Removal of Bone Plates and Pins After Humerus Fracture

Q: Removal of Bone Plates and Pins After Humerus Fracture

Hello： <br>1. <br>When performing open reduction or plate removal surgery for a mid-shaft humeral fracture, there is a risk of injuring the radial nerve (approximately 10% chance), especially since the surgeon has already interacted with your tissues and has a better understandin

Right humeral fracture: issues with the removal of bone screws and plates?

Dear Doctor,
In October 2008, I accidentally fractured my right humerus (near the mid-lower part) while participating in a company event.
I underwent an open reduction and internal fixation with plates and screws.
My recovery has been quite good, but I have a concern: my doctor advised me not to remove the screws and plates in the future, citing the risk of adhesions that could potentially damage nerves during removal.
1.
Is this true?
2.
Would the surgery to remove them be very difficult?
3.
After the removal surgery, would I still need rehabilitation?
This is really troubling me because I genuinely want to have the plate removed.
Lastly, since I have a habit of working out, can I go to the gym and do weight training now?
Thank you for your clarification.
Eric
May 14, 2009

Eric, 30~39 year old female. Ask Date: 2009/05/14

Dr. Li Wenlin reply Orthopedics

Hello:
1.
When performing open reduction or plate removal surgery for a mid-shaft humeral fracture, there is a risk of injuring the radial nerve (approximately 10% chance), especially since the surgeon has already interacted with your tissues and has a better understanding of the relative positions (the nerve in relation to the fracture site).
He will be concerned about the possibility of nerve injury during plate removal, and there is a valid reason for this.
2.
The removal surgery is not particularly difficult, but if it were me, I would not actively seek to remove a plate placed by another surgeon, as each surgeon has different techniques, which may reduce the risk of complications related to wound management.
3.
In theory, rehabilitation can begin after any surgery.
Generally, plate removal surgery does not specifically require rehabilitation, but if you wish to undergo rehabilitation, your orthopedic surgeon would not oppose it.
4.
Whether weight training is appropriate depends on the healing status of your humeral fracture.
I recommend consulting your attending physician, as his response should be more reliable.
Finally, I wish you all the best!
Dr.
Li Wen-Lin, Chief of Orthopedics, Keelung Hospital

Reply Date: 2009/05/14

More Info

When it comes to the removal of bone plates and pins after a humerus fracture, there are several important considerations to keep in mind. Your concerns are valid, and it's essential to understand the implications of both keeping and removing these devices.

1. Adhesion and Nerve Damage Concerns: Your doctor’s advice regarding the potential for adhesion and nerve damage during the removal of bone plates and pins is grounded in medical reality. When hardware is left in place for an extended period, surrounding tissues can develop adhesions, which are bands of scar tissue that can bind to nerves or other structures. If the hardware is removed, there is a risk that these adhesions could be disrupted, potentially leading to nerve injury. However, this risk is often weighed against the benefits of removing the hardware, especially if it is causing discomfort or limiting function.

2. Surgical Difficulty: The difficulty of the removal surgery can vary based on several factors, including the location of the hardware, the amount of surrounding scar tissue, and the overall healing of the bone. In some cases, the procedure can be straightforward, while in others, it may require more extensive dissection to safely remove the hardware without damaging surrounding structures. Your surgeon will assess these factors and provide guidance based on your specific situation.

3. Rehabilitation Post-Removal: If you do decide to have the hardware removed, rehabilitation will likely be necessary afterward. The removal of the hardware can lead to temporary changes in strength and range of motion, and physical therapy may be recommended to help regain any lost function and to strengthen the surrounding muscles. The extent of rehabilitation will depend on how well your bone has healed and how much function you had prior to the removal.

4. Returning to Weight Training: Regarding your fitness routine, it is crucial to consult with your healthcare provider before returning to the gym, especially for weight training. If your fracture has healed well and you are not experiencing pain or limitations in movement, your doctor may allow you to gradually return to your normal activities. However, it is essential to start with lighter weights and focus on proper form to avoid re-injury. Your healthcare provider can give you specific guidelines based on your recovery progress.

In summary, while there are risks associated with both keeping and removing bone plates and pins, the decision should be made collaboratively with your healthcare provider, considering your specific circumstances, symptoms, and lifestyle. If the hardware is causing discomfort or functional limitations, discussing the potential benefits of removal with your surgeon is advisable. Additionally, maintaining open communication about your fitness goals and any concerns you have will help ensure a safe and effective return to your exercise routine.

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