Complications of Orthopedic Screws After Fracture Surgery

Nail rotation

I suffered a right femur fracture from a fall on January 10 of this year and had two metal screws inserted, secured with a steel cable.
During a follow-up appointment on February 15, it was discovered that one of the screws, which was supposed to be anchored in the patella, had flipped over, causing discomfort due to friction with the skin.
Initially, there was just a small area of swelling, but over time, the discomfort has become more pronounced.
I often experience sharp pain when trying to bend my knee.
The doctor initially instructed me to achieve 90 degrees of knee flexion by March 14, but the discomfort prevents me from progressing in rehabilitation.
Can I request the doctor to remove the flipped screw first, or is it necessary to wait until the bone has healed before removal?

Amy, 30~39 year old female. Ask Date: 2016/03/08

Dr. Chen Yongxue reply Orthopedics

Hello, for a patella fracture, using two steel pins and wires for fixation is considered standard practice.
After the surgery, once the swelling subsides, it is common to see the steel pins protruding, which can sometimes be sensitive for the patient.
It would be unwise to avoid rehabilitation due to this discomfort.
Regarding the issue of the steel pin rotation mentioned in your letter, if necessary, you can ask the physician to reposition it.
However, the pins should not be removed before the fracture has healed, as doing so could lead to a complete failure of the rehabilitation process.

Reply Date: 2016/03/08

More Info

After undergoing fracture surgery, particularly with the insertion of orthopedic screws, patients often experience various complications that can affect their recovery and overall joint function. In your case, it appears that you have encountered a situation where one of the screws has flipped, causing discomfort and pain, particularly when attempting to bend your knee. This is a concerning development, and it’s important to address it appropriately.

Firstly, it’s crucial to understand that orthopedic screws are designed to stabilize fractured bones during the healing process. However, complications can arise, such as screw loosening, migration, or, as in your case, flipping. When a screw flips, it can irritate surrounding tissues, including skin and muscle, leading to pain and discomfort. This can also impede your rehabilitation efforts, as you are experiencing significant pain when trying to bend your knee.

Regarding your question about whether you can request the removal of the flipped screw, it is essential to consult with your orthopedic surgeon. Generally, the decision to remove a screw before the bone has fully healed depends on several factors:
1. Bone Healing Status: If the bone is not yet fully healed, removing the screw prematurely could compromise the stability of the fracture. Your surgeon will likely assess the healing progress through imaging studies, such as X-rays, to determine if the bone is sufficiently healed to withstand the removal of the screw.

2. Severity of Symptoms: If the discomfort and pain from the flipped screw are significantly affecting your quality of life and rehabilitation, it may warrant earlier intervention. Your surgeon will consider your pain levels, the impact on your mobility, and your ability to participate in physical therapy.

3. Potential for Further Complications: If the flipped screw is causing skin irritation or other complications, such as infection, it may be necessary to remove it sooner rather than later. Infections can lead to more severe complications, including osteomyelitis, which is an infection of the bone.

4. Surgical Risks: Every surgical procedure carries risks, including infection, bleeding, and complications related to anesthesia. Your surgeon will weigh these risks against the benefits of removing the screw early.

In many cases, if the screw is causing significant discomfort and is not contributing to the stability of the fracture, your surgeon may agree to remove it. However, this decision should be made collaboratively, considering your specific circumstances and the surgeon's clinical judgment.

In the meantime, it is crucial to communicate openly with your healthcare provider about your symptoms. If you are experiencing increased pain or swelling, or if the discomfort is preventing you from participating in rehabilitation exercises, make sure to inform your doctor. They may recommend pain management strategies or adjustments to your rehabilitation plan to accommodate your current situation.

In conclusion, while it is possible to request the removal of the flipped screw, the decision should be based on a thorough evaluation of your healing progress and the severity of your symptoms. Collaborate closely with your orthopedic surgeon to determine the best course of action for your recovery. Your health and comfort should be the priority, and addressing any complications promptly can help facilitate a smoother rehabilitation process.

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