(Mr MC posting)
Broke the top off my tibia in Morzine, and had it screwed back on in surgery in France. Surgeon said that was it, job done, no more surgery required, screw will stay in for life.

Just been for second visit to local fracture clinic, and the consultant seemed to think it was likely I would need more surgery to remove the screw in a few months time. He seemed to suggest that the screw might unscrew or back out into my knee if left in-situ.

Not great news as the extra surgery itself will extend the time of my recuperation by months. Given the 2 opposing opinions I would personally put more weight on that of a surgeon who serves a ski resort and probably does hundreds of identical operations a year (I did exactly what a crashing skiier who stays attached to a ski would do) who treated me as an in-patient than that of a consultant in an outpatients clinic in banbuworzelbury who until he'd walked into the consultation had no idea about my case.

My next visit will be in 6 weeks, apparently with a knee specialist who will be the third consultant in as many visits, so may get a different opinion again, but I am interested to hear about peoples experiences with having had screws, plate etc fitted, and whether they were removed. If youve made it this far thanks for reading!

I had a pin removed from my leg with a pair of Molegrips & a hammer – really

I am in a similar boat, with a plate in the ankle end of my tibia. A friend at work who has had multiple breaks (tibia, fibula, femur, arms, ribs etc etc) recommends getting the plate or some screws removed, as he has experience where the plated part of the bone is rigid, but the rest of the bone gives to absorb shock loads. So, when the bone with the plate/screw is shock loaded all the load is transmitted to the unbolted/unscrewed part, which he says can make it quite sore for some days afterwards.
I have heard of screws undoing themselves as well, I guess surgeons don't use loctite.

Some screw removal can be done in day surgery, so recovery may not be as lengthy as you suggest – I guess it depends where the screw is.

Good luck with it – let us know what you decide

Hi MC

I am a vet and have performed orthopedic sugery on pets and therefore have some practical and theoretical knowledge ( 🙂 ) Edit: sorry didn't want that so sound arrogant sorry 😳

Although screws/plates/prostheses are designed to remain in-situ they can cause problems as well. Some, like proud screws can cause irritation to the surrounding soft tissue, some can loosen d.t. the bone lysis (being taken away) at the screw site etc. My wife may hev to have at least one of her screws removed from a surgical proceedure on her hip last year as it maybe causing her pain in teh soft tissue/muscles overlying it.

Are you in any pain with the crews of did the consultant give any reason like I have listed abouve as to why they need to remove it beacuse most of the time without problems they usually leave them in especially with what teh surgeon said to you in France?

I broke my femur in a car accident and a nail/rod put into my leg. It was taken out about 7 or 8 months later. Taking it out was an overnight stay in hospital. Can't remember having that much physio afterwards, at least when compared to when I broke the femur.

I've also broken my wrist and that was plated. The plate has never been taken out and I did it back in, ooo, 1995.

Broke elbow a couple of years ago – had lots of pins and metalwork in there. I did feel the metal becoming "uncomfortable" after about 6 months of healing, in the end it was taken out under local anaethetic (hammer, tongs, crunching noises…unpleasant but brief).

Had screws in my foot holding metatarsals together a few years ago. These had to be removed in case they broke between the bones. Needed a general anaesthetic, but was in and out in a day. Be warned, if the screws have been in for a few months, then the bone will have grafted onto the screws. It will probably hurt after the anaesthetic has worn off.

I don't think it needs to come out because it has potential to cause a problem, I think it only needs to come out if it starts causing a problem.
Surgery is always best avoided unless absolutely necessary.

[Metalwork in wrist 39 years and counting]

SB
PS – I ain't no doctor, ain't no doctors son.

he should have put thread lock on the screw 🙄

banbuworzelbury

Never heard it called that before..! How is life down there in the rural wilds on the banks of the Cherwell?

On the metalwork point, I only have some holding part of my face together, and that's designed to stay in, so not much help I'm afraid.

I'd err on the side of seeking another opinion, though it has to be said that I do know of someone whose knee replacement had to be re-done after the cement holding the bits in place came loose.

Yep, deffo seek another opinion, payign if necessary.

On the knee front, have you seen Shafighian? He certainly used to have a great rep, and recently operated on my mother's knees.

Broke my Tibial plateau 5 years ago, screws and plate still in and not causing any problems. Doc's in Nottingham hospital never mentioned about removing them. Funny how you forget they are there until you think about it (read about it in a forum post) and then it makes you knee feel all funny.

My Mum broke her tibial plateau about 10 years ago, she broke her other shin at the same time too. She still has all the metal work in too.

I have two small screws in my 5th metatarsal on my left foot.
I was told after the operation that they would not need to be removed unless they cause a problem, which was unlikely. I am a keen runner and have never had any problems with muscle rubbing against the screws so think they will be staying in.
If I had a plate I would have to have it removed as it would probably cause problems rubbing against shoes.

I had a plate for my collarbone. My surgeon recommended removing it 'because is you break it again with the plate still there it will be harder to fix'. He said that if I just sat around vegging out in front of the telly he'd leave it in, but since I was a mountainbiking, unicycling, skiing weirdo and therefore quite likely to break it again he thought it was better removed.

Well, that and the fact that it made him an extra £800.

i am just about to get some metawork installed in my foot – toe fusion in a few weeks. Interested to know how long you guys with metal in your feet were layed up for ? surgeon reckons I'll be off the bike for 3 months…….

having had a plate and 14 odd screws taken out my wrist is 90% more comfortable as they were causing irritation being in, I am very happy I had the lot taken out once it did it's job!

I must disagree with your assessment of surgeons in ski areas being the best authority. Quite often I have heard that they do quick and sometimes hasty repairs that can cause problems later. I have heard many such stories especialy about French and Italian resort hospitals. Always best to get second opinions when you get home.

Mr MC does not have any pain or discomfort as being caused by the pin in his knee. It's just wierd so far we have seen seen 2 different consultants in the same UK hospital 4 weeks apart, one never even mentioned the pin to be removed, other did today. Oh and neither of them speak English as their first language! Back in another 6 weeks to see someone different again!!! I really wonder. I think the thing frustrating Mr MC is that it's the long recovery, he currently signed off work until 1st September (27th June injury occurred) is wondering if/when he can go back especially as consultants still haven't really told him anything other than " see you in 6 weeks" great help!! I think we will mention it to physio next week for their opinion and otherwise wait and see in 6 weeks time then make a decision if we need further assesments.

well I had just written and posted my reply then good old singletrack world lost it by timing out.

Thank you very much.

Can't be arsed to type it again just yet. sorry munqe chick.

<swears at website and decides to do some work instead>

I guess it depends on the surgeons experience in leaving pins/plates in. One surgeon may have encountered more problems than the other and thus recommends removal as a precaution. Opinions are just those so you will get different ones if the results of tests/surgery can vary so much?

I broke my elbow 5 weeks ago and have a plate and 5 screws. I've been told the same as onewheelgood. MTBing and snowboarding means it's better to have them out in case you do something similar.

Arm came out of plaster last Wednesday and is very stiff. Hoping to get back on the bike next month for some slow rides. I managed to bend my arm ust enough to touch my nose yesterday which cheered me up.

Snapped the end off my radius about 4 years ago, so have a t shape plate and 3 screws in. Don't ever remember discussing having the plate removed and it hasn't been an issue really. Probably worth bringing up that you don't want it removed, then they might explain the pros and cons.

One thing I will stress is try and do as much physio as you can to retain the strength. I got lazy after about 3 months, and it's still not right now. Good luck with your recovery.

Given that people on here couldn't even agree which tyres to use, I suspect that a sensible approach might be to take the advice of the doctor, with all that there training over the advice of people who have been operated on….

Internal fixation of fractures allows a quicker return to function, but is not a free lunch. Your tibia has to carry a fair amount of weight, and anything that may potentially cause stress in that area is not always a great thing; the problems can include those stated above.

Remember too that the surgeon in the ski resort operates on people who have come to visit; he doesn't follow up all the tourists he screws back together, and so is less likely to see the results of his operations a few years down the line.

Ultimately it's up to you, but I would be thinking about the longer term, a couple of months recuperation is not a long time…

I had a plate and 6 screws put in a fibula after dislocating and breaking an ankle playing rugby (silly game). They came out after a year, but the op only took an hour or so and I was home next day.

I took the loop stich out myself the following week and did a 25 mile walk in the Welsh mountains after 5 weeks (about which the surgeon was mortified when I told him!), so it doesn't necessarily take all that long to recover – depends upon the injury really.

Anyway, if you have it all taken out you get to keep all the hardware in a jar to show all your mates, which has novelty value if nothing else!

I've had a screw in one ankle since 1978 with no problems, but it isn't near any major joints. Also have three large screws in my right wrist and a metal replacement end on the ulna that side. They went in about 2½ years ago and the idea is that they stay in, though the surgeon said they might take the replacement end off the ulna in the very long term if it starts to give problems. I can set off some security arches just by putting my bare arm through, which is mildly amusing at times.

crikey, the point of posting is Ive had 2 contradictory opinions from 2 so-called experts (and I appreciate their personal opinions might be driven by their experiences, and the french guy might be driven by making money from unneccessary surgery with no followup), but by canvassing for experiences on here I'm effectively garnering a consensus of expert opinion (of each respondents respective surgical advice for their case).

I assume what I fractured was my tibial plateau, which other posters have experienced. It is a minor fracture to the end of a major bone, with only one small screw in there. I can see how having a lot of metalwork removed from a smaller bone (collarbone, foot) might make sense, but removing this screw means having knee surgery. Every doctor I'd ever spoken to about knee surgery (both me n my brother had knee problems in our youths) the rule was "if in doubt, dont" as there is so much scope for causing furher damage by the surgery itself, what with all the ligaments and meniscus.

Taking it out IF it causes pain/problems also seems sensible, but otherwise it seems unnecessary (we dont all have our appendixes removed "just in case"). I take Crikey's point about thinking longer term but at least Ive got some food for thought when I go back-fingers crossed a knee specialist will be able to answer my concerns with some authority.

Dunno about legs, but I had my collar bone plated and they said the decision to take it out or leave it in was dependent on comfort. I had it out cos I'm a skinny bugger and all the bolt heads were making little lumps along my collar bone.

I must disagree with your assessment of surgeons in ski areas being the best authority. Quite often I have heard that they do quick and sometimes hasty repairs that can cause problems later. I have heard many such stories especialy about French and Italian resort hospitals. Always best to get second opinions when you get home.

This is very true – my best man broke his leg boarding in France. the doctors there first said it was sprained, then agreed it was broken but just plastered it and said it would be fine. By the time it was checked in UK it had set into place but very wonky. He had to have about five operations and wear a big brace with wires through the skin for four months. A year and a half on and he still has a bit of a limp.

"with some authority" is the key phrase.

Every fracture is slightly different.

Every ORIF is different.

You need to talk to someone who has experience, who has been specifically trained to deal with this problem.

Expert opinion? Give over; being operated on does not make you an expert; I've had numerous haircuts, doesn't make me Vidal Sasoon!

…and a "minor fracture"… Trust me, tibial plateau fractures are not 'minor'; your tibial plateau is the major structural component of your knee joint, and any irregularity or subsequent deformation could lead to a whole world of trouble.

ORIFs (Open Reduction Internal Fixation) seem to be a great idea; screw and/or plate evrything back together then carry on, but, particularly in load bearing structures, the addition of a steel screw with different tensile strength to bone can cause problems later on.

Take sensible, learned advice from registered, regulated professionals before you do anything.

Take sensible, learned advice from registered, regulated professionals before you do anything.

yup I agree – you won't know what the third surgeon says (don't forget the first surgeon commented on what the thought at the time i.e. has not follow up information) until he says it! As Crikey and I have said each case is different d.t. you being different from anyone else and the fractures all have their differences and each patient has different demands so I think you'd be best to just wait for a 2nd opinion. I just not nice to wait as my wife is in teh same position (she's got to wait another month to see if she needs a peri-acetabular osteotomy!)

crikey, foxyrider good points both.
Crikey, whilst i liked your vidal line, what I'd tried to say was that the posters were passing on the advice they had had from their own expert surgeons, no that having an operation made them an expert. I am a dab hand with a set of clippers, if you want a grade 1, mind!

I never even did GCSE biology (physics nerd myself) so am aware of my own gaping lack of knowledge. I imagined it as a minor fracture in that it was a bit broken off the end, not the big bit snapped (see, technical me) but I should have realised that that bit is taking all the weight/force in my right leg.

Appreciate everyones responses, and realise that in the grand scheme of things my troubles are minor, but it was gutting to think that after 6 weeks off work, already envisaging months of not riding or being active, that those months could multiply.

I think we're saying get the best advice and do it right, then you can get back to being fit in time to get rained/snowed/hailed/frozen on!

Good luck with it, and don't rush back into stuff… 😀

I don't think the operation to remove the screw would be that big, or add that much time to your recovery.

If you have metalwork left in situ – plates or intramedullary nails – they create stress risers at their ends, and can increase your risk of fracturing through those areas. This would not seem to be the case from what you've described.

In general, I've not seen much French medicine that I've been impressed with.

GP, but with fiveish years experience in orthopaedics and trauma before I saw the light.

I've had 2 ops to remove metal work. One to take out 2 screws that were holding the knee joint end of my femur together and one to take out a metal plate and 6 screws from the top of my tibia. Both ops were day cases and took not very long with no problems.

Don't forget to tell them you want to keep the screws and plate as momentos as they'll chuck them if you dont

I've just asked the wife who is an orthopaedic surgeon and she has said that if the metal work is in correctly they do not generally mess around with it. ie the only reason to consider taking it out is if it is in wrong.

As to quality of surgeons. Some one has also suggested that she would only have surgery at a main tertiary hospital. Your man who serves a ski resort may well do the same op day in day out, but therefore his skills might not be so up to date, and he may be more interested in skiing/biking than surgery 🙂

If your not happy still ask to be referred to a consultant at your main city hospital.

"but it was gutting to think that after 6 weeks off work, already envisaging months of not riding or being active, that those months could multiply." All the more reason to let the doctors do their investigation they are thinking about the long term outcome, not just fixing you up and shiping you out!

i broke the side off my tibia and had bone graft and plates and screws in 2006.was riding herts in 4 weeks.
had the metalwork out last march,walked out the same day and was riding in a week.

all good

Fingers crossed then if it does have to come out it's a minor op!! Guess we just have to wait and see until the next consultant appointment! Interesting stories though… appears a lot of MTBers have designer metal work .. I feel left out now 😉 (only joking!!!).

Hi,

My names Abel Joseph. Two years back I was trying to perform a stunt and in the event landed onto concrete ground on my right leg alone causing my tibia and fibula to break and also the ankle to dislocate. I had two screws around 2 inch long onto my tibia and a plate wid 6 screws onto my fibula, both implants being just above my right ankle.

2 years have passed by and I have undergone surgery to remove the titanium implants out. I didnt have any problems as such but preferred to be metal free. After my stitches are removed, would i need to wear a plaster for 6 weeks as most of the weight is borne by the tibia and there are only two screw holes on the tibia?

Please advise and also mention the risks involved if i dont opt for a plaster.

I have two big bolts protruding out each side of my neck. My creator told me it's a design feature.

My opinion – ( pretty much a lay opinion on this) Its very much a matter of opinion and judgement – different surgeons will have different opinions on it and the surgery you had done in France might well be a different type of surgery to that which your UK surgeon would do.

All other things being equal I'd prefer to have the metalwork removed – but if it would be difficult to remove and is causing no problems in place then leaving it would be the best bet.

Removal of metalwork as others have said is very unlikely to lead to a long rehab period.

Listen to a surgeon that you trust. Think once / twice / three times before committing to anything. Get a second opinion if not sure. Listen to your body. If the metal work causes problems maybe have it removed. If the metal work causes no problems leave it. You can always gget the metal removed in years to come.

TJ- spoke to a knee surgeon friend this weekend who said pretty much that-it will depend on that surgeon's experiences, the nature of the specific fracture, and whether the screw is, or is likely to, cause any problems.

the consensus from this thread seemed to be that there is no concensus- some have been left some have been removed, which is consistent with the above.

Seeing a knee specialist at my next referral who will hopefully be able to answer my Q's and come up with a reasoned opinion having reviewed another set of X rays.