Hardware removal after tibial plateau fracture (tpf)

Hi,

I had a bad tibia plateau fracture and 6 months later I got an infection. I had emergency surgery to remove the infection by the skin. They cultured the plate and while not seen, the culture came back positive.

I have 1 plate and 8 screws that need to be removed because of infection.

What is the reality of recovery after hardware removal? My surgeon says I can walk that day. My physical therapist says, I will be 2 weeks partial weight bearing and no driving due to pain.

@blaira I had a bad ankle fracture 4 years ago, and I had my titanium hardware removed. I had pain all the time like someone was kicking me in the shins, it was developing pigment on my skin over the area and I had massive chronic hives. All that resolved after the hardware was removed. It's another surgery, but not as bad as an initial injury surgery, and I could walk after ward. I was warned about fracture risk because of the holes left by the screw tracks and I had to take it easy.

I did find a few links about metal sensitivity which is described as environmental exposure.

Metal Allergy: State-of-the-Art Mechanisms, Biomarkers, Hypersensitivity to Implants
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9739320/
Titanium and Other Metal Hypersensitivity Diagnosed by MELISA® Test: Follow-Up Study
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8192180/
Metal allergy--a review on exposures, penetration, genetics, prevalence, and clinical implications
https://pubmed.ncbi.nlm.nih.gov/19831422/
I'm sorry for what you've been gong through. Getting an infection around any surgical hardware can be serious and involve a lot of further surgeries to clear an infection. I hope you get the healing your looking for.

Thank you for sharing your story and resources. I am hopeful that removing the hardware will help the pain and inflammation and infection.

My surgeon said he may need to use antibiotic cement if my bone is not healed enough. Do you know about intolerance to this surgical material?

Thank you,
Amy

@cockatoolady What advice is your surgeon giving you about an unhealed surgical wound and the screw near your knee? Sometimes there can be an infection if something doesn't heal. If that is the case, they may have to do further surgery.

Hi, thankyou for your input. My surgeon thinks the plate could be inhibiting blood flow to the wound. He now wants to remove the plate. I have had 3 surgeries cancelled due to wound. It is now 9 mths. They also now think l have attracted an irritation or type of dermatitis from the sticky plasters of the many, many dressings l have had and l think they are spot on. I have now left the wound uncovered with no ointments or gels and it seems to be healing albeit very slow. When l was soaking it and putting gels on ,one day it would look good the next l had broken out in little cuts and red dots and the redness was spreading. Blood tests showed l had no infection so something other than the plate was causing the wound to continually flare up. I am still having the plate removed instead of screws l just don't know when. I admit l am scared but l think l need to bite the bullet. That's my story at the moment.

@cockatoolady Recovery after surgery to remove hardware should be a lot easier than recovery after fracture fixation surgery. I'm not sure what you meant by "instead of screws". Wouldn't the surgeon remove both plates and screws? It sounds like the path to better healing. I know in my case, my body does not like metals and I react. That caused pain like I was getting kicked all the time, pigment forming on my skin and chronic hives. Removing the hardware got me back to my ankle being more normal, not perfect because of the injury, but I'm not reminded all the time about it. I was even able to do some mountain hiking.

Hello Jennifer, sorry l was originally getting 2 screws out but the
surgeon has decided the plate really needs to come out now so when they do
that he'll remove all the screws (10). The wound is still the issue so
until they can clear it up l will not be having any surgery done. I have
another plate as well with 4 screws but that one can never come out. It's
an on going saga with me and the wound and l am so over it. Thanks for
answering.

@cockatoolady Have you seen a wound specialist? They can work with you on repeated visits and commonly do this at nursing homes for elderly patients. I'm wondering if something like electrical stimulation with a TENS unit could increase circulation to help in wound healing?

Hi Jennifer, do you know after months of just dressing this wound they got onto a Dermatologist who has suggested l use the steroid cream at night and a moisturising cream for dermatitis thru the day for this week then they'll review it again. To be honest no one knows what the problem is. I can't use a tens machine due to the metal in my leg. It's a catch 22 situation as the plate is some of the problem but the plate can't come out with the wound the way it is and it just doesn't want to heal. I am supposed to go back this week but no notification of what day. Thanks for your input.