Should I have the rod and screws removed from my broken ankle now that it's healed, or leave them in for life?

January 8, 2010 6:56 PM

On 11/15/09 I slipped on ice, fractured my fibula and dislocated my tibia at the ankle joint. I had ORIF surgery that night and a rod and five screws were placed. Since then the fracture has healed and I am having a hard time deciding whether my hardware should stay.

My orthopedic surgeon says it's up to me if I want it removed, and recommends it if the metal "bothers" me. Sure, I'm in pain, but is it because of my inhuman parts? If I do this, it will happen in late February - I don't want to wait and miss out on having the surgery covered by workman's comp. What say ye?

posted by dissolvedgirl22 to Health & Fitness (18 answers total)

Hard to answer this for someone else, but here are some things to consider: How athletically active are you? Are the screws in the tibia or other bones in the ankle? You'll always know the hardware is there, but the degree of discomfort will vary based on what you are wearing and doing.
posted by minimii at 5:28 AM on January 9, 2010

Yes, when you say you're "in pain," can you be more specific? Is it constant? Debilitating? Did you actually ask the surgeon if the pain is from the hardware? I've had junk in my ankle for three years, and sometimes it twinges, but I was told to leave in unless the pain became constant and bad.
posted by JanetLand at 5:31 AM on January 9, 2010

I fractured my humurus (upper arm) and had a plate put in. The arm was somewhat hurting for a good period after the surgery as it was healing and as I was beginning to use it. However, the pain turned out to almost completely be muscle pain and now, I still have the plate put in and it's not bothering me at all. The only issue for me is that the plate is right under the skin in places, so bumping the arm on something hard can make the skin hurt due to compression between the hard object and the plate.

So, your pain may go away or at least be reduced. Furthermore, I would really ask about the surgery risks of getting it removed. In my case, I managed to refracture my arm about 10 weeks after it originally broke, so be sure that your fibula is actually completely healed before you rush the surgery.
posted by bsdfish at 5:36 AM on January 9, 2010

Wow... Unless someone here is an orthopedic surgeon, don't listen to anyone's advice.. If you need more advice on this, get a second medical opinion...
posted by HuronBob at 7:01 PM on January 8, 2010

I had a tib-fib fracture four years ago, and I still have my plates and screws. I've had no pain since my physio, and don't plan on ever having my hardware removed.

Honestly, it's probably too soon for you to decide -- it's been less than two months. See if you can hold off.
posted by ten pounds of inedita at 7:03 PM on January 8, 2010

I would give it at least a year. I still have the screws in my ankle 5 years later, and they don't bother me a bit. But really, I didn't feel completely back to good until a solid year, so wait at least that long to see.
posted by sanka at 7:05 PM on January 8, 2010

Notwithstanding HuronBob's advice, I would like to discuss a couple of issues you might want to consider. First, it appears that your surgeon's expert advice is that you can do well with or without the removal of the metal. Therefore, it appears that the decisions you need to make are not necessarily medical in nature.

You are concerned about having the (possible) second surgery covered by worker's comp. Have you addressed this with the worker's comp carrier? My experience as an employer is that worker's comp will set aside a reserve for a second surgery if it can be shown that it is a natural outcome of the first surgery. If you explain that you are trying to see whether you can save them the cost of the second surgery by testing whether you can get along without it, they might be more reasonable about not forcing you to meet deadlines.

Second, I am assuming that the second surgery will involve general anesthetic and cutting in and around the joint. Discuss these two issues with your surgeon and try to determine what the risks of anesthetic and re-cutting are in relation to the condition as you now experience it.

Last, if you are experiencing pain, ask your surgeon about Gabapentin or some other similar pain medication. This may be a good alternative to a surgery whose own outcome you can't predict. Most people tolerate this type of medication well and it can really help with post-surgical pain.

Good luck with your recovery.
posted by Old Geezer at 7:17 PM on January 8, 2010

I'd want to know whether I'm still eligible for future MRI, should I need one. If not, that would be a strong point for me in favor of having it out, second only to "how will keeping it vs. having it out affect my use of, and pain in, the joint, now and as I age. It sounds like you have the latter point covered.
posted by TruncatedTiller at 7:55 AM on January 9, 2010

I've had various screws/wires in my elbow for the last four years. I've always assumed that they would stay in there unless a problem dictated otherwise. A woman in my office building confirmed this, though from the flip side; she had had similar surgery/hardware, but a couple years after healing, one or two of her screws wormed their way out and started poking through her skin. At that point, she had them removed.

As our experiences show, this is such an individual thing. I've had moments when I've wondered if a particular pain or poking bump is the result of a screw poking out, but only an x-ray/MRI can determine that for sure. And those moments are very infrequent, and have certainly diminished as I've gotten further away from that time when I've thought about it all the time.

For some more data points, all two people I know who have had ankle surgeries similar to yours still have their hardware in five years later. So I'd give your injury some more time.
posted by Madamina at 8:51 AM on January 9, 2010

There's no rush to take them out, you don't need to decide now. I have all my plates and screws and I never think about them. There's no particularly compelling reason to take them out unless the idea of them bothers you. But honestly, I think when the scars have healed and your mobility is 100% and your pain is managed and abated, they will basically cease to exist for you.
posted by DarlingBri at 10:32 PM on January 8, 2010

Leave it in! Don't you want to be a bionic woman?
posted by Chocolate Pickle at 11:10 PM on January 8, 2010

Almost 20 years with rod and screws holding my ankle together and, at this point, they are there to stay. I never missed a beat because of them, though I can tell when the weather is about to change. YMMV
posted by bkeene12 at 11:18 PM on January 8, 2010

I had a bad break in my upper arm put back together with a plate and screws about 24 years ago. At the time, they said they'd take them out again in a few months, but it was never mentioned in follow-up visits, and I wasn't terribly anxious to have them cut through my bicep again to do it, so I never asked.

They're still there today, and don't give me any trouble to speak of; I have more aches and pains (old age) in my other arm than I do in the one with the hardware.

YMMV of course, but if something similar were to happen again, I wouldn't think twice about leaving them in....
posted by nonliteral at 10:53 AM on January 9, 2010

Yeah, I'd definitely ask about MRIs -- those are very good diagnostic tools, and they will only get better as you get older and start to need them. Were it me, the inability to have MRIs would be enough to have the hardware taken out.
posted by Malor at 12:47 PM on January 9, 2010

Sorry to hear about your accident - that sounds very painful.

I like Old Geezer's suggestion. I have quite a bit of hardware still attached to my femur. My orthopedist made a very similar recommendation - as it turns out, tolerance for leaving hardware in is very idiosyncratic, with a slight tendency towards thinner people having more problems. It took me over a year to determine whether I needed to have mine removed. You need to wait until the bone stops aching to evaluate the hardware, and that can take a long time. I ended up leaving my hardware in. And I'm very active and rather skinny as well.
posted by centerweight at 1:38 PM on January 9, 2010

For reference: I have screws in my hand and the metal used by default these days is not magnetic and will not cause you trouble with MRIs or airports or similar.
posted by jacalata at 10:29 PM on January 9, 2010

I've had screws in my tibia for 9 years. They bothered me a lot at first- one stuck out right under my skin and another irritated a tendon which would snap over the hardware painfully when I flexed the joint. I really wanted them out, but I was too busy to justify the time off for surgery. Eventually they stopped bothering me as much and now they're no big deal. (I'm female, normal-range BMI, moderately active.)
posted by pseudostrabismus at 11:42 PM on January 9, 2010

a physiotherapist (physical therapist) might be able to help you figure out what is causing the pain.
posted by y6t5r4e3w2q1 at 3:51 PM on January 11, 2010