Call the Waaaahmbulance

September 24, 2009 4:59 AM

I had a broken bone, it was put back in place with some pins and a plate and now I'm not sure what to do...

Last spring I had a proximal humerus fracture that required surgery. I was in a ton of pain after, but am now totally healed. I have a full range of motion, a scar that's not too bad, and a decision to make.

I'd thought he'd said when I'd last seen him that IF I had problems after a year then he'd take the plate and pins out. Since I felt fine, I figured I was all good, but when I saw him last month for what I thought was just a checkin to make sure that I'd healed properly he said that since it was all healed we should now take the metal bits out. He said it wasn't something that I had to do quickly, but that I should do it soon since 12 to 18 months after they are put in is the best time to remove them.

Here's my question - has anyone had this surgery? How does the recovery compare to the initial surgery? Has anyone left their bionic parts in? The doctor said as I get older I could lose bone mass and that would cause me problems then, or if I were to get hurt in that area again it could be "bad". On the other hand, the idea of having another surgery kind of freaks me out because I'm a total wuss and the thought of recovering from this again isn't something I'm looking forward to.

The doctor really wasn't firm about it one way or the other and it's up to me when and if I want to do it. Now I just have to figure out what to do.....

posted by monkey!knife!fight! to health & fitness (17 comments total)

Can't speak to a broken arm but I broke my ankle in 2005 and had the pin removed 18 months later because it was interfering with range of motion and causing pain. It was trivial compared to the original surgery - outpatient, caused little pain - I wasn't on crutches or in a cast. You have more pieces of metal and what sounds like a worse break so don't know that my experience is relevant - I'd ask your doctor about why it needs to come out and what the recovery would be like.
posted by leslies at 5:18 AM on September 24

I can't speak to having them taken out (my femur nail is probably there for good, because of my age and the nature of that sort of implant), but there is extensive medical literature of the benefits and detriments of removal of different types of hardware. Your age and lifestyle are also major factors. My surgeon basically said: if you were in your early 20s or younger, we would take it out, if you were 40 or so we would definitely leave it in, in your situation it's up to you, we'll take it out if you can feel it or anything like that. I can't feel it at all and my 5k times are faster than ever so I am just leaving it in, at least unless it ever starts to bother me.

However, note that your hardware must be removed if you are going to fight in sanctioned MMA events. I was grateful my surgeon told me that; it did not change my decision.
posted by iknowizbirfmark at 5:23 AM on September 24

Been there done that! Lower arm, outer bone, dominant side.

Doctor said - remove it if it bothers you.

One year later - no serious pain, but if I lean on the arm (imagine putting your arms down on a table, or arm of a chair, or in front of you when lying on your stomach), it feels really uncomfortable because I can feel the hard bits.

One year three months later - surgery easy, recovery much MUCH easier than from original break, mostly covered by insurance (lucky). Surgeon and follow-up doctor same all the way through this, and he was awesome.

Me? I am really, really glad I did it.
posted by whatzit at 5:30 AM on September 24

I've had pins and a plate in my ankle for 3 years now. I was told the plate might have to come out because it's so close to the surface, but that they wouldn't do it unless it began causing debilitating pain. I too am in my 40s.
posted by JanetLand at 5:53 AM on September 24

There's nothing stopping you visiting your university library, or simply using google books to check out some medical text books on the subject.

I gather the advantages to having them removed are:
* If you play rugby or american football you're safer with them removed, as your bone can flex all along, while if it's less flexible where the plate is you can get more bending at the ends of the plate, so you can get fractures at the end.
* If they feel uncomfortable to you you can get rid of them.

The disadvantages are:
* It's an additional operation, with the resulting inconvenience and risk of complications. Historically removals were seen as simple, and given to less experienced surgeons, leading to a higher complication rate.
* After the plate is removed and you have a bunch of screw holes in your arm, it is vulnerable to re-fracturing until the holes have healed.

Personally I chose to keep my plates because getting them removed would mean an additional hospital stay, and the benefits to me seemed negligible.
posted by Mike1024 at 6:04 AM on September 24

Spinal fusion. Screws and bits still in 5 years on. Taking them out never offered as an option. Bones totally fused.
posted by JohnnyGunn at 7:09 AM on September 24

I had a different break, which was fixed with three screws. When I had them removed, I cursed myself for not doing it sooner: I'd been experiencing low-level discomfort all along and had kind of tuned it out. I felt better literally the instant I awoke from anesthesia.

Also, I later had another break in the same spot. If that hardware had still been in place, it could have been really messy.
posted by adamrice at 7:12 AM on September 24

I've had a five-inch plate in my radius for about three years now. The surgeon said that if I wanted I could have it removed after I was fully recovered, but that there was no real reason to undergo an extra surgery unless it was giving me problems for some reason. Sometimes on a cold, damp day it feels a little achy, but other than that it doesn't bug me at all, and I plan to leave it in there forever.
posted by escabeche at 7:16 AM on September 24

JohnnyGunn : Apples to oranges, there. Spinal fusion is an entirely different beast than screws and plates to support a fractured bone. Hardware in a spinal fusion is not supposed to come out. Ever. (For those who aren't aware, the hardware in a spinal fusion becomes part of the spinal structure, unlike plates and pins which are on the surface of a bone.)

m!k!f! : You need more information than you've given us (from your doctor, not just random people on Teh Intarwebz) before you decide. Find out what kind of surgery removing the screws/plates involves, and who's doing it. If nothing else, recovery from this will be far quicker than healing the broken bone.
posted by jlkr at 7:25 AM on September 24

Broke my humerus in a horse fall in 1990 - had it plated and screwed also a bone graft as it was a messy spiral fracture. Healed fine, occasional nerve twinges. Surgeon said he could take it out at two years post surgery but would rather not as the nerve damage in the area was healing well and he didn't want to upset the apple cart.

I'm still riding horses which I'm told is as dangerous as playing rugby/skiing in the context of injury risk. Arm twinges now and again but nothing drastic. Bone has grown all over the plate and screw heads, it's a nice remodelling job (says the surgeon) If I fall off and injure the humerus again I know it may be more likely to fracture near the elbow end AND shoulder end. I never have any problems with the arm. The plate and screws are going to be with me in my grave and I'm happy about that :)
posted by Arqa at 7:31 AM on September 24

If you don't trust your doctor, or don't feel like he's giving you enough information and advice, why not get a second (and third, and fourth if needed) opinion from other doctors? They have the benefit of your specific medical information and records, they've studied medicine for many years, they have treated many patients in your exact situation, and they think about problems exactly like yours for 8+ hours/day.

Anecdotes are fine, but this is pretty important and scary for you. It's worth a few professional opinions as well.
posted by Houstonian at 7:33 AM on September 24 [1 favorite]

My DD has a rod and several pins in her lower leg after a nasty break. Some of the pins has to be removed about 18 months later, and some a year after that, as they were coming out by themselves and causing the kind of pain soldiers with shrapnel get. It's been 8 years; the pins are out, the rod stays. She was 19 at the time and had pain from moderate to severe for about 5 years, partly because of the pins and partly because of the amount of healing she had while still growing. Removing the pins was basically nothing compared to the original surgeries, caused very little pain in comparison to the pins forcing themselves out, and healed quickly.
posted by x46 at 9:38 AM on September 24

I have plates and pins there (both bones of the lower arm, actually). I broke it in 1999, never had them taken out. I figure if they bug me I will at some point, but I don't notice them at all. Why get cut open for no reason, you know?
I've also got rods in both femurs and a dozen or so screws in one of my ankles. The ankle still bugs me, but I've been told by a couple docs that would be the same with or without the screws (just how and where the break was), the rods give me 0 trouble. All from the same accident, a couple months over 10 years ago.

The occasional discomfort in my arm is, judging by the other broken bones I have that were set without surgery, normal for a previously broken bone. "oh, it's gonna rain today," that sort of thing. The metal makes no difference.

But... you may set off a metal detector if it's set super high. I fly a couple times a year and have been through countless metal detectors since I got mine, and they only set stuff off right after 9/11 when paranoia had the dials turned to 11.


I do have an extra bone mass, though, but it's really nothing to do with the metal. It was already growing in before I'd even left the hospital from the initial surgery (so less than three months after the plates were put in). I was told by a specialist it had more to do with where the break was, and that I broke BOTH bones, than anything else. I just overhealed a bit. Which is a pain in the ass, as I can't rotate my arm now. But it's rare and odd. My specialist for that was one of the top hand and arm surgery guys in the US and he'd only seen something like that a couple times in his career. We're talking walls full of degrees and certificates from Doctors Without Borders from helping kids who lost fingers to land mines and stuff. If someone like that says it's super duper rare I wouldn't concern yourself.
posted by Kellydamnit at 9:46 AM on September 24

Keeping the metal bits in place MAY mean (and you should find out for certain) that you'd no longer be a candidate for MRI should you need one. Would you be willing to give up that incredibly useful and non-invasive, diagnostic imaging tool?
posted by TruncatedTiller at 3:54 PM on September 24

... give up access to ...
posted by TruncatedTiller at 3:56 PM on September 24

oh, that is true. I can't have an MRI. I've had cat scans or ultrasounds instead whenever I needed any kind of diagnostic imaging.
posted by Kellydamnit at 7:39 PM on September 24

I've had 2 plates and 9 screws in my ankle since 1994. I had MRIs last year and last week with no problem whatsoever.
posted by acorncup at 12:29 AM on October 4