Humerus Fractures: Recovery, Pain Management, and Surgery Decisions

Humeral fracture

Hello, Doctor: I would like to briefly describe my situation.
In December 2008, I suffered a right humeral fracture while playing softball.
The fracture was in a lightning shape, and the surgeon later inserted a plate and 12 screws.
I also injured my radial nerve, but it was not severed, resulting in an inability to lift my wrist and thumb on the right hand.
Perhaps due to my youth, after more than three months of rehabilitation, my right hand returned to normal.
However, I have noticed that after exercising (such as playing basketball or swimming), the injured area becomes painful when I exert myself or extend my arm, but this pain disappears after about a week.
I am currently considering whether to have the plate and screws removed.
I have read through previous Q&As related to this but still cannot make a decision.

The concerns I am facing are:
1.
The radial nerve is located near the plate, and there is a possibility of adhesion.
During the removal process, it will inevitably be touched, which could lead to a situation similar to my previous inability to lift my wrist.
Although recovery is possible after rehabilitation, the worst-case scenario would be the loss of function in my right wrist.

2.
The post-exercise pain may be due to discomfort caused by the plate and screws, which might improve after removal.
However, this leads back to the concern mentioned above.
If I choose not to have them removed, what methods can I use to alleviate the pain after exercising?
3.
The surgeon mentioned that many cases abroad tend to favor not removing the hardware, as it has minimal impact and does not warrant the risk.
However, my parents believe that since I am still young, the plate and screws are considered foreign objects, and they hope I will have them removed.
I plan to decide that if I do not remove them now, I will not do so in the future, as delaying the surgery increases the risk.
Thank you, Doctor.

snamnm, 20~29 year old female. Ask Date: 2010/07/29

Dr. Shi Guozheng reply Orthopedics

Internal bone screws and plates do not need to be removed unless they affect function or cause inflammation or infection.
Removing the plates may risk damaging nerves, so this surgery should be avoided unless absolutely necessary.
Pain may be due to other causes and can be managed with medication.

Reply Date: 2010/07/29

More Info

Understanding humerus fractures, particularly in the context of recovery, pain management, and surgical decisions, is crucial for anyone who has experienced such an injury. Your situation, involving a humeral fracture from a softball incident, followed by surgical intervention with the placement of a plate and screws, is not uncommon. The fact that you also experienced nerve involvement, specifically with the radial nerve, adds complexity to your recovery and decision-making process.

Recovery from Humerus Fractures
Recovery from a humeral fracture typically involves several stages. Initially, after surgery, the focus is on healing the bone and managing pain. This can take several weeks to months, depending on the severity of the fracture and the individual’s overall health. Physical therapy often begins shortly after surgery to maintain range of motion and prevent stiffness, which is crucial for restoring function.

In your case, it seems that you have made significant progress in your recovery, regaining normal function after three months of rehabilitation. However, the recurring pain during physical activities suggests that there may still be underlying issues, such as irritation from the hardware or residual nerve sensitivity.

Pain Management
Pain management is an essential aspect of recovery. The pain you experience after activities like basketball or swimming could be due to several factors:
1. Hardware Irritation: The presence of the plate and screws can sometimes lead to discomfort, especially during physical exertion. This is because the hardware can cause irritation to surrounding tissues, particularly if there is any movement or strain on the area.

2. Nerve Sensitivity: Since the radial nerve was affected, it’s possible that the nerve is still recovering or is sensitive to certain movements, leading to pain during activities.

3. Muscle Strain: Engaging in physical activities can also lead to muscle strain, particularly if the muscles around the shoulder and arm are not fully conditioned post-injury.

To manage this pain, consider the following strategies:
- Gradual Increase in Activity: Ensure that you are not overexerting yourself too soon. Gradually increasing the intensity and duration of your activities can help your body adapt without causing excessive pain.

- Physical Therapy: Continuing with physical therapy can help strengthen the muscles around the shoulder and arm, potentially alleviating some of the discomfort during activities.

- Pain Management Techniques: Over-the-counter pain relievers, ice application after activities, and gentle stretching can also help manage pain.

Surgical Decisions: To Remove or Not to Remove Hardware
The decision to remove the hardware is a significant one and should be made after careful consideration of the potential risks and benefits:
1. Risks of Removal: As you mentioned, there is a risk that the surgery to remove the hardware could affect the radial nerve, potentially leading to complications similar to those you experienced previously. This is a valid concern, especially if the nerve is adhered to the hardware.

2. Benefits of Removal: If the hardware is indeed causing discomfort or limiting your ability to engage in physical activities, removal might provide relief. Many athletes and active individuals choose to have hardware removed for this reason.

3. Current Recommendations: Many orthopedic surgeons recommend leaving hardware in place unless it is causing significant problems. This is based on the understanding that the risks associated with removal may outweigh the benefits, especially if the hardware is stable and not causing any functional impairment.

Conclusion
Ultimately, the decision to remove the hardware should be made in consultation with your orthopedic surgeon, considering your specific circumstances, activity level, and the potential risks involved. If you choose not to remove the hardware, focusing on pain management strategies and continuing rehabilitation can help you maintain an active lifestyle while minimizing discomfort. Regular follow-ups with your healthcare provider will also ensure that any changes in your condition are monitored and addressed promptly.

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