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 (called the "hardware"), especially if the fracture is unstable or the joint surface has been damaged and for this hardware to be left in the body.
The role of the hardware is simply to stabilise the fracture in the correct position while it heals. 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.
For some types of injuries and operations the hardware is put in on a temporary basis with the intention of removing it within a number of weeks or months (depending on the progress of the injury).
Until some years ago the hardware was routinely removed once the fracture had healed. Then physicians recognised that it is not always straightforward to remove hardware, especially from the forearm bones (radius and ulna). 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. Moreover, it was found generally, that if the hardware is left in, no real problems seemed to occur, and therefore it has become less common to remove the hardware.
The decision to remove any hardware therefore is made on a case by case basis.
As a general rule, the hardware should be removed if it is causing discomfort. In some cases, the hardware irritates the adjacent soft tissues, 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).
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 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 the plate and screws 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.
- 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.