Managing Exposed Artificial Ligaments After Shoulder Surgery: Key Concerns

Exposed artificial ligament

Hello Doctor: Last November, I suffered a distal clavicle fracture-dislocation of my left shoulder, along with ligament injuries.
After undergoing surgery with self-funded artificial ligaments and two titanium screws for fixation, everything healed well.
However, in March of this year, I was involved in a car accident that resulted in a mid-clavicle fracture on the left side.
After a plate fixation and reduction surgery, the skin was too thin and the plate pierced through the skin.
In July, I underwent debridement and suturing, but it still could not support properly.
The plate was removed in August.
Currently, my left clavicle has healed, but the surgical wound is about 0.8 to 1 cm and has not healed well.
The artificial ligament from last year's surgery is exposed, but I do not feel much pain in the wound.
I would like to ask the doctor: 1.
Does this wound indicate an infection? What tests can the hospital perform to check for infection? 2.
Some doctors have advised that all artificial ligaments need to be removed due to the risk of infection causing osteomyelitis.
Is this a high possibility? 3.
If only the exposed part of the artificial ligament is debrided, what is the likelihood of the wound healing? 4.
If all the artificial ligaments are removed, considering it has been a year since the surgery, will my ligaments be affected and prone to injury? Will complete removal affect the function of my left shoulder and left arm? 5.
I have heard doctors say that ligaments do not repair themselves well.
If I have everything removed, will my left clavicle protrude and affect my appearance? I apologize for the complexity of my questions, and I appreciate your response.
Thank you!

yun, 20~29 year old female. Ask Date: 2015/11/29

Dr. Shi Guozheng reply Orthopedics

If there is no discharge from the wound, it is unlikely to be infected.
Blood tests can determine the presence of infection.
Inflammation may occur before an infection develops, making healing more difficult.
Debridement may improve healing, but after removal, further evaluation may be necessary as there is a possibility of complications.

Reply Date: 2015/11/29

More Info

Managing exposed artificial ligaments after shoulder surgery is a complex issue that requires careful consideration of various factors, including the risk of infection, the integrity of the surrounding tissues, and the potential impact on shoulder function. Based on your description, it seems you are dealing with a challenging situation following multiple surgeries and complications. Let’s address your concerns one by one.

1. Infection Risk: The presence of exposed artificial ligaments raises the concern for infection. While the absence of pain is a positive sign, it does not rule out infection. Signs of infection can include redness, swelling, warmth, drainage, or fever. To assess for infection, healthcare providers typically perform a physical examination and may order laboratory tests, such as a complete blood count (CBC) to check for elevated white blood cell counts, and cultures of any drainage if present. Imaging studies, like X-rays or MRI, may also be used to evaluate the surrounding tissues for signs of infection or complications.

2. Need for Removal of Artificial Ligaments: The decision to remove the artificial ligaments depends on several factors, including the presence of infection, the condition of the surrounding tissue, and the risk of developing osteomyelitis (bone infection). If there is a significant risk of infection or if the ligaments are causing complications, removal may be necessary. However, this decision should be made collaboratively with your orthopedic surgeon, who can assess the specifics of your case.

3. Wound Healing Probability: If the exposed portion of the artificial ligament is cleaned and managed properly, there is a chance that the wound can heal without the need for complete removal of the ligament. Factors that influence healing include the blood supply to the area, the presence of infection, and the overall health of the patient. Regular follow-up with your healthcare provider is essential to monitor the healing process.

4. Impact of Ligament Removal on Function: If the artificial ligaments are removed, there is a possibility that your shoulder function could be affected, particularly if the ligaments were providing stability. The risk of re-injury may increase if the natural ligaments are not intact or if there is insufficient support from surrounding muscles. Your surgeon can provide guidance on rehabilitation and strengthening exercises post-removal to help maintain function.

5. Aesthetic Concerns: The concern about the appearance of your shoulder after the removal of artificial ligaments is valid. If the ligaments are removed and the natural support structures are compromised, there is a possibility that the shoulder may appear different, such as a prominence or asymmetry. However, this can often be managed through physical therapy and strengthening exercises to improve muscle tone and support around the shoulder joint.

In conclusion, managing exposed artificial ligaments after shoulder surgery involves a multidisciplinary approach, including orthopedic evaluation, potential imaging studies, and possibly surgical intervention. It is crucial to maintain open communication with your healthcare team to address your concerns and develop a tailored treatment plan. Regular follow-ups and adherence to rehabilitation protocols will be key to optimizing your recovery and function.

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