but I'm worried about how to manage this with my work schedule.
What are the potential impacts on my body if I choose not to remove the hardware? What would you recommend, Dr.
Chen? Thank you for your response.
Sincerely, a concerned individual.

GiGi, 20~29 year old female. Ask Date: 2006/08/29

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 negatively impacting 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 having a foreign body.
3.
Trace amounts of metal may dissolve, and a small number of individuals may experience allergic reactions.
However, the removal of implants also carries surgical risks:
1.
The underlying condition and the surgery itself may damage surrounding nerves or blood vessels, potentially resulting in limb paralysis or ischemic injury to tissues.
2.
There is a risk of fat embolism, which can be life-threatening if it affects the lungs or brain, with an approximate incidence of 1%.
3.
Surgical site infections or re-fractures may occur, which are related to postoperative care, the patient's overall health, and the nature of the original injury.
4.
Some screws or bone materials may break during removal or may be encapsulated by new bone, leading to a decision not to remove them based on safety considerations.
In the case of humeral fractures, the radial nerve often crosses over the steel plate, making it susceptible to injury during surgery, which can lead to nerve paralysis.
Although most patients recover, rehabilitation may 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: 2006/08/29

More Info

Deciding whether to remove metal plates and screws after bone surgery is a common concern for many patients. The decision involves weighing the potential risks and benefits, as well as considering individual circumstances and recovery goals. Here’s a comprehensive overview of the factors to consider regarding the removal of metal implants, particularly in the context of your right humerus fracture.

Risks of Leaving Metal Plates in Place
1. Adhesions and Scar Tissue: One of the concerns you mentioned is the formation of adhesions or scar tissue. While it is true that prolonged presence of metal implants can lead to scar tissue formation, this is not universally problematic. Scar tissue can sometimes restrict movement, but it often resolves with physical therapy and rehabilitation.

2. Infection: Although rare, there is a risk of infection associated with retained hardware. If an infection occurs, it may necessitate removal of the implants regardless of the initial decision.

3. Osteolysis: Over time, the body may react to the metal, leading to a condition called osteolysis, where bone around the implant begins to deteriorate. This can compromise the stability of the bone and the implant.

4. Impact on Future Surgeries: If you ever require another surgery in the same area, the presence of metal hardware can complicate the procedure.

Risks of Removal
1. Surgical Risks: Any surgery carries inherent risks, such as bleeding, infection, and anesthesia complications. The risk of nerve damage is also a concern, particularly in areas where the nerves are closely associated with the bone and surrounding tissues. However, experienced surgeons take precautions to minimize these risks.

2. Recovery and Rehabilitation: Post-operative recovery can be challenging. You may need to undergo physical therapy to regain strength and range of motion, which can take time and may interfere with your work schedule.
3. Pain and Discomfort: Some patients report pain after the removal of hardware, although this is often temporary and resolves with time.

Benefits of Removal
1. Symptom Relief: If you are experiencing discomfort, pain, or a sensation of the hardware being a foreign object, removal may provide significant relief.

2. Improved Functionality: Many patients find that their range of motion and overall functionality improve after the removal of metal plates and screws.

3. Psychological Comfort: For some, the knowledge that the hardware is no longer present can alleviate anxiety and improve mental well-being.

Recommendations
Given your situation, here are some recommendations:
1. Consult Your Surgeon: Discuss your concerns with your orthopedic surgeon. They can provide insights based on your specific case, including the condition of your bone healing and the position of the hardware.

2. Consider a Second Opinion: If you are uncertain, seeking a second opinion from another orthopedic specialist can provide additional perspectives on whether removal is advisable.

3. Evaluate Your Symptoms: If you are experiencing significant discomfort or limitations in your daily activities, it may be worth considering removal. Conversely, if you are functioning well and not experiencing pain, you might opt to leave the hardware in place.

4. Plan for Recovery: If you decide to proceed with removal, ensure you have a plan for post-operative recovery, including physical therapy and time off work if necessary.

In conclusion, the decision to remove metal plates and screws after bone surgery is multifaceted and should be made in consultation with your healthcare provider. Weighing the potential risks and benefits, along with your personal circumstances and recovery goals, will guide you toward the best decision for your health and well-being.

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