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Removing a steel plate to increase the strength of a bone?
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Administrator
Dec 15, 2013
I broke my leg awhile back and I have a nice, shinny steel plate in my leg. I am under the understanding that a steel plate can reduce the strength of a bone as it provides a pivot point for the bone to brake over, and the screws reduce the surface area of a bone.

Considering I am a climber that takes my fair share of whippers, and I like long slacklines, I am constantly landing on my leg from 3 - 6' off the ground. I brought it up to my doctor and he said that the plate will reduce the strength of the bone, but to what degree he did not know.

So, has anyone had any experience with this issue?
20 kN
From Hawaii
Joined Feb 2, 2009
665 points
Dec 15, 2013
From the Eldo 2nd edition guide... stoked!
Hi 20kN, I had a steel plate with 6 screws removed from my collar bone last year. I had the plate in for 7 1/2 years before removing it. The collar bone, in principle, was much stronger with the plate (ei. I had a rock fall unto it, and it broke the skin completely open, but the collar bone remained safe due to the plate). However, over time, the muscles and bone began to grow negatively in regard to the alien material. I consulted a doctor, and he said to leave the plate. A year later, my shoulder started to hurt and finally I just told him to remove it. So here are your considerations:
1. Surgery is always a risk. Always. Does the plate give you GREAT discomfort? enough to balance the risk?
2. The bone will be honeycombed for at least 10 weeks post surgery. You should NOT do ANYTHING at all during this time. I have seen a friend shatter an arm that was honeycombed due to plate removal. This is almost impossible to repair and she will suffer her whole life now. You will also not be able to drink alcohol or smoke because the body has a hard time restoring the calcium to these holes if you do.
3. Get a soft belayer and don't boulder for a while after the holes are filled up. Taking calcium and doing leg presses and other physio will significantly strengthen the bone post surgery.
Good luck and I wish you the best. -Lenore
lenore sparks
From Denver, Colorado
Joined Apr 15, 2007
356 points
Dec 15, 2013
Hey Lenore, I've had a plate on my collarbone for a few years now and have been thinking a lot about getting it removed. Could you describe any changes you have seen post healing? I feel that my shoulder movement and function may be affected by the plate. Have you had a reduction in pain? Was your pain in your collarbone or shoulder or?
Thanks much for any light you can shed on my situation.
Mark Hammond
From Eldorado Springs, CO
Joined Oct 17, 2006
250 points
Dec 15, 2013
Church of the Lost and Found, Left. Summer 2013
Theoretically the bone will be stronger without the hardware. With the hardware in, the bone has holes in it which are filled with metal (the screws) but still this arrangement isn't as strong as continuous bone tissue. When the hardware is removed, the holes remain for a time (during which the bone is weaker) but eventually fill in with more bone to be continuous bone tissue.

I haven't had hardware removed myself, though I have considered having it done to my ankle which has 5 screws and a metal plate. But this hardware has been in there 16 years and it is only a minor annoyance so I'm not sure it's worth having the procedure to have it removed. I've fallen pretty hard on the repaired ankle many times over the years but it's never rebroken (knock on wood).

IMO the strength issue is less important than whether or not you tolerate the hardware. Mine has been annoying at times (my repaired ankle gets a lot more sore than the natural one during hiking, running, etc...) but I think this is more of an issue with the irregular surface of the hardware irritating the connective tissue surrounding, than with the bone itself.
Tavis Ricksecker
From Bishop, ca
Joined Dec 30, 2006
3,922 points
Administrator
Dec 15, 2013
I've had two experiences with this: my leg and collarbone. There are a number of things to consider but the bottom line for an athlete is to get rid of the steel ASAP.

Bone cells are "polarized" and line-up along lines of stress like miniature magnets aligned along the length of the bone. More stress causes more bone to grow, less stress results in bone atrophy. Steel flexes differently than bone and focuses the stress in specific spots (eg. at the screws, plate edges). Thus stress is distributed unevenly and the bone reacts.

For example, a plate across a break in a bone bridges the stress over the break, and the break never reaches full-strength after it heals over. Over time the bone under the plate atrophies because it isn't being stressed.

Bone also atrophies away from the screws in many cases (happened to me), leaving the head floating in soft-tissue and only a few threads left in the bone. The bone cells become aligned along the screws (where the stress is) and not along the length of the bone. They are being asked to do two very different things, and do neither well.

After awhile the bone doesn't flex evenly and high stresses, such as falling off a boulder problem, get focused in certain spots which can result in an unexpected re-break.

After my experience with my leg many years ago, I had them take the plate out of my collarbone after only 4 months. Taking the steel out is fast and easy. They don't put you under so deep, it's less risky. I was conscious and talking 20 minutes after being put under, and was climbing in a week.

So plates are great for holding bones in place while they heal, but for most athletes, they should be taken out after the bones have healed over.
John Byrnes
From Fort Collins, CO
Joined Dec 11, 2007
293 points
Dec 15, 2013
Picacho
Yes take the plate out. I had several surgeries on my hip and did not want to have another surgery to take the plate and screws out because I was in high school. It was made made clear to me by my surgeon that to remove them was mandatory. It reduces the chance of bone infection in the future too if you take it out. saguaro sandy
Joined Oct 12, 2013
140 points
Dec 15, 2013
I delayed having the metal removed from my trocantor major (the top of the femur) for over a year and payed for it. The thigh muscle didnt seem to recover from atrophy until the the metal was out, and as a consequence I overcompensated with the other leg and ended up having a torn meniscus and repair surgery on that. Couldnt sleep on the "metal side" the whole time also.
So although your situation is different Ill echo the previous comments - get that junk out of there!
Andy Donson
Joined Aug 24, 2001
166 points
Dec 15, 2013
There are a variety of types of plates/screws that are used on lower extremity fractures. The location of your fracture, the type of device used, and even the way it was used will dictate the specifics of your situation. I wouldn't worry about the plate reducing the overall strength of the bone. However, if you do have another very significant sudden stress high enough to cause a fracture, the bone is more likely to break at the end of the plate. Depending on the mechanism of injury, the plate can bend and even break also. Often those scenarios make the next surgical repair a bit more difficult.

The metal can remain there indefinitely if it isn't causing any problem. The problems caused usually relate to the plate being over a prominent area with little padding over the plate. This can be an annoyance between it and the skin or structures that pass by it. Some people do seem to have some vague symptoms that improve after plate removal.

As someone mentioned, when the plate is removed you will have a weaker bone for some time, again depending on the configuration of the plate/screws, and the fracture type and location. Screw holes often don't fill back in with bone, but they do adapt to stresses and the surrounding bone strengthens. If you are at high risk for another sudden load with your activities, it may be beneficial to even bone graft the holes in some fashion to encourage them to fill in. You may need to curtail your activities to those that would not involve risk of sudden loading for weeks/months after the removal.
atlclimbingdoc
From Boise, ID
Joined Jan 10, 2011
20 points
Dec 15, 2013
Enjoying a rare, clear day on Mt. Sir Donald
I am currently in a very similar situation. I also broke my leg almost 2 years ago and had plates and screws along the bottom of both the tibia and fibula. I spoke with my doctor about the drawbacks and benefits of leaving the hardware in. He advised me to go back to using my leg as normal (read: heavy use) and focus on what type of pain I was feeling, ie: joint pain vs. hardware pain. Removing the hardware would not alleviate any joint pain he said.

After nearly a year of regular use I decided to remove the metal as I was feeling pain pretty regularly along the plate/screws on the fibula only. The Dr. recommended removing all the metal if he was going to be in there. I was told it would be a simple, quick recovery of 6 weeks and that I could walk out of the procedure. When I woke up I was told I could not bear weight on that foot for another 8 weeks! During the hardware removal he discovered several problems in the joint and went ahead and mended those as best he could.

Bottom line: It sucks being on crutches again (3 weeks to go) but had I not elected to have the hardware removed I would have had a deteriorating condition with worsening pain and less mobility.
Flex
From Flagstaff, AZ
Joined Apr 30, 2007
489 points
Jan 8, 2014
s
Good Lord. Please don't use this website to seek medical advice. Anecdotal "this is what happened to me" stories will give you no fruitful information about your injury. Landon McBrayer
From Salt Lake City, UT
Joined Jun 22, 2010
507 points
Jan 8, 2014
so i broke my left tib and fib 17 years ago, had 2 plates and 8 screws installed, and never had them removed.

i don't have any issues as long as i don't stop being active.
Cpt. E
Joined Dec 22, 2006
106 points
Jan 11, 2014
atlclimbingdoc's summary pretty much covers it. One question though: what's the bone? Your tibia, fibula, or femur? Middle, near (proximal) or far (distal) end? Involving a joint? All those matter in the decision.

It's true that any hardware creates one or more stress risers in the bone, and in theory that weakens it. However, what that really means in vivo is that if you stress the bone hard enough to break it, it'll break there - not that it wouldn't have broken elsewhere anyway. The one caveat to all the discussion up-topic is to be sure that any problem you're having is really from the plates, as opposed to from scar tissue from the soft tissue injury that inevitably accompanies any fracture. If it's really the latter, surgery to remove the plates only makes more scar, and you end up even worse off.
Lee Green
Joined Nov 24, 2011
62 points


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