/ Metalwork - let sleeping titanium lie, or whip it out?

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FrankBooth - on 22 Sep 2016

Last year I broke my ankle (full on trimalleolar fracture). It happened whist cycling in Germany, and resulted in two plates and a dozen titanium screws. A year on I am good to cycle (can happily do 100+ miles) but 20 minutes running, or an hour walking and it swells up. I saw a consultant recently who suggested I may as well have the metalwork out, on the basis that it's not really contributing anymore and might as well not be there. Obviously this means another operation so I'm a bit reluctant to go ahead unless there's any benefit that's a bit more tangible.
What are other people's experience of having metalwork whipped out vs keeping it in?
Post edited at 20:32
Neil - on 22 Sep 2016
In reply to FrankBooth:

Had a titanium rod and screws removed from my femur a year or so after breaking it. I was told that removing it will be far better long-term as bone would strengthen over time whereas the metal would do the opposite. At the time it was frustrating as I felt I'd made a full recovery but after it was removed it felt a lot better, particularly with running.
Wry Spudding on 22 Sep 2016
In reply to FrankBooth:

With her plate, my daughter found the cold painful especially in water or snow. The surgeon said, "ah yes, in Scandinavia, metalwork gets removed as a matter of course especially as the lower leg/ankle bones are close to the surface without much insulating fat to keep it warm." No such problems since it was removed.
NaCl - on 22 Sep 2016
In reply to FrankBooth:

A dozen screws or thereabouts and a metal plate holding my collarbone together after a motorcycle accident 5 years or so ago. I've left it in as I don't really want to go under the knife again unless I have to. Only time it ever bothers me is if I'm carrying something solid and heavy like concrete blocks on my shoulder which makes the screw heads dig into the flesh on the inside. If it starts moving or causing problems then I'll reconsider but as it generally doesn't cause any grief it's fine for the moment.
Timmd on 22 Sep 2016
In reply to FrankBooth:
I understand (in a non medical expert way) that if you break something with metal work in, it can result in another quite messy collection of pieces of bone which need to heal/be pieced together again.

If you can get a decent prognosis on having the metal work removed, and have a lifestyle which makes it not unlikely that you might do something to your ankle again, it could be worth thinking seriously about.

Easy for me to say when I don't have it as something to ponder...

Edit: Ask if you can keep the metal work afterwards? ;-)
Post edited at 23:38
marsbar - on 22 Sep 2016
In reply to FrankBooth:

Do you set off the metal detector at the airport?
James Mann - on 22 Sep 2016
In reply to FrankBooth:

Frank,

Not sure that I am in a position to comment, well not yet anyway. I broke my lower leg very badly about 18 months ago and had two plates and quite a number of screws in order to put it back together.

http://www.ukclimbing.com/images/dbpage.html?id=257296

I have managed to get back to climbing but not as I would like due to pain in the lower leg. There is also the risk that an impact could have fairly catastrophic consequences. About two weeks ago, after advice from a doctor friend, I had the metal removed, the ankle joint cleaned and rebuilding of the tendons and ligaments in the lower leg. It is too early to say what kind of effect this is likely to have, but discussions with my surgeon seem to point to the view that the outcome should be very much better. I think that your case certainly warrants further thought.

I realise that this is a quite unhelpful answer as I can't say whether life is better or not without metalwork. I chose to go ahead with my removal after a great deal of thought and discussion on the basis that the benefits seemed to outweigh the risk.

Good Luck

James
James Mann - on 23 Sep 2016
In reply to Timmd:

No, you don't get to keep it afterwards. I asked but the answer was a definite no.

James
EddInaBox on 23 Sep 2016
In reply to FrankBooth:

> What are other people's experience of having metalwork whipped out vs keeping it in?

From my own experience you don't want to leave it in there any longer than necessary, one would have thought C3PO would have had the decency to at least warm his fingers up before my prostate examination, but ohhhh no!
Timmd on 23 Sep 2016
In reply to James Mann:
I don't know why but that seems unfair . I guess they have to follow medical waste protocols for everything and everybody, or else bad things might sometimes happen.
Post edited at 00:16
walts4 - on 04:55 Fri
In reply to FrankBooth:

Crushed my tib & fib in the ankle resulting in 2 plates & 10 screws. The consultants initial thoughts & statements 6 months after the operation, sure he was patronising me, was that all the metal work would be taken out after approximately a year.
However during the appointment in which it was to be decided whether to remove the metalwork, he completely changed tack & stated that it would be far better to leave the ankle undisturbed.
His reasoning was that the metal work had not restricted any of my lifestyle, I was able to climb, run, ski & carry on exactly as before the accident which in my case is true. Removing everything could also result in a set back that was not apparent before in addition to a lengthy rehabilitation period in regaining fitness & full mobility, something that I definitely didn't want as the years are creeping on.
He explained that the norm is for the metal work to be usually removed if you have a similar operation whilst in Europe, but the thinking in the UK is that you are better to leave undisturbed unless there is serious discomfort.
I decided eventually to leave the metal work in with the proviso that I could come back if there is any discomfort or restriction as the screws are almost visible on the most protruding part of both the tib & fib.
I feel no pain or discomfort from the metal work but dread ramming my ankle into a granite crack & catching the screw heads whilst wearing low cut climbing shoes.
The other myth, but obviously can only go on what the consultant stated, is that the ankle would be stronger with the plates & in the case of breaking the ankle again, in my case it would occur above the plates as these are stronger than the bone.
I feel the cold in the plates when entering very cold water & have to be wary when buying new boots as too the fit & feel over the ankle but personally, I feel this a small price to pay for what has occurred.
thommi - on 06:10 Fri
In reply to FrankBooth:

Hey up. I have a Russell Taylor nail in my right lower leg, full length between my tib and fib with about 6 bolts, and that ain't never coming out. Been there about 14 years and the only issue I ever have is a slight ache in damp weather or if I bang my leg exactly where one of the bolts is as a small lump of bone has formed over it and its quite pointy. Other than that it is no bother. Running, walking no bother with either. Tom.
FrankBooth - on 09:38 Fri
In reply to marsbar:

no - that was one of my questions to the original surgeons, but apparently titanium doesnt
FrankBooth - on 09:43 Fri
In reply to walts4:

I'm quite undecided. I saw a consultant (in the UK) in July, who basically said it was up to me and he was happy to leave the decision open for a further six months. I'm airing on the side of having it out on the basis that it's no longer helping in any way, but don't really relish the idea of another couple of months off doing anything while it all heals.
Will Hunt - on 09:49 Fri
In reply to FrankBooth:

I have one of these that goes down to the knee:
http://orthoinfo.aaos.org/figures/A00392F13.jpg

At the time the consultant explained that even in high risk groups (armed forces, motorcyclists etc), they don't bother taking metalwork out afterwards, as the perceived harm of another operation and recovery time outweighs the risk of later complications.

It hasn't affected me in any way (no feeling of cold or discomfort etc) so I've not thought about ever having it removed.
nniff - on 09:56 Fri
In reply to FrankBooth:

I had a plate and six screws in my collar bone. The plate and four screws were removed, but the other two screws stayed - imagine a long diagonal break - the plate and four screws were along the side of the break, and the two screws that remained clamped the two halves together. Made sense to me - only downside is that the points of certain shirt collars touch above one of the screw heads and it's uncomfortably tingly. Rucksack - no problem.
solostoke - on 10:40 Fri
In reply to FrankBooth:

Same fracture and metalwork for me. Mine was mildly annoying me. Had it removed and within a few days it was like a new ankle! Had to take it easy for 6 weeks so as not to snap it before it had strengthened fully. Couldn't believe how much better it was. I think some of it was down to the keyhole they did inside the ankle at the same time smoothing and washing it out etc.
Sealwife - on 11:48 Fri
In reply to FrankBooth:

Other half broke his lower leg (can't remember if it was tib or fib) in a climbing accident a couple of years ago. Break didn't heal well, so had metalwork added 6 months later.

He had it removed last year because a) screws at ankle level were causing discomfort and b) surgeon told him that in the event that he suffered another break in a similar area with the metal rod still inside the leg, the result could be fairly catastrophic (shattering the bone and having to remove a bent rod - eek).

Operation was straightforward and he recovered quickly.

He also asked if he could keep the titanium rod and was told no (though I think he might have been given one of the screws on the sly).
Toby_W on 12:38 Fri
In reply to FrankBooth:

Let me know, I broke mine... nearly 16 years ago

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

I've been thinking of having the screws out as they rub when I wear some boots but otherwise no bother.

Be interested to hear what you do and how it goes. Looking at mine it does not look like much of an op.

Cheers

Toby
Dave Williams - on 13:47 Fri
In reply to James Mann:
> .... There is also the risk that an impact could have fairly catastrophic consequences. About two weeks ago, after advice from a doctor friend, I had the metal removed, the ankle joint cleaned and rebuilding of the tendons and ligaments in the lower leg.....

Following a groundfall, I ended up with a very bad calcanial and sub-talar fracture. Nine pins and five plates later and all was seemingly well. Following advice from 2 separate orthopedic consultants, I had all the metalwork removed about 4 years later for exactly the same reason as James in what I assume would have been a fairly similar operation.

It's definitely a potential cost -potential benefit issue. The risk of infection from any foot surgery is apparently quite high and is often cited as a reason for leaving well alone. However, after giving me graphic descriptions of the consequences of another fall onto a metalwork laden ankle as well as possible outcomes (worst-case scenario being amputation) and as I was still climbing, both consultants were dead keen to have the metalwork removed, otherwise they'd have advised otherwise.

Being back in a cast for 6 weeks and on crutches for a further 8 weeks, as well as much rehab, was extremely frustrating but totally worth it as far as I'm concerned. Not only was the continuous discomfort/ minor pain/ irritation from the metalwork completely removed, the nagging fear of the possible consequences of another fall went away too. I also ended up with a slight gain in flexibility.

Would I elect to have the metalwork removed again? Yes, without any hesitation whatsoever. I'm back climbing at a similar or higher standard than before the initial accident and 7 years after being told that I'd never be able to walk further than about a mile ever again, and despite post-injury arthritis, yesterday I did a reasonably fast ascent and descent of Tryfan via the North Ridge. If time would have allowed, I'd have continued on up Bristly Ridge, followed by a traverse of the Glyderau ....

Take professional advice and consider your options carefully. I took well over a year, with much research and then a second opinion, before I decided to have the metalwork removed.

Good luck Frank, with whatever you decide to do.

PS: Against all protocols; I was allowed to keep all my metalwork as my consultant was seemingly a bit of a free-thinking maverick.
Post edited at 13:50
Owen Meany on 13:54 Fri
In reply to FrankBooth:

I would be interested to know other people's experiences too. I have a plate in my lower leg having broken my tib and fib in a skiing accident about 5 years ago. The plate itself is cracked due to my bones healing very slowly and me being encouraged by my physio to get rid of my crutches rather earlier than I should have done, resulting in a second break. I still get niggly pain from it and it swells after long walks or running, but I'm nervous about having it removed having had such a difficult time with it taking so long to heal when it was originally broken.

OM
Tricky Dicky - on 15:11 Fri
In reply to FrankBooth:

If it aint broke, don't fix it.

I have a series of staples that held my breastbone together after heart surgery 2 years ago. One of them sits under the skin and is annoyingly painful, so I'm having that one whipped out, but leaving the others in place. The staples and wire from previous heart surgery in my youth stayed in for nearly 40 years without causing any problems.

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