Removal of plate and screws from tibia fracture

@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).

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.

I thought I would give an update on my ankle fracture. I got a fiberglass cast for 4 weeks after the splint/cast was removed. At that time the stitches were removed and that felt a bit better because they were no longer being pulled on by the cotton liner inside the cast. There was a bit of swelling and the first few days in a hard cast were the worst. I would have ankle pain and some pain and numbness in my toes on the pinky side and all I could do was elevate my foot and use pain drugs. It got easier as the swelling got better, and because my leg muscles got smaller from non use. Last week, I was happy to have the cast removed and now have a Aircast walking boot. I am supposed to put a little weight on my foot and gradually increase it. That is easier said than done. If I increase the weight, I have a lot of pain and it can last an hour or more after I stop and elevate my foot. The incisions still hurt and are very tender to the touch. I still have swelling and the ligaments hurt on the side of my foot when I move it. I am supposed to be working on getting back the range of motion. My calf muscle just hangs there and is pretty small, but today is the first day that I can see some movement in it when I flex it. I've been calling this my bird leg. Last night, I tried some myofascial release to try to help loosen the tightness of the incisions and scar tissue and I think it helped because today there is visibly less swelling and I am starting to see the normal shape on the top of my foot where all the tendons head toward my toes. Another big improvement is that I have been able to walk up and down stairs by leaning a lot on the handrails and no longer have to sit and scoot to do this. My foot does turn purple and blotchy in a downward position and elevating it clears that, and I think the degree of this is improving too. My next followup will be a 3 month post op appointment.

@jenniferhunter Oh, you poor girl, I know this is not a part of our problem, but this is my granddaughter with her long hair, she will be 9 August 14th, on my birthday. I'm sorry I just learned how to put pictures on a post.
You are having more trouble than I am after my 9 hour surgery. I feel so bad for you. It must be really painful. I know my daughter had a cast on for a broken arm by her wrist growth plate that they were concerned about. Anyway, I know about the swelling hers got unbearable and they cut it to loosen it and wrapped it with stretchy wrap. We were in Iowa when it happened, but lived in Seattle at that time. Anyway, her cast fell off after the swelling came down and I just put it back on. I hope this gives you a laugh, because you could sure use one.
I am so sorry you are having so much pain and trying to walk. You are worse that the back fusion surgery I had, I am off all pain pills and wear my brace and try not to bend, twist, or lift anything over 7 pounds. So I know how hard it can be to get back on your feet. I will think and pray that your foot and all the parts of it will heal so you can have less pain. Don't be scared to use your pain pills you need them at this time. Let us know how you get along.

@jenniferhunter Oh, you poor girl, I know this is not a part of our problem, but this is my granddaughter with her long hair, she will be 9 August 14th, on my birthday. I'm sorry I just learned how to put pictures on a post.
You are having more trouble than I am after my 9 hour surgery. I feel so bad for you. It must be really painful. I know my daughter had a cast on for a broken arm by her wrist growth plate that they were concerned about. Anyway, I know about the swelling hers got unbearable and they cut it to loosen it and wrapped it with stretchy wrap. We were in Iowa when it happened, but lived in Seattle at that time. Anyway, her cast fell off after the swelling came down and I just put it back on. I hope this gives you a laugh, because you could sure use one.
I am so sorry you are having so much pain and trying to walk. You are worse that the back fusion surgery I had, I am off all pain pills and wear my brace and try not to bend, twist, or lift anything over 7 pounds. So I know how hard it can be to get back on your feet. I will think and pray that your foot and all the parts of it will heal so you can have less pain. Don't be scared to use your pain pills you need them at this time. Let us know how you get along.

@lilypaws Thanks. The days do pass slowly when efforts are great. I have come a long way, but have a long way yet to go. After I walked down the stairs this morning, my ankle ached for an hour an a half. Maybe this will signal depositing more bone and in time that will stop it from hurting from pressure. Today my feet look about the same size, so that is progress.

I think I've figured out some of the problem on why I have so much pain after a little bit of weight bearing in the boot. The weight of the Aircast cam boot is resting on my injury and hanging on my foot with every step. I have my surgery incisions on both sides of the ankle, and the tibia on the front of the ankle was in pieces, more than I had realized. The boot has 3 points where velcro straps secure it; on the top of the foot, just above the ankle, and at the top of the boot. The weight of the boot is resting on my ankle because that is where the ankle flares out and the angle changes from my leg. It has an air pump that snugs it up by putting some air at the back behind the ankle, and the air puts pressure there and pushes the ankle forward against the boot where it is very sensitive to touch especially where the plates are. I feel best with no boot and my foot elevated on the couch. I tested to see if I had the same pain after standing up without the boot using just my orthotics for support, and that wasn't bad. I had some discomfort, but not the same degree of pain. I also have a sprain that has been healing along with the fracture, and moving does make the ligaments hurt, so that has been part of the pain too. I did also try on my athletic shoe with the orthotics and got my foot into it. It is still a bit tight, but I was able to stand and transfer weight from foot to foot and not cause a lot of pain doing that. The shoe doesn't contact most of the sensitive places. It is still too tight to wear. I'll discuss the boot with my doctor.

I think I've figured out some of the problem on why I have so much pain after a little bit of weight bearing in the boot. The weight of the Aircast cam boot is resting on my injury and hanging on my foot with every step. I have my surgery incisions on both sides of the ankle, and the tibia on the front of the ankle was in pieces, more than I had realized. The boot has 3 points where velcro straps secure it; on the top of the foot, just above the ankle, and at the top of the boot. The weight of the boot is resting on my ankle because that is where the ankle flares out and the angle changes from my leg. It has an air pump that snugs it up by putting some air at the back behind the ankle, and the air puts pressure there and pushes the ankle forward against the boot where it is very sensitive to touch especially where the plates are. I feel best with no boot and my foot elevated on the couch. I tested to see if I had the same pain after standing up without the boot using just my orthotics for support, and that wasn't bad. I had some discomfort, but not the same degree of pain. I also have a sprain that has been healing along with the fracture, and moving does make the ligaments hurt, so that has been part of the pain too. I did also try on my athletic shoe with the orthotics and got my foot into it. It is still a bit tight, but I was able to stand and transfer weight from foot to foot and not cause a lot of pain doing that. The shoe doesn't contact most of the sensitive places. It is still too tight to wear. I'll discuss the boot with my doctor.

Jennifer, when can you stop wearing the boot altogether?