Should I have implanted metal removed after my fracture has healed?

Question: Should I have implanted metal removed after my fracture has healed?

Answer: Implanted metal can help broken bones heal properly. While these implants do not help the bone heal faster, they can help to hold bones in the proper position while healing takes place. Implants may include:

• Metal plates and screws

• Pins

• Intramedullary Rods

Do metallic implants need to be removed?
In most cases it is not necessary for implants to be removed. There are some exceptions where your doctor may recommend an implant removal. For example, some doctors recommend removal of syndesmotic screws (for high ankle sprains) before weight-bearing is resumed.

However, in most cases, implants can stay in the body without causing problems, and the removal of an implant should not be considered a "routine" part of treatment.

Why are metal implants sometimes removed?
In some patients, metal implants can cause irritation to surrounding tissues. This may cause bursitis, tendonitis, or local irritation. In these cases, removal of the metal may relieve this irritation.

Will the removal of a metal implant make symptoms go away?
This is very difficult to predict. In patients who have pain that is clearly coming from irritation caused by the metal, the chance of pain reduction is much more likely. If the pain is more generalized, and not clearly an irritation, the chance of pain resolution with metal removal is more difficult to predict.

Can problems arise with the metal removal?
Yes. There are potential complications of this type of surgery. The most common problem is metal removal can be quite difficult, especially with deep implants that have been in place a long time. Furthermore, removing the implant can lead to weakening of the bone where the implant was removed. For example, fractures through holes where screws were implanted are not uncommon. Discuss with your doctor the potential problems associated with implant removal.

So what's the bottom line? Should I have the metal removed?
If you are having symptoms caused by metal irritation, then removal of the implant may be helpful. Your doctor can help you determine the chance that metal removal will alleviate your symptoms, as this needs to be evaluated on a case by case basis.

_Sources:

Busam ML, et al. "Hardware removal: indications and expectations" J Am Acad Orthop Surg. 2006 Feb;14(2):113-20.

Brown OL, et al. "Incidence of hardware-related pain and its effect on functional outcomes after open reduction and internal fixation of ankle fractures." J Orthop Trauma. 2001 May;15(4):271-4.