Do metal plates and screws need to be removed from the bone after a fracture has healed?
Guy Slowik FRCS, Orthopaedic Surgeon
It is common now for broken bones (fractures) to be fixed with metal plates and screws or a long nail, especially if the fracture is unstable or the joint surface has been damaged, and for this hardware to be left in the body.
Using metal plates and screws, or a long nail, allows the bone after a fracture to be restored to an optimal position, anatomical if possible, back out to normal length, normally aligned, and to be held rigidly in a stable position while the bone healing occurs.
The role of the hardware therefore is simply to stabilise the fracture in the correct position while it heals.
Normally, it takes about 6 weeks for fractures of the upper limbs to heal and about 12 weeks for lower limb fractures to heal. Sometimes, depending on the mechanism of the injury and nature of the fracture, it may take considerably longer.
Once the fracture has healed, the hardware has done its job. It is no longer really needed.
But it's not always necessary to remove the hardware.
Until some years ago the hardware was routinely removed once the fracture had healed.
Then Orthopedic Surgeons recognised that it is not always straightforward to remove hardware, especially from the upper arm (humerus) and forearm bones (radius and ulna).
They began to realise that significant complications can occur following removal of the hardware. Some of these complications can be serious. For example, nearby nerves could be injured during the removal of the hardware due to scarring from the original injury. If such a nerve injury occurred it could potentially be far worse than the original bone injury!
Moreover, it was found generally, that if the hardware is left in position, mostly, no real problems seemed to occur.
Therefore it has become less common to remove the hardware.
Sometimes, the presence of the hardware may irritate the surrounding soft tissue causing discomfort. For others cold weather may be problematic (though this tends to settle within a few years)
The decision to remove any hardware therefore is made on a case by case basis.
As a general rule, the hardware will be removed if it is causing discomfort.
However, you should not assume that all discomfort or pain in the region of the original fracture stems from the hardware. There may be other causes. The hardware should be removed only if the surgeon is satisfied that your symptoms are probably due to the presence of the hardware causing irritation and other possible causes have been excluded (and the fracture is healed).
The hardware must of course be removed if it is obviously causing a problem for example because it has become loose, or is associated with infection
In addition, the hardware should be removed in:
- Children and teenagers: In children and teenagers the metalware is usually removed
- Active athletes: There is a small potential risk of a new bone fracture occuring at the tip of a metal plate, where the plate ends on the bone –as this is a possible area of weakness of the bone. A fracture in this area is called a "peri-implant fracture". In active athletes therefore, even without symptoms, a good case can be made to remove the hardware to lower the possible risk of a further fracture occuring at some time in the future. Not all orthopaedic surgeons would agree that this is a good enough reason to remove the hardware.
If you decide to have your plate and screws or intramedullary rod removed:
- It is preferable to wait until 18 months after the fracture has healed before removing the hardware. This allows enough time for the bone to recover to its normal pre-fracture strength.
- Your symptoms may disappear completely after the hardware is removed. But they may not disappear fully. This suggests that it was not the hardware that was causing the problem.
- After removal of the hardware wait at least 12 weeks before participating in contact sports. A further fracture can occur through the screw holes. It takes a number of months for the bone where the plate was removed to regain its strength.
Bottom line therefore to the question (in an adult) as to whether to remove the hardware once the fracture has healed:
No. - If it is not causing any problems at all.
Yes. - If it is causing painful symptoms due to irritating the adjacent soft tissues, if the metal is loose, or if there is an infection at the fracture site.