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Diabetic. Surgery done for fractured tibia and fibia. Should metal plate be removed before it corrodes?

DOCTOR OF THE MONTH - Feb 2014
Feb 2014
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Orthopaedic Surgeon, Joint Replacement
Practicing since : 2004
Answered : 5931 Questions
Question
This question is regarding my girlfriend, age 27, who broke her leg rollerskating with me about 9 and a half months ago.
She broke her tibia and fibia, and had to have a metal plate about 7 inches long ( 8 screws) attached to the outside of the bone. it ends right at the end of the ankle and mid calf.

She has had type 1 diabetes for 3 years now and went for a blood test, she had an HDL of 90, LDL of 220, total cholesterol of about 313, she is now on lovastatin 10 mg and lisinopril 2.5 mg. A1C was 4.7. However, she had elevated liver enzymes, and was told to quit taking acetaminophen and ibeuprofen which is a good idea, as acetaminophen is not great for the liver. However, she is in pain now, especially when it rains, something with the barometric pressure hurts the leg.

My question is, should this metal plate be removed before it corrodes, rusts, and causes a problem down the road? It can't be good for the body to have a metal plate remaining. I've read many concerns about the metal leaking into the bloodstream and micro movement between the screws and plate creating metallic residue.
Would it be a good idea to have a trace metal analysis done at a testing facility to see if this is a valid concern? Do you know how much something like this would run?

Also, if for some reason the plate and screws had to be removed down the road due to continued pain, etc, wouldn't it be best to do it now before she gets older where surgery would be much more difficult and dangerous?
Posted Sun, 5 May 2013 in Bones, Muscles and Joints
 
 
Answered by Dr. Saurabh Gupta 1 hour later
Hello and Welcome to XXXXXXX
Thanks for writing to us.

There is no need to remove the metal plate unless there is sign of infection, loosening of implant or the screws and plate causing impingement.

It is not a good idea to have a trace metal analysis done.There is no need of doing this.

If it had to be removed for some reason like continued pain , it is better to remove after 1 year.

Hope this helps you.Please do write back if you have any additional concerns.

Wishing her good health...

Regards.
Dr Saurabh Gupta.
Orthopaedic Surgeon.
Above answer was peer-reviewed by
 
Follow-up: Diabetic. Surgery done for fractured tibia and fibia. Should metal plate be removed before it corrodes? 11 minutes later
Thank you very much Dr. XXXXXXX that helps greatly. Is it normal to have pain at this stage 9 months? If there is still pain after one year, would you recommend plate removal?

In your experience, does plate removal result in the pain subsiding?
 
 
Answered by Dr. Saurabh Gupta 10 hours later
Hi,
Thanks for writing back.

It is not uncommon to having pain even after 9 months of surgery.
During surgery some soft tissue handling done and later it may case some fibrosis and might be the cause of dull pain.
I suggest her to do physiotherapy exercises to strengthen the muscle around the ankle and leg. These will ease her pain gradually.

If three is still pain after one year, she can go for plate removal after an check x-ray.

If there is some impingement of plates or screws, plate removal will ease the pain.

Hope this will helps you. Let me know if you have any more concern.
Please accept my answer if you have no further queries.

Wishing her good health.
Regards.
Dr Saurabh Gupta.
Orthopaedic Surgeon.




Above answer was peer-reviewed by
 
Follow-up: Diabetic. Surgery done for fractured tibia and fibia. Should metal plate be removed before it corrodes? 3 hours later
Thank you so much Dr. XXXXXXX one more thing. I'm not sure what impingement is, the definition I found is, "painful mechanical limitation of full ankle range of motion secondary to an osseous or soft-tissue abnormality"

Is this correct? Does there have to be soft tissue abnormality for it to be impingement and justify removing the plate?

Thank you!

 
 
Answered by Dr. Saurabh Gupta 22 minutes later
Hi XXXXXXX

Sorry for wrong interpetation.
Here it means that if the plate or screws impinges to the to the overlying skin due to its prominence.

Hope this will helps you.

Regards.
Dr Saurabh Gupta
Orthopaedic Surgeon
Above answer was peer-reviewed by
 
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