Should I have these metal plates removed from my forearm?
September 19, 2005 8:51 PM   Subscribe

I recently had a pretty nasty bicycle accident and had to have two metal plates put in my forearm. I've been given the option of having another surgery around the end of the year to have them taken out, but I really want to get back to work, and to be able to ride again, so I'm seriously considering just leaving them in. Are there any downsides to that? Or conversely, if anyones chosen to have them removed, why?
posted by atom128 to Health & Fitness (30 answers total)
This has nothing to do with health, but if you leave them in, you're going to have to build extra time into your trip every time you go to a public access building or an airport. You can get a medical card stating that the detectors are going off because of the metal in your arm, but you'll be pulled aside every time while they sort that out. My father has an internal defibrillator (& medical explanation card,) and he's constantly irritated at the hassle of going somewhere, knowing he's going to get examined at the metal detectors.
posted by headspace at 8:54 PM on September 19, 2005

My father has a couple screws in his ankle from an hyper-competitive bar-league softball incident. Anyway, he left them in and has never had problems - physical or with metal detectors.
posted by mullacc at 9:02 PM on September 19, 2005

Response by poster: My doctor said titanium plates (which are what I have) normally get through airport security undetected. Either way, I don't have any plans for travel (too poor and still getting settled in/reaquainted to San Francisco) but I'll keep that in mind.
posted by atom128 at 9:08 PM on September 19, 2005

Also, never, ever have an MRI. Never even be near an MRI. MRIs are huge rotating magnets. An MRI would pin your arm to the side of the machine, and might even rip out the plates.
posted by maschnitz at 9:29 PM on September 19, 2005

I have two titanium plates in my arm, two titanium rods in my femurs (both), and a dozen pins in my ankle.
I've never set off airport security, and after six years I don't plan to get them removed at any point.

But you should wear a medic alert for the previously mentioned MRI issue. If anything should happen and you're unconscious emergency personnel won't know unless it happens to be the same hospital that put the plates in.
posted by Kellydamnit at 9:42 PM on September 19, 2005

actually, MRIs don't affect titanium implants.

I've got titanium hardware holding my hip together, and that's all pretty much there forever. My doctor never mentioned any potential problems arising from that. But your specific case may well be different. No problems with airport security either, for what it's worth...
posted by flod at 9:46 PM on September 19, 2005

maschnitz: Really? Rip out the plates? That seems a little extreme.

atom128: I broke my arm when I was 14 years old and wound up with two plates and 11 screws in my right forearm. I was tempted to get them taken out when my arm healed, but I didn't want to spend (another) six weeks in a cast. Fifteen years later, they're still there, and I haven't had any serious problems. I've never had a metal detector go off (my hardware is surgical stainless steel, fwiw), and I am rarely aware that I've got metal in my arm.
posted by lewistate at 9:50 PM on September 19, 2005

My friend broke his femur in a snowboarding accident, he had a titanium rod from his knee to his hip. The doctors recommended that he have it removed once he was healed. They explained that with his active lifestyle and young age, that it was best to remove it. They explained that any future breaks to that leg, or a motorcycle accident or injury could bend the rod, break the bone, and make the surgery to fix things quite traumatic.

He had one simple operation to remove the screws first, and then another months later to completely remove the rest of the hardware.
posted by tumble at 10:02 PM on September 19, 2005

Response by poster: lewistate - That's good to hear, sounds like we did about the same thing. I forget how many screws I got but I do remember one is 6" and one is 10" (one of the bones was broken in two places.) How are you, 15 years later? I've had nightmares about not being able to draw or make prints (my profession and love). I still can't hold a pen.
posted by atom128 at 10:07 PM on September 19, 2005

maschnitz: Really? Rip out the plates? That seems a little extreme.

Just for the record, MRI (the "M" is for magnetic) will only effect metal that is also magnetic. Titanium, aluminum, etc are unaffected.

But if you had a steel plate in your arm, yes, it could be ripped out. The magnets are extremely powerful, on the order of 60,000 x the earths magnetic field. People who have shrapnel in their tissue or tattoos with iron ferrite in the ink need to take precautions.
posted by qwip at 10:09 PM on September 19, 2005

quip and flod are right.
Any medical implants done in the US in recent years will be non-ferromagnetic and therefore safe in and around MRI's. Old/foreign/homemade implants should be checked out first.
(I only include foreign because I don't know for sure)
posted by Corpus Callosum at 10:52 PM on September 19, 2005

I have one very large pin going into my hip, one long rod down my femur, and several screws through the rod into the femur. They are all titanium. They don't set off metal detectors at airports. I've actually had an MRI with them in: no problems.

However, I'm six years out from my injury (spiral fracture of the femur, on my bicycle). I have yet to fully rehab. For reasons not entirely clear, my left leg is still significantly weaker than my right, despite trying to rehab it. I am not a couch potato at all (climbing, biking, hiking, walking, skiing, skating).

It has been posited by my doctor that the metal rods are causing muscular problems, and holding the left leg back. They told me when I got the surgery that the rods might need to come out. I've not yet taken the plunge and had the surgery, and concomitant bone-grafts, 6 weeks of bed rest, and 6 months of rehab to remove them.

All of which is just a really long-winded way of saying keeping them in is not guaranteed to be problem free.
posted by teece at 10:54 PM on September 19, 2005

There have also been cases of people having tiny steel shards in their eyes that they've forgotten about, then they get an MRI, and...yeah. Not pretty.

As someone who's gotten MRIs done, it'd be a good idea to let them know of the plates, etc if you ever need an MRI - while the plates may be titanium, other components may not be. It might be on the paranoid side, but it's still worth it to let them know.
posted by spinifex23 at 10:55 PM on September 19, 2005

I've had nightmares about not being able to draw or make prints (my profession and love). I still can't hold a pen.

Not to be naggy, but this could be a good excuse to learn to use your non-dominant hand to draw and write. It might open up some creative areas in your head, if you buy into the left/right brain theory stuff. Davinci could write with both hands, in mirror images of each other.
posted by mecran01 at 10:57 PM on September 19, 2005

Also, I had two screws placed in my ankle and removed six months later. It did require a general anesthetic but I was up and walking in a day or so (IIRC). Also, the surgeon was able to clean up the scar from the first surgury while he was in there.
posted by Corpus Callosum at 10:58 PM on September 19, 2005

re: MRI magnets. this is a gallery of stuff that's been sucked into MRI machines. note the floor polishers... those things are heavy.

i dont know about stuff being ripped out of your skin, but people with stents in their arteries can be killed by the MRI as the intense magnetic field of the fixed magnet can cause the stents to migrate. another big problem is eddy currents can be induced in any metal in your body and can get quite hot and burn you. also amazingly, if you have any metal shards in your eyes (like from a machine shop accident) the MRI can dislogde the shards and damage your eye...
posted by joeblough at 11:23 PM on September 19, 2005

A recent Myth Busters addressed the tattoo in an MRI issue and they even used an super iron oxide ink mixture for one of their tests and found no response. However, tattoos older than 20 years apparently contain metal fragments and may cause pain, and in the very least, both types of tattoos cause artifacts in the image.

(anyway...end of sidetrack)
posted by artifarce at 11:38 PM on September 19, 2005

Response by poster: Yikes now I'm scared to get an MRI lest Tony the Tiger (???) attacks.

mecran01- I have been trying to write a little. It's hard, and near illegible. I always thought it'd be cool to be ambidextureous though. I should try drawing, I bet charcoal would be manageable.
posted by atom128 at 11:45 PM on September 19, 2005

I was told by my doctor that, although the rods are titanium, some of the screws and other componants are not. (Surgical steel? I have no clue... I was on morphine at the time and not lucid enough to take notes). All I know is the orthopedic surgeon was the one who told me "no MRIs."
posted by Kellydamnit at 5:34 AM on September 20, 2005

Old/foreign/homemade implants should be checked out first.

Am I missing something? Homemade implants?
posted by elquien at 7:10 AM on September 20, 2005

Been there, done that. My surgeon said there was no need to have the plate and screws removed, but I actively went for the removal because the plate was so uncomfortable.

It was on the outside/bottom of the arm (same side as the pinky), so whenever I put my arm down flat on a table it was hugely uncomfortable. This is a movement that got in the way for writing, lying down, typing, anything. The removal was much much easier to go in for and recover from than the original surgery and break that necessitated it. If you can hold off those couple of weeks, and won't take a huge financial hit on doing the removal, I'd say go for it.

As others have reported, I did not have trouble with metal detectors ever, anywhere. These were steel plates and screws.
posted by whatzit at 7:21 AM on September 20, 2005

Hmm, I've got basically the same break as you (motorcycle accident though), and I've had the plates for about 4 months. My hand had really limited motion when I first got out of surgery, but within a month I had most of my range of motion back, and now I've got all of it back, plus the strength in my hand. I dunno how your surgery went, but I ended up with some minor nerve damage that is slowly but surely healing itself (doctor said it would be about 6 months or so for it to be fully repaired).

I've been through metal detectors, and sure enough, they did not get set off (a nice reminder of how BS those things really are). My doctor said that MRIs would not be an issue, as modern implants are non-ferrous.

I will say, one thing I think that helped me get my full motion back faster, video games. That and the fact that I'm a programmer by trade, and thus constantly typing, meant that I got plenty of exercises to keep my hand limber.

As to removal, well, my doctor said it wasn't necessary, although I do have worries along the lines of tumble's friend. I haven't decided whether or not to take them out yet, but basically here's the pro cons of taking them out as I see them:

In case of another accident, breaking those bones again with the plates will make a bad break a 100x worse.

Freakish metal buried in my arm is no longer there

Major surgery to remove the plates followed by several more months of recovery time.

Can no longer impress the chicks by saying I broke my arm saving a box full of puppies falling off a cliffs ledge by diving over the cliff and cradling them in my arms as my body was dashed against the hard rocks below, then pointing to the plates in my arm as proof.
posted by KirTakat at 7:30 AM on September 20, 2005

Response by poster: I'm gonna have to use that puppy story. Heh. Ive been trying to type a bit too (along with the physical therapy excercizes my doc told me to do), but its hard as my fingers can't bend to well yet. I did get some nerve damage, too, my thumb is a little messed up.

After reading all this, im leanings towards leaving it in for now, and waiting till i have some time in the future to get it removed, mostly as the plates exacerbating a new break sounds terrifying. I hope I never break another bone again.
posted by atom128 at 7:41 AM on September 20, 2005

My younger brother had some rods and pins put in to correct rather severe scoliosis. They were originally designed to be left in, but they ended up coming out because of a massive infection that developed about a year later. I think his case was somewhat rare, but it can happen.
posted by electroboy at 8:01 AM on September 20, 2005

Based on my own experience, I'd say "get them out." I broke my hip in a bike wreck and required three 10-cm screws My orthopod suggested that I have them taken out after about a year. I waited about 2 years (I was reluctant to go under the knife again). The very moment I came out of the anesthesia, I felt an improvement. There had been low-level pain the whole time I had those screws in that I just gotten used to. I was kicking myself for waiting so long to have them removed.

Then two years after that, I wrecked and fell on the same side. If those screws had still been there, well, I'd have been screwed. As it is, I've got 11 screws and a plate in my pelvis that my orthopod will not remove because they're in too deeply.
posted by adamrice at 8:14 AM on September 20, 2005

I've had a stainless steel plate and six screws in my upper arm for 19 years now. They had originally suggested removing them after a year, but implied that it would be no big deal to leave them in, so I have.

The original surgery (break repair) included a warning of a low (but finite) possibility of nerve damage causing loss of use of the hand, and most of the recovery time was involved in healing / physical therapy for the muscles cut to insert the plate (it's under my bicep, and they went through it to place it.) Not surprisingly, I wasn't in any hurry to deal with either issue again.

Due to the location the thing has never bothered me (after healing), and I've got full range of motion. I rarely (but sometimes) have set off metal detectors.

I'm guessing that unless something unexpected goes wrong, the plate will be with me from here out. After reading this I'm wondering about getting "Don't MRI" tattooed over it, though :-)
posted by nonliteral at 8:55 AM on September 20, 2005

In regards to my nerve damage, it basically consisted of some wierd tingling on the outside edge of my thumb, especially when I stroked it with a fingernail (not a common occurence mind you!). Also that was the slowest digit to work properly, it was a while before I could make a full fist. But that's all fine now.

While I do have some dull pain still like AdamRice had, I suspect that's in large part because the injury is only 4 months old.
posted by KirTakat at 10:12 AM on September 20, 2005

Am I missing something? Homemade implants?

See Tetsuo: The Iron Man.
< /derail>
posted by Aknaton at 10:32 AM on September 20, 2005

(Sorry elquien. Mostly joking but also referring to any metal that might have gotten in to your body by non-medical means. Think nails, projectiles.)
posted by Corpus Callosum at 11:52 AM on September 20, 2005

Okay, so I'm a latecomer to the thread, but given some particular familiarity with this I thought I'd chime in anyway. I've had many an opportunity to place various plates/screws/rods into people, and here's what I can tell you:

1) Most surgeons will not routinely take out hardware, unless there is a particular reason to take it out (reasons can include prominence of the hardware under the skin, movement of the hardware out of place, pain, or to rule out the hardware as a source of pain). As you yourself have pointed out keenly, it's a whole second operation with associated risks and recovery times. The important thing is that if you are not experiencing any problems with it, there is no reason why the plates can't stay in you forever. With plates for a so called both-bones forearm fracture, there is very little chance that there will be a problematic reason to remove them.

2) In all likelyhood, they are made of stainless steel (we use some specialized implants made of titanium, but the typical plates that should be used for this purpose are steel). Yes, steel is ferromagnetic, but no, it will not generally be a problem to get an MRI. Any MRI facility will ask you about having metal implants, but once you give the details of what you have, they will be okay with scanning you. You may feel some movement of your arm, or, more importantly, some warmth. But no plates will be ripping out of your body :-) Implants that preclude an MRI are a) brain aneurysm clips, b) cardiac stents, and c) pacemekers/defibrillators. The former two are because they are not very firmly fixed in place, and in locations where a slight bit of movement can kill you. The latter is because the device can malfunction with the magnet.

3) Likewise, airport security. Generally it's not enough metal to set the things off, but with "heightened security" and maybe upturned thresholds these days, I tell patients not to be surprised if it does happen. It's not a problem, since you'll have a very prominent matching scar to prove your "I had surgery on my arm" story is legit. Again, this is different than people with pacemakers/defibrillators--they can't go through metal detectors, because the device could malfunction.

4) Your healed-bone-and-steel-plate-combo is probably stronger that even the healthy bone was before it broke. There is not much worry that you would brake it "100 times worse" if you were to get into an accident again. (actually, from this standpoint taking the stuff out will leave behind weak points in the areas of the empty screw holes).

So there you have it. Longish answer, but the short of it is, leave 'em in. Every now and then we take hardware out not because they are problematic but because the patient really really wants them out and is psychologically not comfortable with the thought of having stuff left in them. But medically speaking, should be fine.
posted by Dr. Sam at 9:17 PM on October 29, 2005 [2 favorites]

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