Broken ankle hardware: take it out or leave it be?

August 14, 2023 9:47 AM

Should I have surgery to remove the plate & pins from my ankle? My Doctor is not sure it's necessary but it's been over a year & I'm still having trouble running.

I broke my ankle (real bad tri-malleolar) at the end of May 2022 (bouldering). I like my Doctor lots & she will do the hardware removal if I decide to (I've got a a pin in the medial malleolus & a big plate & many pins on the fibula). I'd rather not have surgery again! But I am still having trouble with pain when walking long distances and running. I'm not a super serious runner, no more than 3 miles at a time every few days, but the pain when running is bad enough to have messed up my gait & cause occasional knee pain on the opposite side. I do think think that I am still improving! Just at a glacially slow pace.
There's some complicating factors which are: when I describe what I'm feeling to my Doctor, she says it doesn't sound like pain due to the hardware. I can't really go get a second opinion (I'm on medicaid cause I'm broke) and my financial situation is precarious enough that it would probably be better to get this taken care of now, when I do have access to health care, than to put if off until sometime in the future.
I'd welcome any advice or personal stories about the experience of having hardware removed! Should I get this done even if it might not help? I'd like to be able to go on long hikes and have less unpleasant runs someday!

posted by velebita to Health & Fitness (16 answers total)

I had huge improvements from hardware removal in my foot and ankle. My doctor wasn’t sure the hardware was causing the problems either, but I now have greatly reduced pain, improved gait, and improved range of motion.
posted by wheatlets at 9:52 AM on August 14, 2023 [2 favorites]

I haven't had a broken ankle, but I have had a broken hip. My doctor told me I could have the hardware taken out after 18 months IIRC; I wasn't eager to go under the knife again and wound up waiting an extra 6 months.

It was worth it. I'd had low-level pain that had just become part of the background noise of daily life. Running more than a block or two had been painful. Literally the instant I woke up from anesthesia, I thought to myself "oh god, that's so much better."

I will mention that there was some scarring of my muscles around the incision that pulled my knee out of alignment, so running was still a problem afterward, but I was able to resolve this with some very intense deep-tissue massage.
posted by adamrice at 9:56 AM on August 14, 2023

I know a lady who broke her ankle (spectacularly! complex fracture! surgical repair!) and, because she was under 45? (or so... don't recall exactly, but certainly under 50) the doctor gave her ~18mos to recover from the surgery to put the hardware in, and then pulled the hardware out. It wasn't even really a discussion; the thinking as I understood it was "you're plenty young, you've got plenty of living to do, there's no reason to leave this hardware in place."

So I don't know if the thinking has changed in a long time, but in the late 90s, it was apparently unthinkable for a reasonably young, reasonably healthy person to be expected to cart hardware around for decades. The doctor was explicit that an older patient would get to keep the hardware in; the risk of surgery + the lack of (say) bouldering activity for a 60+yo would've bade it a no brainer.
posted by adekllny at 10:00 AM on August 14, 2023

I badly broke mine (tib/fib and dislocated) and got the hardware out a year later due to not being able to wear boots or any shoes higher than the site because anything touching the screws caused pain. I don’t remember if I had pain on walking or running, but I did have restricted range of motion and they thought taking the hardware out would probably help that too. Ten years on I don’t have any pain but I do still have some restrictions in my range of motion. I suspect that’s more down to not doing the physio exercises properly.

A fairly major annoyance was that I was expecting to be able to walk out post surgery but they found a damaged tendon that needed stitching back together and I woke up to find I was going to be back in plaster/on crutches for another few weeks. Also day surgery sucks.
posted by corvine at 10:49 AM on August 14, 2023

Climber here. My experience + a bunch of friends' experiences all point to YES.

My spinal hardware is in to stay. But my foot stuff came out -- turns out one screw was sticking into a nerve, keeping me from bending my big toe. Another plate was in my peroneal retinaculum, which ended up having to be repaired later, but I wouldn't have known that with the plate there, couldn't fully pronate or supinate with it. Another screw was under my heel, and I "shouldn't" have felt it but I sure did!

100% better once out.
posted by Dashy at 11:00 AM on August 14, 2023 [2 favorites]

Clinicians are always conservative about doing any surgery unless it is absolutely needed, because there are risks. They need you to basically insist on having the procedure so they can skirt any liability claims for giving bad advice should it go wrong.
But if you are still having issues after 1 year, they are unlikely to get better on their own and may get worse.
Better to get the hardware out now, while you are still young than to wait 10 years and end up doing it anyway.
posted by Lanark at 11:38 AM on August 14, 2023 [2 favorites]

Do it. My anecdote is that Kid Blah had a major leg injury with hardware, and like you he recovered but not quite fully. He did have the hardware removal surgery, and he then made some additional recovery that was quite helpful. However in his case he has never (in 5+ years) been able to get back to 100%. Let's call it 98%, and we'll take it.
posted by BlahLaLa at 12:09 PM on August 14, 2023

I broke my ankle basically same as you (bilateral malleolus fractures, two plates) in 2020 right before COVID, and because of COVID, waited until I was vaccinated to consider hardware removal surgery even though I was in considerable pain and having episodes where the joint would buckle when putting weight on it even though my X-rays and bone healing looked perfect. I am small and the hardware is quite large on me in relation to my body and it was rubbing a tendon and possibly damaged the tendon more by waiting. I had the same experience as everyone else here of nearly instant improvement and relief once they took the plate out on the bad side. The removal surgery was way less of a big deal than the first surgery and I was only off my feet for two or three days instead of weeks. I say get it out.
posted by slow graffiti at 1:48 PM on August 14, 2023

I had a tib-fib-ankle fracture in 2010, fixed with a bunch of screws in the ankle and an IM rod through the tibia. They took most of the screws out after a year and it helped so much with ankle mobility, but I had lasting heaviness and a dull pain in my leg that lingered. I was told the IM rod couldn't come out but finally found a cowboy doc willing to do it, 7 years after it was initially inserted. It was the BEST decision. Healing was quick, and all the weird sensations I had felt were finally gone. Highly recommend doing it if you're even thinking about it. I wish I had done it sooner.
posted by mcgsa at 2:07 PM on August 14, 2023

Another to add to the chorus of yes, remove. Broke my tib-fib in 25+ places in 2008. Titanium rod IM + 4 screws. The surgeon insisted my pain wasn't from hardware, pointed to the place on the x-ray where he said he saw proof the hardware wasn't touching anything. But said he'd remove it if I wanted him to. I did want him to. And he did remove it. And there was much rejoicing. No pain whatsoever from that day forward. Best news: Hardware removal incisions had an extremely fast healing time. It was basically just a couple of cuts that had to heal up, with glue, no stitches.
posted by ImproviseOrDie at 2:32 PM on August 14, 2023

When I broke my tib/fib and got screwed back together, it was the hardware in the knee that was the worst. Didn't really notice the ankle unless I struck it against something. But life was MUCH better with all the metal out (around 18 months later, like most others in-thread).
posted by Pallas Athena at 2:55 PM on August 14, 2023

I have a screw in my knee. It hurt a lot for the first couple years - it felt like a ligament was getting caught on the screw head and twanging off it like a very painful rubber band. But I kept the screw in because I didn't have time to remove it, and a couple decades later, it doesn't hurt and I don't ever think about it. The twanging stopped after a year, I assume my body built up some protective tissue in there somewhere.
posted by nouvelle-personne at 3:34 PM on August 14, 2023

I had a tri-mal fracture +dislocation of my right ankle about 8 years ago. I have NOT had my hardware removed. The thought of removing it makes me queasy. I'm not a runner; I walk a few miles a day. Haven't really had a problem but do have some occasional pain which I challenge up to arthritis in that ankle.

To me it seems like an iffy idea - it might help, it might not. I'd have to have definitive proof that the hardware was causing the problem before I'd consider further surgery on my ankle. The people above who are saying "it worked" all have different circumstances so I don't know that I'd rely on those opinions. Not a very helpful response but as a fellow tri-mal ankle sufferer, I wish you all the best!
posted by mulcahy at 7:21 PM on August 14, 2023

If you'd like a second opinion, call your Medicaid plan provider's Member Services line; many plans do cover a second (in-network) evaluation.
posted by Iris Gambol at 7:32 PM on August 14, 2023

Not me, but my partner would say, "Yes!

Spiral tib-fib fracture, lots of discomfort from the hardware (IM nail, plate and some extra screws in and around her ankle) had similar inconclusive consults until she talked to another surgeon who recognized that she is active and recommended having it out. The removal surgery & recovery was trivial compared to the initial install, and it can be scheduled for a time that's more convenient than when you had it put in!

According to the surgeon she consulted with, risks of not getting it out include accelerated osteoporosis due to the hardware taking some of the load on your bones that generally promotes bone growth, and also acting as a stress riser that can cause a fracture in the future at the end of the plate or rod.

Recovery time for the second surgery was in the order of a few weeks contrasted with a few months for the repair after initial fracture. Boots fit better, flexibility improved, much discomfort was removed, overall no regrets.
posted by snoboy at 10:12 PM on August 14, 2023

Response by poster: Thank you everyone for all the anecdotes & support! I am happy to report that I am now 2 weeks post hardware removal and I feel so much better already. The surgery was really quite easy & I didn't need any painkillers more serious than ibuprofen afterwards, and I was walking (slowly) without crutches by the next day. I admit I was kinda dubious about the people who said they felt better immediately after surgery but it's true! Every morning for the last year I'd wake up & stretch & have to work past this bad stiff feeling in my ankle & the morning after surgery it was gone for good. And when I go outside in the cold there's no more random aches from the metal. I have to wait a month before I can start running again but otherwise I'm feeling great and am very glad that I took your collective advice.
posted by velebita at 11:47 AM on November 24, 2023 [3 favorites]