Complications of Exposed Artificial Ligaments in Orthopedic Surgery

Exposed artificial ligament

Hello Doctor, I would like to ask a few more questions:
1.
When you mentioned that further evaluation might be needed after removal, does that mean there could be an impact on the function of my left shoulder and hand? For example, if the artificial ligament is completely removed and the clavicle only tilts slightly upward, could that still affect the function of my left shoulder and hand? Would it be necessary to consider re-fixing the clavicle? What is the likelihood of needing reconstructive surgery?
2.
Currently, my wounds are temporarily covered with artificial skin for protection, but there is still some discharge.
The attending physician mentioned after the surgery that there was no infection, but recent X-rays show that while the clavicle is healing, its shape is not very aesthetically pleasing, with the mid-section being narrower than the two ends.
Could this be a sign of poor healing possibly caused by an infection?
3.
In cases like mine where the artificial ligament is exposed, do you recommend complete removal?
Thank you for your response.

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Questioner: Yun / Female / 27, 2015/11/29
Hello Doctor, last November I had a distal clavicle fracture and dislocation in my left shoulder, along with ligament injuries.
After undergoing surgery with a self-paid artificial ligament and two titanium screws, everything healed well.
However, in March of this year, I was involved in a car accident resulting in a mid-clavicle fracture.
After undergoing plate fixation and reduction surgery, the skin was too thin and pierced through.
Following a debridement and suturing surgery in July, it still could not support, and in August, the plate was removed.
Currently, my left clavicle has healed, but the surgical wound is about 0.8 to 1 cm not fully healed, and the artificial ligament from last year's surgery is exposed.
I currently feel little pain at the wound site.

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 the entire artificial ligament needs to be removed due to the risk of infection leading to osteomyelitis.
Is this a high possibility?
3.
If only the exposed part of the artificial ligament is debrided, what is the likelihood of wound healing?
4.
If the entire artificial ligament is removed, considering that it has been a year since the surgery, will my ligaments be affected and at risk of re-injury? Will complete removal impact the function of my left shoulder and hand?
5.
I have heard doctors say that ligaments do not repair themselves well.
If I have the entire ligament removed, will my left clavicle protrude and affect its appearance?
I apologize for the complexity of my questions and appreciate your response.
Thank you!
Responder: Miaoli Hospital / Orthopedics / Dr.
Shih Kuo-Cheng, 2015/11/30
If there is no discharge from the wound, it is unlikely to be an infection.
Blood tests can indicate whether there is an infection or inflammation, which may lead to difficult healing.
Debridement may help.
After removal, further evaluation may be necessary as there is a possibility of protrusion.

yun, 20~29 year old female. Ask Date: 2015/11/30

Dr. Shi Guozheng reply Orthopedics

A slight upward tilt of the clavicle does not actually affect its function.
Since the clavicle has healed, it is not due to the influence of an infection.
If an infection cannot be resolved, then it would be necessary to remove the implant.

Reply Date: 2015/11/30

More Info

When considering the complications associated with exposed artificial ligaments in orthopedic surgery, it is essential to understand the potential risks and the implications for recovery and functionality. In your case, the exposure of the artificial ligament following your shoulder surgery raises several important questions regarding the management of your condition.

1. Impact on Shoulder and Hand Function: The concern about whether the removal of the artificial ligament could affect the function of your left shoulder and hand is valid. If the artificial ligament is removed, there is a possibility that the stability of the shoulder joint may be compromised, leading to issues such as shoulder impingement or instability. If the clavicle (collarbone) is not properly supported after the removal, it may lead to upward displacement, which could further affect shoulder mechanics and function. In some cases, reconstructive surgery may be necessary to restore stability and function, particularly if the shoulder joint is significantly affected.

2. Wound Healing and Infection: The presence of discharge from the wound can be indicative of infection, even if your doctor previously stated there was none. It is crucial to monitor for signs of infection, such as increased redness, swelling, warmth, or fever. Diagnostic tests, including blood tests (like a complete blood count) and imaging studies (such as X-rays or MRI), can help assess for infection or complications. If the wound is not healing properly, it may require further intervention, such as debridement or additional surgical procedures.

3. Decision to Remove the Ligament: The recommendation to remove the entire artificial ligament stems from concerns about potential infection leading to osteomyelitis (bone infection). The risk of infection is a significant factor in deciding whether to remove the ligament. If the ligament is causing ongoing issues or if there is a high risk of infection, complete removal may be warranted. However, this decision should be made in consultation with your orthopedic surgeon, who can evaluate your specific situation.

4. Healing Probability and Functionality Post-Removal: If only the exposed portion of the artificial ligament is debrided, the healing probability can be high, especially if there is no underlying infection. However, the overall success of this approach depends on the extent of the exposure and the condition of the surrounding tissues. If the entire ligament is removed, there is a risk that the shoulder may not have the same level of support, which could lead to functional deficits. It is essential to discuss with your surgeon the potential for rehabilitation and physical therapy to regain strength and mobility after such a procedure.

5. Long-Term Effects on Appearance and Function: After the removal of the artificial ligament, there is a possibility that the clavicle may appear elevated or protruding, especially if there is a lack of soft tissue coverage or support. This could affect not only the aesthetic appearance but also the functional dynamics of the shoulder. The long-term impact on your shoulder and hand function will depend on the extent of the surgery, the rehabilitation process, and your body's healing response.

In conclusion, the management of exposed artificial ligaments is complex and requires careful consideration of the risks and benefits of surgical intervention. It is crucial to maintain open communication with your healthcare provider, who can guide you through the decision-making process based on your unique circumstances. Regular follow-ups and monitoring are essential to ensure optimal recovery and to address any complications that may arise.

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