Do Metal Plates and Screws Need to Be Removed from the Bone After a Fracture Has Healed?

When you’ve undergone surgery to repair a fracture, metal plates, screws, or rods may have been used to help stabilize and support the bone while it heals. Once the bone is healed, most patients wonder whether the hardware needs to be removed. In many cases, it’s safe to leave the metal in the body unless it causes discomfort or other complications.

However, deciding whether to remove the hardware is a personal choice and can depend on factors such as symptoms, the location of the hardware, and your surgeon’s recommendation. This article will explore the reasons for and against hardware removal, the surgical process involved, and potential complications to consider.

Is it Safe to Leave Metal Plates and Screws in the Body?

Before we consider whether to remove or leave hardware, we need to know whether it’s actually safe to leave hardware in the body forever. The short answer is yes—metal plates and screws are designed to be biocompatible and generally safe to leave in the body without causing harm. Orthopedic implants are typically made from stainless steel, titanium, or other non-corrosive materials that won’t degrade inside the body.

In some cases, leaving the hardware in the body is preferable, particularly if there are no symptoms like pain, irritation, or infection. Most patients go on to live normal lives with hardware in place without any negative effects.However, in other cases, the hardware may need to be removed if it causes issues such as pain, discomfort, or limited mobility.

Reasons for Hardware Removal

There are several reasons why your surgeon may recommend hardware removal, even if the bone has fully healed. Common reasons include:

1. Pain or Discomfort: If you experience persistent pain at the site of the implant, it may be a sign that the hardware is irritating surrounding tissue, causing discomfort.
2. Soft Tissue Irritation: The metal hardware can sometimes irritate surrounding muscles, tendons, or other soft tissues, potentially leading to impaired mobility.
3. Infection: In rare cases, the hardware may become infected, requiring removal to prevent the spread of infection.
4. Allergic Reactions: Some patients may develop an allergic reaction to the metal used in the hardware, leading to the need for removal.
5. Fracture Around the Hardware: Occasionally, fractures occur around the hardware itself, and removal may be necessary to allow the bone to heal properly.
6. Patient Preference: Some individuals simply prefer to have the hardware removed for personal reasons, even if it is not causing any problems.

Potential Complications of Hardware Removal Surgery

While hardware removal surgery is generally safe, it is still a surgical procedure and comes with potential risks and complications. Although these complications are rare, they should be taken into consideration when deciding whether to proceed with the surgery. Based on available studies, the likelihood of each complication occurring is generally low, but they do remain possibilities:

1. Infection: Less than 2% of patients experience infections after hardware removal surgery.
2. DVT (Deep Vein Thrombosis): The risk of DVT is typically below 1%, but increases depending on patient immobility or preexisting conditions.
3. Nerve Damage: Occurs in approximately 1-2% of cases, especially in areas with significant scar tissue or near major nerves.
4. Pain and Swelling: Temporary discomfort occurs in about 10-15% of patients but usually resolves quickly with proper postoperative care.
5. Fracture Recurrence: Very rare, occurring in less than 1% of cases, though higher in cases where the bone has not fully regained strength.
6. Scarring: While all patients will experience some level of scarring, problematic or severe scarring occurs in a small percentage, often under 5%.
7. Bleeding and Hematoma: The risk of significant bleeding or hematoma formation is below 1%.
8. Delayed Healing (if not fully healed): For some patients, bone healing after hardware removal can be slower than expected. This might occur in cases where the bone has not fully healed before removal or if there are underlying health conditions affecting the healing process.

Additionally, the location of the hardware plays a significant role in the complexity of removal. In some areas, such as the forearm, removing hardware can be more challenging due to extensive scarring and the proximity of nerves. Identifying and preserving the nerves during surgery can be difficult, increasing the risk of nerve injury. On the other hand, hardware located in areas like the clavicle, which is just beneath the skin, tends to be easier to remove with fewer complications.

It’s important to ensure that the bone has fully healed before hardware removal is considered, as removing hardware from an unhealed or partially healed bone can lead to re-fracture or other complications.

What’s Involved?

Hardware removal surgery involves reopening the original incision (or making a new one if necessary) to access and remove the screws, plates, or rods. The procedure is typically done under local or general anesthesia, and in most cases, the patient is discharged the same day. The length of the procedure depends on the size, number, and location of the hardware being removed, but it is generally treated as a day-case procedure.

While the surgery is often straightforward, some cases—particularly those involving deep implants or hardware embedded near nerves or tendons—can be more complex. Your surgeon will discuss the risks and benefits with you beforehand, taking into account your specific situation.

Recovery After Hardware Removal

Postoperative care following hardware removal is similar to that following the initial surgery. You’ll likely experience some pain, swelling, and discomfort around the incision site. Pain can typically be managed with medications, and most patients can return to light activities within a few days.

You’ll need to follow your surgeon’s postoperative instructions closely to ensure a smooth recovery and minimize the risk of complications. Physical therapy may also be recommended to help restore movement and strength in the affected area.

Returning to Activities

After hardware removal, it’s essential to ease back into your daily routine to prevent complications. Recovery timelines can vary depending on the extent of your surgery and the location of the hardware.

Returning to Work

The time you’ll need to return to work depends largely on the type of work you do:

• Sedentary Work: If you have a desk job or other sedentary work, you may be able to return within one to two weeks, assuming there are no complications. Your surgeon will likely recommend taking short breaks throughout the day to avoid stiffness or discomfort.
• Active Work: If your job involves physical labor, heavy lifting, or extended periods of standing or walking, your return to work may take longer. Typically, you’ll need to wait at least four to six weeks before resuming active duties. In some cases, particularly if the hardware was located in a weight-bearing bone, you may need clearance from your surgeon before returning to full activity.

Returning to Sport

When it comes to returning to sports, particularly high-impact or contact sports, a gradual approach is critical:

• Non-Contact Sports: Activities such as swimming, cycling, and running may be resumed sooner, usually within six to eight weeks after surgery. Your surgeon will advise you based on your healing progress.
• Contact Sports: For more physically demanding or contact-heavy sports like football, rugby, or martial arts, you’ll need to wait at least 8 to 12 weeks to allow full healing. It’s important to avoid re-injuring the area, and your surgeon may recommend using protective gear during your return to sports.

Returning to the Gym

After hardware removal, your gym routine should be resumed cautiously, with a focus on light exercises and gradually increasing intensity:

• Cardio and Light Weights: Within the first six weeks, light cardio exercises such as walking on a treadmill or using a stationary bike can be started. Light weights and resistance exercises that do not put stress on the affected area can also be introduced.
• Strength Training: For those focused on strength training, it’s important to avoid lifting heavy weights too soon. Your surgeon or physical therapist may recommend waiting at least 8 weeks before incorporating heavy lifting into your routine. It’s crucial to pay attention to your body and avoid exercises that cause pain or discomfort.

Should I have the hardware removed?

Before making a decision about hardware removal, it’s essential to weigh the risks and benefits. If the hardware is not causing any irritation or problems, it’s usually left in place. However, some patients simply prefer to have it removed, and the surgeon may agree to do so. It’s also important to consider that in some cases, removal can be challenging or risky. For example, hardware in areas such as the forearm may be difficult to remove due to significant post-surgical scarring, and nerve damage could occur.

In such cases, unless there is a good reason to remove the hardware, it may be better to leave it in place, particularly if the surgeon advises against removal.