Options for Removing Clavicle Screws After 5 Years: Risks and Complications - Orthopedics

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When it comes to the management of retained hardware such as clavicle screws after a significant period, there are several factors to consider, including the risks and potential complications associated with removal versus retention.
Firstly, it is important to understand that the decision to remove or leave the screws in place often depends on the individual patient's circumstances, including the presence of symptoms, the condition of the surrounding tissues, and the potential for complications. In your case, the screws have been in place for five years, and the head of the screw has been worn down, complicating the removal process.


Options for Removal
1. Surgical Removal: If the screws are symptomatic (causing pain or discomfort), or if there is a concern about the integrity of the surrounding bone or soft tissue, surgical removal may be warranted. However, if the screws are embedded and difficult to extract due to wear, this could increase the risk of complications during the procedure, such as fracture of the clavicle or damage to surrounding structures.

2. Observation: If the screws are not causing any symptoms, many orthopedic surgeons recommend leaving them in place. The risk of complications from retained hardware is generally low, and many patients live comfortably with screws in place for years without issues.


Risks and Complications of Removal
1. Surgical Risks: Any surgical procedure carries inherent risks, including infection, bleeding, and anesthesia-related complications. In the case of removing screws, there is also a risk of fracturing the clavicle or damaging nearby nerves and blood vessels.

2. Post-Operative Complications: After removal, there is a possibility of developing a hematoma (a localized collection of blood outside of blood vessels) or seroma (a pocket of clear fluid), which may require further intervention. Additionally, the area where the screws were removed may take time to heal, and there could be a temporary increase in pain or discomfort.

3. Non-Union or Delayed Healing: If the screws are removed and the bone has not fully healed, there is a risk of non-union or delayed healing at the site of the previous fracture. This is particularly concerning if the bone is still in a vulnerable state.

4. Long-term Outcomes: While many patients do well with retained hardware, there can be long-term issues such as chronic pain or discomfort, particularly if the hardware is prominent or if there is a reaction to the metal.

Risks of Not Removing the Screws
1. Potential for Future Complications: While the risk is low, there is a possibility that the retained screws could become a source of irritation or lead to complications such as infection or hardware failure.

2. Impact on Future Surgeries: If you ever require further surgical intervention in the area, the presence of retained hardware can complicate the procedure.

3. Psychological Impact: Some patients may experience anxiety or discomfort knowing that there is foreign material in their body, even if it is asymptomatic.


Conclusion
In summary, the decision to remove clavicle screws after five years should be made in consultation with an orthopedic surgeon who can evaluate your specific situation. If the screws are not causing any symptoms and there are no signs of complications, it may be advisable to leave them in place and monitor the situation. However, if you are experiencing discomfort or have concerns about the screws, seeking a second opinion or further evaluation may be beneficial. Regular follow-up appointments can help ensure that any potential issues are addressed promptly.