Metalwork that has been used to treat a broken bone or an elective condition such as arthritis does not normally require removal. It is safe inside the body and causes no long term side effects.
There are some instances when metalwork will need to be removed:
Prominence
This may occur if a screw, wire or plate can be felt beneath the skin. It may cause irritation with clothing or footwear. This is more common where bone is relatively superficial and is not covered with much soft tissue or muscle, such as around the ankle, the top surface of the foot or elbow.
Irritation
Metalwork may also cause irritation of surrounding soft tissue within the body, such as tendons, muscles or nerves.
Infection
Superficial infections following surgery occurs in about 1 in 100 cases. The risk increases if you are a smoker, or have a condition such as diabetes or rheumatoid arthritis. If infection occurs within the deep tissues around metalwork, it will need to be removed, as bacteria can collect around the metal
On the day of surgery
You will be seen by Mr Davda or a member of the team to check your consent and mark the limb. Surgery is typically performed under general anaesthetic, which can be discussed with your anaesthetist. The whole process of taking you to the operating theatre, having surgery and recovering from anaesthetic thereafter will take about half a day.
In most cases, you will be able to go home the same day. Sometimes, it is necessary to spend a night in hospital depending on your general health and immediate recovery from the operation. Local anaesthetic is also applied at the time of surgery to provide pain relief and numb the operated area. This can last for up to a day after.
The wound will be dressed and wrapped in a bandage which stays on until the first post operative check about two weeks following surgery. This should be kept dry if possible. The bandage can be placed in a plastic bag or commercially available liners when showering.
After The Operation
It is not uncommon for the wound to bleed a little and stain the bandaging. In the case of metalwork removal from the foot and ankle, you are advised to keep the elevated on 2-3 pillows as much as possible, and limit the amount you walk to as little as practically possible. This will help reduce the swelling in the foot and promote healing of the wound.
At about two weeks, you will be seen in the post operative clinic, or by the local practice nurse if closer, when the wound will be checked, and the bandage reapplied. You may need a further check up 6 weeks later and if needed, xrays will be taken.
Common Questions
When can I drive?
You are allowed to drive once the stitches have been removed and the dressings taken down at the two week appointment. You must be able to perform an emergency stop. You are advised to contact your insurance company to ensure you are covered to drive.
When can I fly?
You are advised not to fly until the wound has been checked at about 2 weeks.
When can I go back to work?
This will depend on the type of work you do. For example, if you have a desk job you may be able to return to work after two weeks; if you do a physically demanding job, you may need 2-4 weeks off.
When can I return to sport?
You can usually return to sports six weeks from the date of surgery. This allows time for the bone to fill in once screws and plates have been removed. Recreational walking, or non impact sporting activity such as swimming may be resumed earlier, once the wound has been checked at the check up appointment following surgery.
Complications of Surgery
Failure to remove metalwork – occasionally it may not be possible to remove all the metalwork that is within bone. This because the metal may fatigue, screws can break or is to firmly embedded. Trying to remove the metal may increase the risk of injury to adjacent soft tissues such as nerves or blood vessels, or fracturing the bone. In these rare instances, the metalwork is safest left alone and in situ.
Fracture – once screws and plates have been removed, the gaps and holes within the bone need to fill with fresh bone. This process takes about 6 weeks. During this period, the bone is relatively weak and at risk of fracture. Hence, impact activity such as running is avoided for this time. The risk of fracture is low at about 1 in 100.
Infection – this can occur in a small percentage of patients. If this is the case, it is possible that further surgery may be required to remove infected bone or screws. Minor infections are commoner and normally settle after a short course of antibiotics.
Numbness and tingling – this occurs at the surgical site, as a result of minor nerve damage and usually recovers over the course of six months.
Blood clots – A clot in the calf of the operated foot (known as deep vein thrombosis or DVT), or a clot in the lung (known as pulmonary embolus or PE) is rare. Please inform the team if you have had a DVT or PE before, or if you have a family history of clotting disorders. You may require a short course of a blood thinning injection if this is the case, or if operating on both feet at the same time.