Removal of plate and screws from tibia fracture

Thanks everyone! Update: I went back to my doctor and X-rays were done. My break has healed well and he said the plate and screws could come out. Turns out I have 15 screws not 8. There are 9 in my ankle alone. I have surgery on Feb 19 and was told that I would go straight into a walking boot for about a 3 week recovery time. The downside is I was told I more than likely will eventually have to have an ankle replacement. I’m praying that is not the case. I’ll give an update after surgery and recovery.

I had a comminuted spiral fracture of the right tibia/fibula back in 2005. It damaged my tendons and muscles in my lower leg and I suffered nerve damage when they cut a significant nerve branch along the front of my leg near the ankle. I have lived in pain every day since then, I am in a pain management program (which now with the opioid crisis is a nightmare) and I am talking with the pain management doctor about possibly removing the plates. I have two - a twelve inch plate on the tibia and a 6 inch plate on the fibula with a 4 inch piece of cadaver bone to replace the bones that were too badly damaged to be repaired.

I never thought about having them removed because I thought insurance wouldn't cover it. The cautionary tale on this is that my leg would be as if I just broke it again with the holes through the bones,etc. What are the percentages for someone like me to have the pain reduced or gone so I am not taking opioids? Is it worth the 3 months of down time (guestimate based on the recovery from before)? I know the nerve damage is permanent but that's the least of my issues. Has anyone had their insurance company fight the surgery?

A lot of you know me from other discussions on Connect, and I'm joining you here because in a recent injury, I dislocated and broke my ankle, both the tibia in 3 places, and the fibula which was open and broken through the skin. The first surgical procedure placed external fixation with 2 pins that were screwed into the front of my shin (tibia) and 1 pin that passed transversely through my heel bone with external rods that connected it all together with a frame. That was a difficult thing to live with, and the external fixation was recently removed in a surgery at Mayo. Now I have 2 small titanium plates screwed on my tibia, and a screw placed internally into the fibula. I am still in my first splint/cast and on my next visit will have the stitches removed. I am at the beginning of what will be a long journey in recovery. With all the incisions and wounds, no matter which way I turn my leg, the cast will rest on a tender spot. This has been very painful, and I don't do well on pain medicine, but I have reached a tolerance level for pain and weaned off the pain medicine in the last several days. On my X rays, I see the holes left by the pins that had pierced my bones, and I know my body will heal these and fill in the bone. I've learned what is is to be disabled and have to think about how I can get from one place to another which is difficult. At least now, I don't have the immediate pain from lowering my leg out of an elevated position when I need to hobble around with the walker. I've learned to slow down and rest. When I need to stand at the sink, it helps me to have a canvas folding stool, so I can put my knee into it and be balanced against the normal leg. I also have added some webbing straps to a walker, so I can use my knee in the same way and take some pressure off my arms and hands. It helps to be a patient person, and there is no other choice because all I can do is wait for my body to heal and do my best to help that happen.

Hello @jenniferhunter

I appreciate your post on two levels. The first is an update on your injury and surgeries, but also sharing with us your philosophy about patience.

You have really found accommodations for your current physical injuries. I find it especially interesting that you, "added some webbing straps to a walker, so I can use my knee in the same way and take some pressure off my arms and hands." I'm trying to picture this. Can you provide a few more details as to where the webbing straps are attached to the walker?

@lisaferret, I see you that first posted about the removal of the plates that were put in when you were injured. I was just wondering what your final decision on that. Were you able to have them removed? How are you feeling now?

@cgavin61, Did you have your surgery in February to remove some of the hardware that was used after your injury? If so, how is your recovery coming along? Does your doctor still think you will need an ankle replacement?

@hopeful33250 Here is the webbing sling I added to make this walker easier to use. It is a tie down strap that you can get at a hardware store that has a secure clasp that locks the webbing. I looped it through several times and secured the clip. This lets me move more like walking instead of hopping off one foot. I can swing the good leg through without having to hop off of it to advance. I find that my good leg and hip tire very easily from having to bear all the weight constantly, and this helps me be better balanced. I can also prop my foot up on the sling when I sit on the couch.

Thanks for the picture, @jenniferhunter! This looks great. You have the mind of an engineer.

@hopeful33250 Thanks Teresa. I guess I learned that from my dad. He was an engineer and he built things in his wood shop.

@jenniferhunter - I agree that it is a genius mod! Wish I had thought of that while not weight bearing for a year!

I too am at the crossroads and need to make a decision. I suffered an open segmented fracture on my right tibia following a car crash and got a plate and screws on the knee and the ankle. I also had a muscle flap created where I lost a big part of the flesh and muscle on my shin and calf.

There were two main tibia fractures - one has healed and the other is a bit more stubborn. Doc inserted two screws on fracture to incite growth and it is showing some spot welding but has yet to heal. After three years my doctor doesn’t think the second fracture will ever heal but that the plate is holding just fine and that there is no risk of it breaking. I experience a lot of pain on my ankle and knee and would love the plate to be removed so I can have less pain and more mobility. But it is a complicated case - my flap could fail if during the removal of the plateits blood supply is disrupted. If the flap fails, I could lose the leg altogether. It is a small chance though. My surgeon thinks a smaller compression plate and another bone graft could finally heal the broken tibia segment (80% chance).

Surgeon won’t give me a recommendation though. He just says it is my leg and I only know the pain and if it is worth going through all this. I have been going back and forth for months and still can’t make up my mind. My pain is much worse during winter and I am sort of back to active but it took me two and half years to get there. Now I am looking at possibly six months of healing time and pain ahead of me.

This forum is useful to know what others have been through and whether they think getting metalwear out is worth it. Although in my case I would just be switching from a plate to a compression plate. Forgot to ask what the difference was (I get so upset during appointments I forget to ask pertinent questions).

@cynometra You have a complex case, and it may be worth another opinion. That being said, I was surprised to find out what is possible when I listened to a Mayo radio podcast that interviewed my orthopedic trauma surgeon, Dr. Sems. He talked about a case of failed healing of a fracture that caused over 3 inches of a leg bone to die and the patient was facing loosing the leg, but was advised to go to Mayo. Dr. Sems used an external fixator that the patient adjusted every day that allowed her to regrow that 3 inches of bone and heal her leg. Bone remodels because of pressure and the fixator is screwed into the bone and encircles the leg. The patient adjusted a small increment everyday which "stretched" the bone and it expanded. It was a long process over months and included some surgical procedures, but she healed and recovered. I started with a fixator on my leg right after the injury which was painful, and I can only imagine the pain of adjusting one every day, but the patient had a goal and it was worth it. If you can come to Mayo, you might get some other options. They also have a regenerative medicine research group and it may be worth asking about that too. With my fracture, it fractured into the ankle joint space and I've been told to expect post traumatic arthritis and wishing I could prevent that, so it might be worth my asking about it. Here's a link about the research.
https://www.mayo.edu/research/centers-programs/center-regenerative-medicine/focus-areas/musculoskeletal-regeneration