Screw Displacement and Bone Healing After Fracture Surgery

Q: Screw Displacement and Bone Healing After Fracture Surgery

Hello： If it has not healed after 8 months, the medical likelihood of nonunion requiring further surgery is high. <br>The presence of metal screws and malalignment of the fracture can create an unstable environment for healing. <br>Ultimately, it may be necessary to undergo addit

Screw displacement

Earlier this year, I was involved in a car accident that resulted in a comminuted fracture of my right femur.
After surgery, a steel plate and 12 screws were implanted.
About four months later, an X-ray revealed that three of the screws at the fracture site had shifted.
I asked my doctor if another surgery was necessary, and he said that the displacement was within an acceptable range and that surgery was not needed, but I should avoid any further movement.
However, during subsequent check-ups, it was noted that my bone healing was progressing very slowly, and there was even a month where there was no growth at all.
I would like to know if the screw displacement could be hindering the healing process, or if it is due to my own physiological condition (it has now been 8 months).

Wei Chen, 20~29 year old female. Ask Date: 2015/09/04

Dr. Wang Shouji reply Orthopedics

Hello: If it has not healed after 8 months, the medical likelihood of nonunion requiring further surgery is high.
The presence of metal screws and malalignment of the fracture can create an unstable environment for healing.
Ultimately, it may be necessary to undergo additional surgery to enhance fracture stability and perform autologous bone grafting.
Thank you!

Reply Date: 2015/09/04

More Info

Understanding screw displacement and bone healing after fracture surgery is a complex issue that involves multiple factors, including the nature of the fracture, the surgical technique used, the quality of the bone, and the overall health of the patient. In your case, you experienced a comminuted fracture of the femur, which is a serious injury that often requires careful surgical intervention and rehabilitation.

When screws or plates are used to stabilize a fracture, their primary role is to hold the bone fragments in the correct position to allow for proper healing. If screws become displaced, it can potentially affect the stability of the fracture site. However, as your doctor mentioned, if the displacement is within an acceptable range, it may not necessitate further surgical intervention. The key concern is whether the screws are still providing adequate stabilization to allow for bone healing.

Bone healing is a biological process that can be influenced by several factors, including:
1. Blood Supply: Adequate blood flow to the fracture site is crucial for healing. If the blood supply is compromised, healing can be delayed.

2. Bone Quality: Conditions such as osteoporosis can affect the quality of the bone and its ability to heal. If your bone density is low, it may take longer for the bone to heal.

3. Age and Health: Older age and certain health conditions (like diabetes or smoking) can impede the healing process. Your overall health status plays a significant role in recovery.

4. Mechanical Stability: If the screws are displaced, it may lead to instability at the fracture site, which can hinder the healing process. However, if the displacement is minimal and the fracture remains stable, healing can still occur.

5. Biological Factors: Individual biological factors, including genetics and nutritional status, can also influence healing. Adequate nutrition, particularly calcium and vitamin D intake, is essential for bone health.

In your case, the fact that your bone healing has been slow, and there was a period of halted growth, could be attributed to a combination of the factors mentioned above. The displacement of the screws might contribute to instability, but it is also possible that your body is responding slowly due to intrinsic factors such as bone quality or overall health.

It is essential to maintain regular follow-ups with your orthopedic surgeon. They may recommend imaging studies, such as X-rays or CT scans, to assess the healing process and the position of the screws. If the healing continues to be inadequate, your doctor might consider additional interventions, which could include surgical revision or other treatments to promote bone healing, such as bone stimulators or even bone grafting.

In summary, while screw displacement can potentially affect bone healing, it is not the only factor at play. The healing process is multifaceted, and it is crucial to consider all aspects of your health and the specifics of your injury. Open communication with your healthcare provider will help you navigate this recovery process effectively.

Similar Q&A

Understanding Screw Displacement in Orthopedic Surgery After Fractures

Hello Dr. Lee, I would like to ask about a situation following a car accident where I fractured my tibia and fibula. I underwent surgery and had an intramedullary nail implanted. However, after more than two months, an X-ray showed that one of the screws near the knee has protrud...

Dr. Li Yongheng reply Orthopedics
Hello, as long as the bone screws are not displaced significantly due to activities like walking, there should be no major issues, so please don't worry too much.

Risks of Leaving Bone Screws and Plates in After Fracture Surgery

Hello Doctor, I had a tibial plateau fracture in my left leg due to a car accident in 2019. At that time, I had a titanium alloy plate and screws inserted at my own expense, with plans to remove them after a year. However, I became pregnant and postponed the removal due to concer...

Dr. Chen Yongxue reply Orthopedics
Hello, 1. In the future, if osteoporosis occurs with age, will it have an impact? No. 2. If a severe injury leads to a fracture, will the existing bone screws affect the fracture surgery? This is possible. Additionally, implants do not provide benefits when placed in the body...

Understanding Proximal Radius Fractures: Healing and Complications

Hello, doctor. Due to a car accident, I sustained a displaced fracture of the distal third of the radius. On December 7, I underwent reduction with absorbable bone screws and received absorbable bone graft. The doctor advised that to prevent adhesion, I could occasionally remove ...

Dr. Shi Guozheng reply Orthopedics
Whether there is any displacement of the bone requires further examination with X-rays. You need to return to the hospital where your original surgery was performed for follow-up.

Understanding Bone Pin Migration: Challenges and Solutions in Orthopedic Care

Hello Doctor, 1. In January of this year, I underwent surgery for a fracture of the fourth toe on my right foot, where a bone screw made of a bioabsorbable material was inserted, which does not require removal through another surgery. 2. Around March, I noticed that the bone s...

Dr. Chen Bochen reply Orthopedics
Hello, 1. Typically, the hospitalization for the removal of bone screws lasts about two days, and there is no need for a recovery period. Just make sure to keep the wound dry and avoid covering it tightly. 2. It's okay if the bone screw cannot be located; usually, partial...