Hi all. I am currently one year post operation from a compound tibia and fibula fracture that I have had. Well, I am having 8 screws and 1 plate. So, I am having an appointment with OS the next week where we are going to talk about ankle pin removal. Really want them out very bad! My ankle is still swollen after so much time and I can feel the pins every single time when I put on some weight on the ankle. I can explain what does it feels like if you’re interested in it. it feels like my leg is resting on 2 very and very large cylindrical pieces of metal on each side of my ankle! So now, the question why I came here is: what it is the % of the ankle pin removal cases as well as what are the risks of doing so? I would like to be a little bit informed when I go to the appointment so I could know what I should tell, ask etc. my doc. generally, I would like to know as much as it is possible. Maybe somebody went through it? what are your experiences. Thanks a lot!
Removal of ankle pin
- Thread starter hamish
- Start date
Hi there hamish. So well, the removal of the hardware it is usually made in cases where it is causing some problems. around the distal tibia, due to the fact that there is not so much of a soft tissue envelope, some of the patients are complaining of their boots (shoes) rubbing on the palpable hardware that it is under their skin. Having that said, in such cases, typically a pin removal can be appointed.
But, you should know that before the hardware is scheduled to be removed, all the bones need to be totally healed up. also, it is pretty commonly advised that the soft tissues to be totally healed up as well as the scar tissue matured and softened too. in the time of the injury as well as subsequent surgery, the vascularity around that are is disrupted. So well, some new blood vessels need to grow back in as well as the soft tissue need to be able to withstand another insult.
About your case, with an open fracture (or also being called compound fracture), the soft tissues are of an essential significance. Pretty common, nearly all the surgeons are going to want the soft tissue envelope over the facture to be very well grown, with minimal edema or swelling over there, with no redness as well as no warmth before forcing the area once again. in case the soft tissue is not able to take the insult then there is a pretty high risk of skin “swamp” that is going to require a graft or flap rebuilding. Therefore, having all of that said, as much as the bone is being healed completely as well as the soft tissues are able to withstand one other “infringement” then the hardware can be removed.
Now, the success rate of taking out the hardware for pain, in such cases when there is clear, definite issues caused by the hardware, it is pretty good. BUT, in case there is not any clear problems but the hardware is being taken out only to see if this is going to help then the success rate is not that good.
Next, you’ve asked for the risks. I don’t intend to scare you, but you need to remember that the removal of the hardware is just any other surgical procedure that is why it has all of the usual risks that it is having a major orthopedic surgery, as a general line, these are being showed like: infection, wound healing troubles, bleeding, pains, damage to some of the surrounding structures and here we can mention the blood vessels, tendons, nerves and ligaments. Also there might be a need for some further surgery, failure to achieve the wished results and need for rehab. But, there are some special risks that are carrying different procedures in particular, and now talking about yours in particular it carries the following risks (besides the ones mentioned above): fracture of the bone in the time it is being taken out the hardware, failure to be able to remove a part of even all of the hardware, a requirement to replace a new hardware afterwards.
Those screw holes that are left after the removal of the hardware are typically requiring approximately 6 weeks or so in order to fill in again (some patients more time, some less, in case everything’s alright). most of the surgeons are going to allow their patients to weight bear as permitted, with no having any twisting activities or impact for those 6 weeks. So most of the patients are being able to ambulate right off the bat, however they may have to use crutches or a cane until their soreness from that surgery is going to subside. Also, as much as I know, a few surgeons are going to place a short leg cast for a couple of weeks as a protection in this regard but this is mostly depending on what is found during the surgery.
Anyway, all of these points are something that you are going to need to talk about with your surgeon when you’re going to meet. Anyway, commonly, with closed fractures of the distal tibia, the hardware is usually able to be removed after one year to about 18 months or so. However, in the open tibia factures as you have had, it may take a little bit longer because of the significant soft tissue problems. since there has been one year, chances are, it might be done, but there’s nothing that I can tell you for sure. It might be or it might not be done, all of this is depending on your surgeon’s opinion, that is why all of this you need to discuss with your surgeon, he’s going to explain you why he decided to do the surgery or why he has decided not to do it. I wish you good luck as well as good luck to your surgeon if you’re going to have the surgery. Best of luck 
Thank you a lot for your detailed reply, I appreciate it very and very much. I will surely going to add all of this info to my question lists and I’m going to report back with some updated information the next week. I really appreciate very much your response. I would also like to talk with somebody who has had their ankle pin removal as I would like to ask them a couple of questions too. thanks!
Hey Caments and everyone else who is interested. As I have said that I’m going to come back with some updates, here I am. as I have found out, I am having a bone spur growing on the ankle bone at a right angle with the bone (it is inside the bone, I am guessing the tibia). Most likely, this is exactly what is causing my swelling and my discomfort as well as that extremely annoying burning sensation that I am getting on the ”knob”.
Besides, other than this bone spur, my ankle has healed and my doc said that there are no signs of any arthritis. When I’ve been talking with my surgeon he has advised all the screws/pin removal, bone spur shaving/filing as well as a general clean up of that area. He has also mentioned that approximately 75% or so of the patients that are having my type of injury are having their screws and pin removed.
So, here is the recovery for this: one week ambulating without air cast or boot, but with the crutches for having a balance. After that, 2 weeks ambulating with cane and then it is supposed to be fine. also, no driving for one full week, stitches out after that week. To be honest, it seems pretty fearsome for me to have 8 pin/screws holes in my leg bones but not need to have at the least an air cast…
I am now wondering how quickly the bone is filling in the holes… my fault, I have forgot to ask this question… I’m going to ask them on my next visit. I’m now making another list of questions. And I have also forgot them to ask how likely the bone spur is going to grow again. gonna add this question there too. there are a couple of them more. by the way, my surgery is being scheduled in approximately 4 weeks. My doc haven’t told me the exact date, be he said that soon he’s going to tell me exactly when. Wish me good luck. I see that nobody responded, isn’t here nobody who has gone through a similar situation to mine? Anyway, thank you Caments once again for your help. I’m just praying that my surgery is going to pass well without any “complications”. Best regards.
Hey hamish, generally, it is taking apprx. 6 weeks for your body to fill the screw holes in with bone. As I said, for some longer periods for some less.
But, the screws hole is able to act as stress risers and this can make the bone easier to break. It is like for example perforations in the paper is making it easier to tear it up. this is the reason why most of the surgeons are going to recommend no twisting or impact loading for approximately 6 weeks (as I mentioned in the previous post). Plus, typically, the crutches as well as the cane at the beginning are for the patient’s comfort due to the fact that the ankle is going to be a bit sore after the surgery. However, you shouldn’t be worried as much as you are not going to go out and try to play sports or to run because you should be just ok even without any external support.
I know that many years ago, docs were putting their patients in casts for those 6 weeks, however, later this has been proven to be unnecessary, but that’s only in case the patient is taking it all easy and (s)he is not doing anything very silly. So well, after those 6 weeks, mostly depending on how is your ankle doing from house-cleaning, you are going to be able to start gradually increase the impact activities. But remember that it should be done gradually and slowly! However, then again, all of this should be discussed with your surgeon because it depends from a case to anther and I can’t know how it is particularly your case. Your surgeon needs to take a look at the inside of your ankle and he would be able to tell you what to do.
I wish you good luck with the surgery and I hope that doing that would take care about the discomfort you’re feeling. Best regards