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Syndesmotic screw removal after broken ankle?
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By Paul Fleming
Feb 18, 2013

Broke my ankle about a 8 weeks ago (being lowered off a climb by a guide, fell about six feet) and had it repaired. Now the question is, do I undergo surgery to remove syndesmotic screws? My doctor says he usually doesn't remove the screws unless they are causing pain or impede range of motion. I'm thinking this may be fine for people who aren't going to really stress their ankle, but not for someone who wants to continue climbing/skiing/kiteboarding etc. Medical articles I've read says that the screws frequently loosen or break. (olc.metrohealth.org/SubSpecialties/Trauma/Media/Other/Manjoo>>> )The most recent metastudy (www.ncbi.nlm.nih.gov/pmc/articles/PMC3117259/pdf/402_2010_Ar>>> looks at outcomes from 7 other recent studies) says that removal of screws results in outcomes that are similar to results if the screws become loose or break. Results for the intact screws were the worst.

While it would be great to avoid surgery and the additional time I would have to spend on crutches after screw removal, I'd rather not have to deal with it later.

Anyone have to make this decision that has an opinion, or a bad experience with leaving the hardware in place?


ankle
ankle


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By DannyUncanny
From Vancouver
Feb 18, 2013

My non-medical opinion is get it removed if you can. It's the trade off between the immediate risk of surgery, or the life long risk of your body having complications with the hardware. In my case, the screws were too long (sticking out the far side) and gouging cartilage in my ankle joint.


Try and ask the surgeon if you can keep the screws. Mine wouldn't let me have them because they are supposedly a bio hazard.


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By Adam Winters
Administrator
From the Shire
Feb 18, 2013
Red-tail Hawk, Buttermilks

Looks a lot like my x-ray.

I broke mine summer of '09 and still have all the hardware with no complications. I'd say unless it's bothering you or preventing you from performing certain activities then leave it be. That stuff is meant to stay for life. I have one screw head on my outside ankle bone that I can feel thru my skin and it chafes a little with my mountaineering boots and ski boots but I've learned to deal with it. Most people I know with hardware have accepted to live with it forever. If you don't notice it then there's really no point in going thru another surgery in my opinion.


hardware
hardware


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By Guy Keesee
From Moorpark, CA
Feb 18, 2013
Big Boulder, just a bit downhill from Temple of Kali. Alabama Hills, CA.

I like to feel mine through the skin.... lets me know just whats holding me together. :>)

I noticed that your injury was when a GUIDE lowered - dropped - you.

Were they using some sort of "funky guide style belay devise?" Just looking for info.


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By Adam Winters
Administrator
From the Shire
Feb 18, 2013
Red-tail Hawk, Buttermilks

DannyUncanny wrote:
Try and ask the surgeon if you can keep the screws. Mine wouldn't let me have them because they are supposedly a bio hazard.


That's weird. I had one screw removed that stabilized my tibia and fibula while the ligament in between them healed and my doc gladly gave it to me to keep. They cleaned it up and handed it over. My doc is one of the top orthopedists in the country (Mammoth, CA) and treats the US ski team when injured in the area. Don't understand the whole bio-hazard reasoning. Seems if it's properly cleansed then there's no risk.


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By Paul Fleming
Feb 19, 2013

Guy Keesee wrote:
I noticed that your injury was when a GUIDE lowered - dropped - you. Were they using some sort of "funky guide style belay devise?" Just looking for info.

He was using an ATC guide in lower mode (with brake strands redirected through a carabiner above the device.) Accident happened when I was getting lowered (from the top) off a 70 M ice climb. Lowered over the first two steps and when I was backing over a 6 foot ledge at the bottom I dropped to the ground. I think the problem was that I was out of sight and hearing distance (it was windy) and he continued paying out enough rope to relieve all of the stretch in the double ropes, as he did not realize I was backing across a ledge. My analysis is that it is inherently unsafe to be lowered off a climb where you are out of sight and can't hear one another. It would have been much safer to rappel, which I will do in the future.


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By Paul Fleming
Feb 19, 2013

Adam Winters wrote:
That's weird. I had one screw removed that stabilized my tibia and fibula while the ligament in between them healed and my doc gladly gave it to me to keep. They cleaned it up and handed it over. My doc is one of the top orthopedists in the country (Mammoth, CA) and treats the US ski team when injured in the area. Don't understand the whole bio-hazard reasoning. Seems if it's properly cleansed then there's no risk.

The screws bridging the tib-fib are the ones I am concerned about. I plan to ask to have those removed (or I anticipate they will break) and leave the rest in place.


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By Michael Schneiter
From Glenwood Springs, CO
Feb 19, 2013
Goofin' on the Grand after soloing the Upper Exum with my wife.

Paul Fleming wrote:
Anyone have to make this decision that has an opinion, or a bad experience with leaving the hardware in place?

I would always defer to scientific studies or a doctor's expertise than personal experiences but here's my experience.

I had two screws placed in my medial malleolus of my right tibia in 2004. My doctor said then, and maintains now, that as long as they don't bother me they can stay in indefinitely. I saw him recently and we discussed it briefly. I don't even notice they're in and have had a great experience of climbing a ton, running marathons, backcountry skiing and ski mountaineering racing, etc. It has never hindered me. I felt like the area was slightly more sensitive for a year or two but nothing that held me back from doing anything. For example, if I was running in snowshoes and a snowshoe bumped that area it felt more sensitive than if I did it to the other ankle. I also wonder if sometimes that was just in my head because now I don't have those experiences and I think it could be because I've basically forgotten about it.

I have heard from people that have had screws loosen and basically start to back out and then they had them removed. But, I know it's an uncomfortable thing to have them taken out and to have to go through a recovery period again so I'm happy to leave mine in for as long as possible.


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By John Ryan
From Poncha Springs, CO
Feb 19, 2013

My wife had a bimalleoral (if I remember correctly) ankle fracture - tib/fib break during a roller derby practice. She has one plate and a bunch of screws. Her injury was early September 2012. Her orthopedic surgeon told her what you're hearing in this forum - no need to remove the hardware unless it becomes painful or annoying. So far it is not bothering her, and she has returned to her favorite activity of roller skating - not near full strength or range of motion yet but getting out there. One of her teammates had an exact fracture maybe six months earlier. She was annoyed by the hardware but left it in, and about 9 months after surgery it stopped being a nuisance to her anymore, so she left the hardware in and it doesn't seem to hinder her.


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By crankenstein
Feb 19, 2013

My hardware looks similar to the photos above and it has caused me no problems yet. It's been over a year since it was installed and I would never think about another surgery unless it was really causing a problem for me.


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By kovarpa
Feb 19, 2013

I had two screws put in when I broke my tib/fib in 2005. The screws were getting irritated when wearing boots and in general were causing pain so I had them removed ~9 months after the initial surgery.
While recovery from the injury and the first surgery was long (and painful), the recovery from having the screws removed was very quick.


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By George Bell
From Boulder, CO
Feb 19, 2013
Hip trouble ...

Hate to think of it, but what would happen if you break your leg again? Would it be better or worse to have the screws in place? Would they hold your tibia together or make whatever breaks worse? I imagine this is a pretty complex question ...


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By Woodchuck ATC
Feb 19, 2013
Rock Wars, RRG, 2008

Looks alot like mine from 5 years ago....but I only had 4 shorter screws put in. they stay in place. no problem with them so far, but as the swelling went down over 3 years, the screw heads did become noticable against my skin. As long as nothing rough grinds against the bone, it's OK for me.


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By Guy Keesee
From Moorpark, CA
Feb 19, 2013
Big Boulder, just a bit downhill from Temple of Kali. Alabama Hills, CA.

Paul... thanks for the answer... ouch!

Agree with the lowering.


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By Chris treggE
Administrator
From Madison, WI
Feb 19, 2013
Best day of climbing ever.  Darin Limvere photo.

George Bell wrote:
Hate to think of it, but what would happen if you break your leg again? Would it be better or worse to have the screws in place? Would they hold your tibia together or make whatever breaks worse? I imagine this is a pretty complex question ...


My understanding is that these plates and screws are not load bearing, they just hold stuff in the proper alignment for the bones to heal. The bones themselves are stronger than the metal.

I wouldn't have a surgery to remove stuff unless it was causing a specific problem. I still have plate and screws in my wrist from 8 years ago.


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By heather ann
Feb 3, 2014

Question: What does it feel like when your screws break? How do I know? I had a spiral fracture of my fibula, tibia in 7-8 chunks, and talus "crumbled" (apparently that is a technical term) in 10/12. Got 2 plates and 15 screws. Had 2 syndesmosis screws removed in 1/13 as planned from beginning. Dorsiflexion continued to be severely limited so had bone chips removed from joint in 4/13. Freakish swelling problems started, so had all hardware removed in 11/13 HOWEVER this surgery was with a different doctor (I live in rural upper MI, traveled to Minneapolis for surgery #4) and he put the syndesmosis screws back in. He said they would probably be fine long term. Well, about a month ago I started to develop severe pain with bearing weight AFTER resting. So, particularly bad in the morning. Feels like there are sharp rocks inside my joint. Oddly, the pain eventually goes away with continued weight bearing...then comes back after I've rested for any length of time. I carry crutches around with me and use them any time I get up for the first 1-30 minutes of walking, depending how long I've been resting. Has anybody ever experienced pain that appears to be CAUSED by rest??? Any words of wisdom would be appreciated...I'm getting tired of this. Thanks!


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By Kevinmurray
Feb 3, 2014

I have the same problem with pain after rest or even driving for a while. Spiral fracture of big bone at ankle on rt. leg with an external fixator for three months is what is the cause of my problem. Very limited mobility is what causes most of the pain. This happened 11 years ago and I just deal with it. Pain goes away with a couple minutes of weight on it. Sorry no words of advice. High possibility of arthritis with these types of breaks, lot's to look forward to.


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