Removal of metal structures (wires, plates, screws) after previous surgical interventions at the Juhelp Clinic

Today, most surgical interventions in traumatology and orthopedics are performed using metal structures. There are both supporters and opponents of removing all metal structures.

The first argue their point of view by the fact that the presence of foreign bodies in the body affects the body as a whole. The latter argue that modern metal structures consist of alloys that are indifferent to the body. It is clear that all low-quality metal structures must be removed. In this article we will talk about modern, high-quality metal structures, the manufacturers of which believe that they do not need to be removed.

There are no axioms regarding “remove or leave” today. Each specific case must be approached individually. It depends on the metal structure itself, where it is located, age, patient requirements, etc. In all cases, the decision is made by the doctor together with the patient.

There are absolute and relative indications for the removal of metal structures.

Surgery to remove metal structures after osteosynthesis of fractures

Removal of metal structures is a planned operation, which is performed after the consolidation (fusion) of the fracture , the formation of a full-fledged bone callus, this occurs after approximately 8-12 months. There is quite a lot of debate about whether it is worth removing the metal structure after osteosynthesis if it does not interfere?

A few reasons:

• In any case, this is a foreign body and no one can predict how the metal will behave in a few years, even though it is a high-tech titanium alloy. This includes metallosis, and suppuration of metal structures, up to such complications as osteomyelitis.
• If the metal structure begins to interfere after 3 or more years, then the callus will “grow” over the plate or screws, or the rod, so that it will be very difficult to technically remove it. Therefore, implants should be removed routinely approximately one year after installation.

Another thing is that the removal of structures from the pelvic bones is often accompanied by heavy bleeding, extensive tissue damage, and the risk of trauma to the pelvic organs. As a result, implants should be removed only when absolute indications arise—complications, signs of implant rejection, etc. Only structures that fix the symphysis pubis can be removed as planned; during this operation, extensive trauma can be avoided.

Contraindications

Although it is advisable to remove the metal structure, in some cases this should not be done.
For example, when the elements are located near the neurovascular bundle and the presence of a scar process, which makes it difficult to detect the structure. In such cases, if the doctor moves incorrectly, damage to a nerve or vessel may occur. This also includes all situations where the structure is located in an anatomical area where repeated surgery can lead to injury to anatomically important nodes and organs. The structures are not removed in elderly people suffering from osteoporosis, since otherwise the risk of re-fracture increases sharply.

In addition, there are also general contraindications to elective surgeries and anesthesia.

Emergency removal of metal structures

Indications for emergency removal may include:

• deep suppuration,
• intolerance to the material from which the implant is made,
• unstable fixation,
• formation of a false joint,
• no signs of callus formation over time.

Technically, removal of osteosynthesis is a simple operation if the metal structure is installed correctly, according to the accepted technique. When the spokes are located externally, simple mechanical removal is performed. With intraosseous fixation using pins, nails, screws, a full-fledged operation is performed under general anesthesia or general anesthesia. As a rule, this is an intra-articular implementation. Skin dissection occurs with excision of the primary scar, or without excision. The joint capsule is opened, the structure is mechanically removed with special instruments, followed by suturing of the capsule, soft tissues, and skin.

To determine the condition of the implant, a control radiography is performed immediately before the operation to determine possible migration of screws or wires. Also the use of computed tomography.

Removal of wires after surgery

Kirschner wires are mainly used to fix small bones and joints (toes and hands, metatarsal and metacarpal bones). Immobilization is usually carried out for 4-6 weeks after surgery. Faxing can be either external, i.e. the end of the needle is located above the surface of the skin, and the inner one, i.e. the wire is completely submerged under the skin to reduce the risk of infection and patient discomfort. Used for temporary fixation. There is also submersible osteosynthesis with knitting needles and wires for osteosynthesis of larger bones according to Weber, for example, for:

• fracture of the patella;
• rupture of the acromioclavicular joint;
• fracture of the olecranon process.

In these operations, the pins and wires are removed 8-12 months after the operation, since the fusion of these bones requires more time and more stable fixation.

Intramedullary metal osteosynthesis

The method is used for various injuries of the femoral neck. Doctors choose open or closed options. For older people, this operation is a real chance to get back on their feet and not be bedridden. Intramedullary metal osteosynthesis is included in the category of intraosseous operations, during which the comparison of fragments is carried out manually. After which a fixing rod is inserted into the medullary canal of the bone.

Complications after surgery are rare. They are mainly associated with poor quality metal structures. The second cause of complications is the introduction of a foreign body into the bone marrow canal, which can cause compression and disrupt blood supply. In isolated cases, destruction of the bone marrow followed by fat embolism is possible.

Removal of pins and wires after osteosynthesis of the patella according to Weber

For fractures of the patella (patella) with displacement of fragments, an osteosynthesis operation is performed, i.e. fastening of bone fragments to restore the integrity of the bone and, accordingly, the function of the knee joint. Because if you refuse surgery, the patient risks remaining disabled.

For osteosynthesis of the patella, the Weber technique is used in the vast majority of cases. When bone fragments are fastened with two titanium Kirschner wires and additionally tightened with titanium wire in an 8-way pattern. This allows you to quickly and very effectively restore damaged bone and, importantly, the metal structure is minimal in cost. But she has one big minus. Very often, patients experience discomfort and pain in the area of ​​the pins and wire, since it is located right under the skin. Therefore, removal of the metal structure from the patella is often performed.

After the bone has grown together and the metal structure has fulfilled its function, it can be removed. Complete bone fusion occurs in 6-8 months, in some cases 1 year. It is after this period that the metal can be removed.

Before this operation, standard blood tests must be performed; the list can be viewed here.

The operation is often performed in a day hospital setting, i.e. a few hours after the operation the patient can go home. Local anesthesia, conduction or anesthesia. The operation itself takes 30 minutes. Finding wire and knitting needles is usually not difficult for the surgeon. After the metal structure is removed, the wound is sutured and an aseptic dressing is applied. The patient comes for dressings on the first day, then he can change the dressings himself or in a medical institution near his home. Sutures must be removed 14 days after surgery. In the early postoperative period, painkillers and antibacterial drugs are prescribed.

Approximately 1 month after surgery to remove the metal structure from the patella, you can gradually increase the load and return to your normal rhythm of life.

Preparation

If the removal of metal structures is carried out in a hospital, the patient again undergoes a standard examination, including:

1. general clinical blood and urine tests;
2. coagulogram;
3. hospital complex for infections (HIV, syphilis, hepatitis B and C);
4. ECG;
5. fluorography;
6. X-ray or CT scan of the fracture site with the structure installed.

Before the operation, the patient is consulted by an anesthesiologist and a therapist.

Removing the plate after surgery

Plates and screws are used to fix almost any bone in the human body. This is a very reliable and convenient method of osteosynthesis. Today, there are a huge number of plates of various shapes, sizes and modifications for a certain type of fracture. The most common examples of plate osteosynthesis are:

• Osteosynthesis of the clavicle;
• Osteositis of the humerus
• Osteosynthesis of the external ankle;
• Osteosynthesis of tibia fractures;
• Osteosynthesis of metacarpal and metatarsal bones;
• Osteosynthesis of the radius and ulna.

The plates are usually removed 8-12 months after surgery.

Removal of the rod (pin) after surgery

Intraosseous (intramedullary) rods with locking screws or, as they are also called, pins are used to fix fractures of tubular bones, and in particular transverse and helical fractures with a small number of fragments and splinters. Also, preference for intraosseous osteosynthesis is given due to the speed of the operation, minimal invasiveness and low traumatic nature of the operation. It is worth saying that the fixation with the rods is very good and dosed loads on the operated limb can be given after just a few days.

After successful surgery and healing of the fracture, as a rule, the dynamic screw is removed and the load on the limb is increased for complete healing of the fracture. 1 year after surgery, when the fracture has completely healed, the screws and rod are routinely removed.

Almost always, the operation to remove the rod does not take more than 30 minutes. Removal occurs using similar tools as during installation.

Difficulties may arise when removing the rod; it is not installed correctly. Or the threads and screw heads are torn off. In this case, you will need to drill out the screws and rod.

Diagnostic procedures

The decision on the need to surgically remove the metal structure is made by a specialist in traumatology or orthopedics based on the collected clinical history, data from the results of examination and analysis of radiographs.

In this case, the resulting images must show clear signs of bone fusion. In situations where plates or screws are placed in the area of ​​important nerve endings or vascular tissues, during the removal of metal structures there is a risk of recurrent fracture in this area. If there are dangerous concomitant diseases, removal of the metal retainer may be refused.

Surgical interventions are carried out as planned, but if there is a risk of damage to vital organs, removal is carried out on an emergency basis.

Removal of the pin-rod apparatus, Ilizarov apparatus after surgery

Removing the Ilizarov apparatus is not difficult, since the needles and rods are located above the skin. After general or regional anesthesia is performed, the wires are “bitten” and removed from the bone. If there are rods, they unscrew. Wounds are treated with antiseptic solutions and aseptic dressings are applied.

Our clinic performs removal of all types of metal structures.

The cost of removing a metal structure depends on the complexity of the operation and the location of the implant, as well as on the type of anesthesia that is required for removal.

Rehabilitation activities

The recovery course is prescribed by an orthopedic surgeon and a rehabilitation specialist in each case individually. The degree of damage, the method of surgical intervention, the general condition of the patient, his age and the presence of chronic diseases are taken into account. The program includes not only medication prescriptions, but also physiotherapy, massage, and exercise therapy.

The main goal of physical therapy is to improve blood circulation, fully restore limb function and prevent pain.

Therapeutic massage after metal osteosynthesis of the spine is prescribed on the fifth day after surgery. At first it is simple stroking and tapping, which over time transforms into a full-fledged massage. The purpose of the massage is to improve blood circulation and resolve swelling.

Physiotherapy – paraffin baths, UHF, electrophoresis, magnetic therapy and inductothermy. The choice of method depends on the location of the fracture, the type of operation and the type of metal structure installed.

If you strictly follow all the doctor’s recommendations, absolute recovery occurs after three to six months.