Should surgical implants be removed?
Q: To correct the fracture of radio and ulna in the left forearm, my 15-year-old son underwent surgery one year ago. Two plates with 12 screws were fixed in the forearm to correct the fracture. He has fully recovered from the fracture and is able to use the arm as a normal person. Q1. Now that plates have done their job, is it advisable to remove these plates? Q2. If yes when should be have them removed? Q3. If no, what are the side effects or complications of not removing them?
A:Ideally speaking all implants that are not part ofthe body and have served the purpose for which they were inserted should be removed in due course of time. In the case of forearm fractures the fracture remodeling and restoration to near normal strength takes about 1½ years. It is recommended that implant removal should be 1½ years after fracture union.If you remove them early there is a risk of re-fracture. To answer your third question, 1. Normally these implants are made out low reactive stainless steel (316L)and there should be no problem. Rarely you do have metal reaction, corrosionof these implants. If this happens patient will have pain at the site ofcorrosion. X-ray may also show changes. 2. These implants protect the bone from the normal stresses of activity. Thisprotection though useful in the beginning while the fracture is consolidating,prevents the bone from regaining normal strength. 3. the screw holes act as stress holes and fractures are known to occurthrough these holes. 4. there are also problems of doing magnetic resonance imaging if steelimplants are in place. Presence of an implant is a relative contra indicationto doing an MRI.Having said these things, a number of people do not get the repeat surgerydone for removal of implants. Since your son is young, he has a long lifeahead of him it may be worthwhile get it done 1½ to two years after fractureunion.