The plates, screws and nails put in during fracture surgery (all called "platin" in everyday Turkish) are usually made of stainless steel or titanium; once the fracture has healed they may be left in place or, in selected cases, removed [1]. The general advice today is to remove an implant only when it causes symptoms and after the risks have been explained [2]. Removal surgery has risks of its own, such as refracture, nerve injury and infection [3][4].
What is "platin", and what is it made of?
In fracture surgery the bone fragments are put back into position and held together with implants such as plates, screws, nails and wires; this is called internal fixation [1]. In everyday Turkish all of these implants are called "platin" (platinum) and the operation "platin surgery". The implants, however, are not made of platinum; they are usually made of stainless steel or titanium [1].
Implants rarely cause an allergic reaction. The exception is nickel allergy: nickel is found in some of the metals used in orthopaedics, so tell your surgeon if you have a nickel allergy [1].
What does each implant do?
Internal fixation often allows an earlier return to function; even so, the fracture may not heal properly, the plate or nail may break, and the risk of infection is reduced but not removed [1]. When the fracture will heal is described in the patient guide's articles on wrist, ankle, collarbone, hip and children's forearm fractures; fracture healing and casts are covered in a separate article. Ask your doctor how many hours the first operation will take.
The main types of implant are [1]:
- Plate: like an internal splint that holds the broken pieces together; it is attached to the bone with screws
- Screw: the most commonly used implant; used alone or together with plates and nails
- Nail (intramedullary nail): placed in the hollow centre of the bone; used for most fractures of the thighbone and of the shaft of the shinbone
- Wire and pin: hold pieces too small to be fixed with screws; usually removed after a certain time
Do the implants have to come out?
Once the fracture has healed, plates and screws may be left in place or, in selected cases, removed; nails may also be left in the bone [1]. According to one hospital leaflet, leaving the implant in the body generally does no harm [6].
For decades metal implants were removed routinely because of concerns about corrosion, allergy and cancer [2]. It is now reported that a tumour developing near an implant used in fracture care is extremely rare, and that allergic problems caused by implants are uncommon [3].
When removal is necessary is not well defined; guidelines hardly exist, and opinions and practices differ widely [2]. The general advice today is to remove implants only in patients with symptoms and after the risks have been explained, because patients without symptoms have been reported to develop complaints after removal [2]. A meta-analysis of forearm shaft fractures in adults likewise does not recommend removing the plate, especially in patients without symptoms, but states that more reliable evidence is needed [4].
Airport detectors are another common question: in a 2007 study a walk-through detector at airport security settings picked up 88 per cent of joint replacements and 32 per cent of plates; intramedullary nails and wires were not detected [7].
Reasons for removing them
Most reasons for removal are relative and based on the patient's complaints or wishes; true medical reasons, such as infection or an implant that reaches into a joint, are less common [2]. When an implant is removed because of pain, relief of the pain cannot be guaranteed [3]. Screws and rods in the spine are a separate subject and are assessed by the relevant specialty.
The main reasons for removal are [2][3][6]:
- Pain or discomfort where the implant lies
- An implant that is prominent, irritates the soft tissue or has caused a sore in the skin
- Infection around the implant
- An implant that has moved or broken
- Some implants in children who are still growing
- The wish of the patient or family, after the risks have been explained
Timing of removal, and children
If the decision is to remove the implant, the operation is done after the fracture has healed [1][4]. In children the bone is still growing, so how the implant and the growing bone will affect each other is considered separately; there is no evidence-based guideline on whether and when an implant should be removed [3]. The rate of problems from implants left in place is quite low; the decision is often made jointly by the patient, the family and the surgeon [3]. According to a review of children's fractures [3]:
- Wires and pins provide temporary fixation and are usually removed after 3–4 weeks; those with ends outside the skin can often be taken out in the outpatient clinic
- Flexible nails in the forearm are removed at 1–2 months if their ends are exposed and at 3–6 months if buried; in the thighbone many surgeons remove them at 6–12 months
- For plates and screws the appropriate time is not well established; the literature reports 8–14 months
How is the removal operation done, and how long does it take?
Implants in the arm and hand are usually removed under general anaesthetic, sometimes under a regional anaesthetic that numbs only the arm [5]. The surgeon usually removes the implant through the incision of the first operation [6]. Most patients go home the same day [5][6].
How long it takes depends on what is to be removed and where: a hospital leaflet on the foot and ankle gives between half an hour and one and a half hours [6].
"Screw removal surgery" is not always easy; the procedure can be very challenging [2]. A screw can strip or break, and larger or new incisions may be needed, especially if bone has grown over the implant; the operation can take as long as the first one or longer [3]. If removing all of it would do too much damage to the bone, the surgeon may leave part of the implant in place [5].
Risks of removal surgery
Removal is not a harmless procedure; its risks should be discussed beforehand [3].
In a meta-analysis of 23 studies of forearm shaft fractures in adults, there were 52 refractures among 732 patients whose plate was removed and 21 among 1,670 patients whose plate was left in; removal significantly increased the risk of refracture, but the certainty of the evidence is very low [4]. A systematic review of 871 patients, cited in a review of children's fractures, found a complication rate of 10 per cent with implant removal [3].
The main risks reported by the sources are [2][3][4][5][6]:
- Refracture: the bone is temporarily weaker and can break through a weak point such as a screw hole
- Injury to a nerve or blood vessel
- Infection and problems with wound healing
- Not being able to remove the whole implant
- Bleeding, a blood clot in a vein, a tender scar, lasting swelling and joint stiffness
- Symptoms that do not go away or get worse
Recovery after the operation: work, driving and sport
The times below are taken from the patient leaflets of two hospitals in England; your surgeon will tell you which apply to you [5][6].
Arm and hand: the arm is kept raised for 24–48 hours and the stitches are removed after about two weeks; most people can drive after one week and return to work after 1–2 weeks [5]. Because the bone is temporarily weaker, contact sports are avoided for 6 weeks [5].
Foot and ankle: the first week or two should be spent resting with the leg raised; you should not work or drive until you are told you may, and full recovery can take several months [6].
Simple painkillers are used for pain; a doctor or pharmacist can advise which is suitable [5]. Swelling (oedema) may last up to three months, and the scar may be firm and tender for up to eight weeks [5].
When not to wait
Whether your implant is still in place or has been removed, seek medical care without waiting in the following situations [3][5][6]:
- Increasing pain, redness or swelling at the site of the operation, or a fever; these may be signs of infection
- Fingers that turn pale or blue, feel cold, lose feeling or tingle
- Pain, swelling or redness in the leg; these may be signs of a blood clot in a vein
- An implant that comes through the skin, or a sore in the skin over it
- A fall or a blow to the same area after the implant has been removed; the bone is temporarily weaker and can break
Frequently asked questions
- Should the implants be removed, and is it harmful to leave them in?
- Removal is not necessary in every patient: once the fracture has healed, plates and screws may be left in place or, in selected cases, removed [1]. The general advice today is to remove an implant only when it causes symptoms [2]; leaving the implant in the body generally does no harm [6].
- When are plates and screws removed?
- If they are to be removed, this is done after the fracture has healed [1][4]. In children, wires are usually taken out after 3–4 weeks; for plates and screws the literature reports 8–14 months, but the appropriate time is not well established [3].
- How long does removal surgery take?
- A hospital leaflet on the foot and ankle gives between half an hour and one and a half hours; it depends on what is to be removed and where [6]. Removal can also take as long as the first operation or longer [3].
This article is a general summary; diagnosis and treatment decisions are made by the doctor who examines you.
Sources
- Internal Fixation for Fractures. American Academy of Orthopaedic Surgeons (OrthoInfo), n.d.. orthoinfo.org
- Indications for implant removal after fracture healing: a review of the literature. European Journal of Trauma and Emergency Surgery (Vos DI, Verhofstad MHJ), 2013. pubmed.ncbi.nlm.nih.gov
- Indications for and Risks Associated With Implant Removal After Pediatric Trauma. JAAOS Global Research & Reviews (Montgomery BK, et al.), 2022. pubmed.ncbi.nlm.nih.gov
- Removal of Forearm Plate Leads to a Higher Risk of Refracture: A Systematic Review and Meta-Analysis. Orthopaedic Surgery (Cao R, et al.), 2024. pubmed.ncbi.nlm.nih.gov
- Patient Information Leaflet for: Removal of Metalwork Surgery. Norfolk and Norwich University Hospitals NHS Foundation Trust, 2023. nnuh.nhs.uk
- Removal of Metalwork: Foot and Ankle. The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, 2024. rjah.nhs.uk
- Detection of orthopaedic implants in vivo by enhanced-sensitivity, walk-through metal detectors. The Journal of Bone and Joint Surgery, American Volume (Ramirez MA, et al.), 2007. pubmed.ncbi.nlm.nih.gov
This article is general information and does not replace an examination or imaging. If you have symptoms, see a doctor.
More in this area
- Ankle fracture: cast or surgery, and when can you put weight on it?
- Broken bone healing time: when does the cast come off, what eases the itch?
- Muscle strains and tears: how to recognise one and how long it takes to heal
- Osteoporosis (bone thinning): how is it detected and how are fractures prevented?
- Stress fracture: what are the symptoms and how does it heal?