How long after ankle orif should one wait to have hardwear removed? Doc said a screw, which is just under skin must come out or I will have trouble wearing shoes and it could cause ROM issues. I am still nwb and 10wks post orif. Doc.said surgery could be done 3mo. My? Is will bones be strong enough then. How long will I be recovering.
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replied December 10th, 2011
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In general, it is usually recommended that hardware from an ankle ORIF be left in for 12 to 18 months. It can be left in forever, if it is not bothering the patient.

Often, the fibular plate, if placed directly lateral, becomes proud once all the swelling and edema has gone away. Thus, some patients have problems with footgear rubbing on the area.

If the screw the surgeon is talking about is a syndesmosis screw, these are routinely removed around the time the patient becomes weight bearing or a little after. These are usually removed so that the tibiofibular joint can regain it physiological spreading with weight bearing. Also, if it is not taken out, the ankle dorsiflexion (bringing the toes up) may be limited.

If it is just one screw, it is not a problem and can usually be taken out at any time. Often, a syndesmosis screw can be removed in the clinic, depending upon how superficial it is and how much the patient can tolerate. Local anesthetic is used, but some patients just can't take the idea of the screw being removed while they are aware and may feel some weird sensations.

The rest of the hardware can be left in place.

Even if it is not a syndesmosis screw, and it is just one of the screws in the plate, it still should not be a problem. By almost 6 months post-op, the bones should be healed. The soft tissues may not be completely rehabilitated yet, though. Final results from a significant ankle fracture may take a year to be known.

You state you are still numb. Is that just around the incisions, the whole foot, part of the foot, etc? If it is just around the incisions, that sensation may or may not come back. It is not uncommon to have numbness around the incision, because when the skin is cut, the small nerve branches to the skin are also cut. Some times they regenerate, but not always.

Occasionally, when doing an ankle ORIF, one of the larger nerves, such as the sural nerve on the lateral side, gets stretched. It can go to sleep for a while. As a result the area it supplies, like the lateral border of the foot for the sural nerve, will be numb. These usually wake up, but it may take 6 months or more.

If it is more than just around the incision or in a specific dermatome, it may need to be evaluated why you would have whole foot numbness. That would entail involving several peripheral nerves. So, the question is why would several nerves be affected.

Are you still nonweight bearing because of the ankle or the pelvic fracture, or both? Usually by 10 weeks, an ankle fracture is healing well enough that range of motion and at least partial weight bearing can be started. But, you have sustained significant trauma to your body, and it is going to take quite a while to fully recover from it.

You should discuss the surgery with your surgeon, if you have concerns about it. You never have to have surgery, as long as you understand the risks/benefits. If you do not want the screw taken out, you don't have to have it out.

Good luck. Hope you are doing well with your therapy.

So, if it is just one screw, it shouldn't be a problem at all.
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