Ankle pin removal – orthopedics forum – ehealthforum total hip replacement surgery recovery time

The removal of hardware is usually done in cases where it is causing problems. Around the distal tibia, since there is not much of a soft tissue envelope, some patients complain of their shoes/boots rubbing on the palpable hardware under the skin. So, in these cases, usually a removal can be scheduled.

Before the hardware can be removed, the bones have to be completely healed. It is usually also recommended that the soft tissues have completely healed and the scar tissue matured and softened. During the injury and subsequent surgery, the vascularity around the area is disrupted. New blood vessels have to grow back in and the soft tissue must be able to withstand another insult.

With an open fracture (compound fracture), the soft tissues are especially of importance. Usually, the surgeons will want the soft tissue envelope over the fracture well matured, with minimal swelling or edema, no redness, no warmth before violating the area again.

If the soft tissue cannot take the insult, there is a risk of skin slough, which would require graft or flap reconstruction.

The success rate of taking hardware out for pain, in cases where there is clear, definite problems caused by the hardware, is very good. However, when there is no clear problem and the hardware is taken out, just to see if it helps, then the success rate is not very good.

Removal of the hardware is any other surgical procedure and carries all of the usual risks of a major orthopedic surgery: in general these are given as – pain; infection; bleeding; wound healing problems; damage to surrounding structures including tendons, ligaments, nerves, blood vessels; failure to achieve desired results; need for further surgery; need for rehab. Special risks of this procedure in particular: failure to be able to remove part or all of the hardware; fracture of the bone when taking the hardware off, requiring replacement of new hardware.

The screw holes that are left after the removal of the hardware usually take about 6 weeks to fill in. Most surgeons will allow their patients to weight bear as tolerated, with no impact or twisting activities for 6 weeks. So, most patients are able to ambulate right off the bat, but may have to use a cane or crutches till the soreness from the surgery has subsided. A few surgeons will place a short leg cast for a few weeks for protection, depending upon what is found at surgery.

This is something that you will need to discuss with your surgeon. But, usually, with closed fractures of the distal tibia the hardware can be removed after a year to 18 months. In open tibia fractures, it may be a while longer, due to the significant soft tissue issues. Again, something to discuss with your surgeon.

If this is the case, then the fibrous tissue has to be manually removed with a currette (instruments that looks like a tiny ice cream scoop) and then the hole packed with cancellous bone graft, usually harvested from the iliac crest (pelvic brim) or the proximal metaphysis of the tibia.

With the spine, it just sometimes happens that patient do not fuse when a spinal fusion is done. Of course, the patient should be evaluated for reasons why the fusion did not occur, such as an infection, bone defeciency diseases, poor surgical technique (such as not getting a solid fixation with the hardware, so that the bone can heal), and so on. Of course, smoking is very detrimental to any bone healing and can actually prevent fusions and fracture healing.

But, again, if your surgeon is going to be back in around the ankle to take more screws out, and there is truly no bone growth withing the previous holes, they should probably be curretted and bone grafted, so that they do not continue to act as stress risers. Sometimes, just curretting out the fibrous tissue will do the job, but usually it does take adding in some bone graft, since they have not healed once already.

As to the supplements, some patients swear by the joint supplements which have the natural joint proteins in them: glucosamine, chondroitin sulfate, and hyaluronic acid. You can usually pick up these in pill form or in drink form at your local pharmacy. However, it has been noted that the patients who do get a benefit from these, have to use them for an extended period of time (three months or more) before a benefit is noted. Some patients will note a benefit sooner, but the authorities say that a patient should not give up on them until they have been used for at least three months.

Usually, screws have to be drilled out when the hex head hole that the screw driver fits into is stripped, or the threads of the screw are stripped. It is just like trying to get a stripped screw out of wood or metal, the shaft of the screw is bored out, a special instrument placed in the hole, and the rest of the screw removed. Usually, this can be done without making the screw hole too much larger than it would have normally been. Occasionally, the whole screw shank and threads have to be overdrilled, then the hole is just a bit larger.

I am a 55 year old female and VERY physically active (hike, bike, snowboard, golf, snowshoe, etc). I suffered a comminuted bimalleolar fracture/dislocation in July 2012 (hiking), ORIF same day, 7 screws and a plate on the fib, two long screws in the tib. Once the swelling from the injury/surgery started to subside, it was apparent the hardware was proud and I could see every screw along the length of the plate. I could also ‘feel’ the hardware – always ‘aware’ it was there and it was VERY uncomfortable and painful (electric shock, jump out of my skin painful) to the touch. After 6 months I was begging for it to be removed. My OS agreed to remove it after 8 months (not the same OS who did the ORIF surgery).

Everything was removed on March 19, 2013 and the difference was striking! I no longer have discomfort anywhere along the outer edge of the fib, and only minor tenderness on the tib which is already subsiding. Come to find out, not only were the screw heads proud on the outer edge of the fib, but the sharp ends of the screws were peeking out of the bone on the inside edge and into the muscles! No wonder I was always in pain!

Since the removal I have been nearly pain free and getting a much better range of motion. Word to the wise, if the hardware really hurts, don’t wait a year to get it removed. Conventional wisdom only applies if you feel satisfied your recovery is conventional.