/ Broken Ankle. Metal pins in or out?

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Chris Perry - on 11 May 2013

I am looking for advice from people who might be in a similar position to what I am in. I broke my ankle about 3 years ago and had to have two pins put in there. I recall the doctor saying that if they caused problems the pins could be removed. Since it's healed, I've had no trouble at all with my ankle.

However, I was recently told by someone that if I fell again with the pins being in my ankle that it would make any injury loads worse. I have also been told that it is always better to have them taken out to help prevent the early onset of arthritis.

So, pins in or out? If out, what is the operation/recovery time like?

Cheers!

Any
Maxey56 - on 11 May 2013
In reply to Chris Perry: I'm in almost exactly the same position as you, except mine where put in two years ago. My doctor told me it was now standard practice to leave them in unless there was a problem at a later date, this makes a lot of sense too me. I remember asking about arthritis, and been told that it shouldn't have too much of an effect:) Also never heard anything about them making a second injury in the same place any worse, so personally I'm happier to stay put rather than undergo more surgery.
pwhiteside - on 11 May 2013
In reply to Chris Perry:

I had 9 screws and 2 plates put in when I was 25. I put up with them for 3 years but they were a pain. Boots rubbed the screw heads and movement felt more limited. Went to the doctor who recommended I got them taken out and that was that. Turned out to be a really good decision. Loads more comfortable now and a little better movement too. Op was a fairly quick one, (think about 15-20 mins but was about 8 years ago now). Recovery was pretty quick and no crutches after the first day. Had to be careful not to bang it or fall on it for about 6 weeks to make sure the bone had fixed itself up properly.

In my opinion, do it, you won't regret it.

Best of luck,

Paul
Mostro - on 11 May 2013
In reply to Chris Perry:

I have no experience of injuries such as yours but, speaking as an engineer, changes in stiffness tend to act as stress concentrators. That means that if you put you bone under great load, it would be more likely to break in the region where stiffness changes quickly. Metal is much stiffer than bone, so it will be more likely to break near the interface.`

That said, if you take the metal out, the bone will inevitably be weaker for a while because the holes will act as stress concentrators. Hopefully, in time, they would fill in with new bone and you would end up better off (because your bone would no longer contain either stress concentrator).

Because there are several stages to healing and bodies do not work perfectly, I guess this is why there is some uncertainty about the benefits. The doctors may also be thinking about saving the cost of an operation..
Boogs on 11 May 2013
In reply to Chris Perry:

Its definitely a subjective thing , I would say have the metal work removed if you can . That said I've still got some in place from a few years ago that I should of had removed but didn't get around to , but I think thats partly down to having woken up mid surgery when the surgeon was cracking open my pelvis to get some bone/marrow for the bone graft .

Recovery time shouldn't be more than 6 weeks to full recovery/strength as long as your sensible , eat well get good rest & stick to any physio strictly .

If you decide against removal I really wouldn't worry about pins causing more damage , of course its possible but fairly unlikely . I think age can affect the healing process a fair amount too , as in the younger you are the quicker you will get back to full strength generally .I'm Sure you will make the right choice .

Being self employed had a bearing on my decision not to as well .
Andy Kassyk - on 11 May 2013
In reply to Chris Perry:

I had two pins in in my right ankle in 1979. They're still there. Sometimes my ankle hurts and walking is painful but never for long. I suspect the pain may be due to arthritic changes but I don't think I'll have the pins removed now. Hasn't really affected my climbing at all
August West on 11 May 2013
In reply to Chris Perry:

I had plates and pins in both heels ten years ago. After five years I had most of the metalwork out of my right foot because one of the screws had worked loose (they left a couple of screws in because the bone had grown round them too much). The right foot was always more painful and had less movement than the left and even with the metalwork out it's still the worse of the two.

As for recovery time, withing six weeks of having my metalwork removed I was climbing up shafts at the bottom of Jingling Pot.

I'm still pondering whether having my left foot done would be a good idea or not.
mattbell - on 12 May 2013
In reply to Chris Perry: Why not ask your GP to refer you to an Orthopaedic surgeon. None of us know what metal work you have in your ankle, I don't think there are any orthopods on this forum. Normally another operation is best avoided unless it's causing you bother. Generally looking for an operation to be done ends in trouble!
pneame on 12 May 2013
In reply to Mostro: this is exactly right biologically also. Speaking as an ex orthopedic researcher. Likely for most people, leave them in, but for people who subject their muskuloskeldtal system to unusual loads, take them out.
Chris Perry - on 12 May 2013
Thanks for all the advice, I am still none the wiser though as there doesn't seem to be a clear cut answer for doing either. Perhaps I'll book in a consultation with my GP...looking really far ahead, just think it might be weird when I (eventually) die and get cremated for my remains to be a pile of ash with two surgical steel screws sticking out!
Dave Williams - on 12 May 2013
In reply to Chris Perry:
>
> However, I was recently told by someone that if I fell again with the pins being in my ankle that it would make any injury loads worse. I have also been told that it is always better to have them taken out to help prevent the early onset of arthritis.
>
I smashed my calcanium and damaged my ankle due to a 3 metre ground fall in 2009, ending up with 9 pins and 5 plates. Despite making a reasonable recovery, I was in constant pain and irritation from all the metalwork. During a follow-up CT guided corticosteroid injection to try and pinpoint the source of the pain, the doctor carrying out the procedure, on seeing all the metalwork, asked me how I'd done it. After I told her, she said "of course you're no longer climbing". When I said that I was she was horrified and said that if I had a similar fall again, the presence of metalwork would cause all manner of complications and there was a risk that I could even loose my foot.

That was it, the decision was made. I discussed it with my consultant (who'd also assumed I'd given up climbing) and he even warned me against doing any climbing until the metalwork was removed. (I ignored his advice.) Some months later he managed to remove all the metalwork in a 4 1/2 hour operation, some 2 hours less than it had taken to put it all in initially.

I was non-weight bearing for two weeks, but was then walking without crutches within a further five days. I was back climbing within 6 weeks after removal. By now I have significant arthritis issues, pain and stiffness due to the injury, but this was never my reason for getting rid of the metalwork.

I have no regrets whatsoever. As pneame and others have also advised, if in doubt, get it out. :)

HTH

Dave


ezzpbee - on 12 May 2013
In reply to Chris Perry: I had screws, bolts and a plate to my ankle after a spiral fracture and was also advised that I would be better off having them removed at a later date, as they could be a problem later on in life and under strain I always felt like the plate was too rigid and caused pressure against my boots.
Had them removed and not had any problems since.
pneame on 12 May 2013
In reply to Dave Williams:
Good news Dave - I'd wondered how all that was doing.
Cheers
Peter
shaun walby - on 13 May 2013
In reply to Chris Perry: Dig out your old paperwork with surgeons name on, contact his teams admin and ask the question to the only person qualified to answer it. If your very lucky you might get a reply. I think you have a valid question and I'd cleanly be interested in hearing the answer re the pin in my ankle...I'll ask my orthopaedic contacts and see what I can find out....I,ll let you know.

Failing the gold standard....any climbing orthopaedic surgeons care to comment?

The general rule has been leave alone unless they cause problems...however given climbers at at increased risk of foot/ankle injuries the increased density/ridgidity the metal causes "could" act as a force multiplier (as previously mentioned).....I'd be interested to here what an ortho surgeon had to say.
Sam_in_Leeds - on 13 May 2013
In reply to Chris Perry:

Had my pin put in to repair a badly broken femur 7 years ago with no problems.

TBH, I'm more than happy to follow surgeons advice and leave it there.

Surely every time you have a general anaesthetic you put yourself at risk so why have a general when you don't need it?
Toby_W on 13 May 2013
In reply to Chris Perry: So I did this:

http://www.ukclimbing.com/images/dbpage.html?id=2263

About ten years ago and it's all still there. One screw rubs on some boots but apart from that perfect and a full recovery.

I would like it out but:
i) any operation has risks, you need to consider these.
ii) busy busy, when do you fit it in so as not to miss out on stuff. You just know it will either be a mini heat wave and the best summer in years or the perfect storm and ice like you've never seen it if it were winter.
iii) I just can't be bothered.

Good luck deciding.

Toby
Michael Ryan - on 13 May 2013
In reply to Chris Perry:

Tib and fib, Pott's fracture 34 years ago: ground-fall. I've had pins in since then, Right ankle, always had slight swelling and slight restriction in movement. No athritis. Ran four fell races last week.
Chris Perry - on 18 May 2013
In reply to Toby_W:

Bloody hell that's a lot of metal work! I just have the 2 pins in my right fibula. I only notice them when wearing certain boots like ski touring boots.

Glad to hear Michael that you are going strong after 34 years. I did wonder if running fell races/marathons would wear out the joint more. But clearly not!

I've had a chat with the doc. He's booking me in to get a consultation in the near future. For those that wanted to know, I'll keep you informed!
Nez - on 18 May 2013
In reply to Chris Perry: this is beginning to sound like the scene from jaws. ie that's not a scar. If something is causing a problem get someone to get take a look. If it's not leave it alone. As you've had an injury that's had to be stabilised you can probably say your joint surfaces aren't perfect anymore. Either from misalignment or damage from the incident. Deal with any problems and try not to break it again. It's really hard to be specific as all injuries are hugely different (despite the 'I did this and had pins=plates etc' posts). And without imaging no one can really advise you any better. Get well and climb. Nez.

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