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nail removal after tibia spiral fracture (Page 1)

I broke my tibia 14 months ago, spiral fracture. I had the nail and 4 screws put in. Long story short. I had non union so had a larger nail put in 6 months after the original break. It is now 8 months later and Im still experincing pain. I've had all 4 screws already removed. And since I had the last ones removed 4 weeks ago. I now have pain throughout my entire lower leg. Does this make sense? Is the nail moving around? And final most important question. Should I have it removed and has anyone else removed theirs?
Thanks in advance
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First Helper User Profile Gaelic
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replied January 21st, 2008
my experience
hi
I have just had my tibial rod removed after having it in since april 2004. It was always my intention to have it removed for several reasons...
1. I've had doctors tell me that the rod does cause higher levels of heavy metals in the blood.
2. I've had doctors tell me that it is a good to have it out to help avoid problems in later life.
now that it's out it actually does feel better...lighter even (unless thats just in my head)

i have no education in medicine or orthopaedics but my experience tells me that after such an injury, pain will exist for years to come.

In my situation there were several fractures of the tibia (compound), and a clean break of the fib following a car accident. I had a rod and some screws put in, with the top screws taken out a year after accident. a year and a half later I had the metal out while they rebroke my tib and fixed up the angle of my bones. Steel back in. A year later they took it all out. hopefully this marks the end of it.

hope this helps. ask me any questions you want.
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replied February 24th, 2012
I had a break from a soccer injury 16 months ago. Nail, two screws near knee, two screws near ankle (that broke 8 weeks post op).

Thought everything was fine, doctor said not to worry about broken screws (sports doctor). Started playing over 30 soccer league on a small field about 4 months ago with no problems.

Played first full sided game last night in a competitive league and my knee just did not feel "right" when I pushed. Speed and mobility were okay it just felt wrong on the left side of my right knee. Previously the only pain was when I took off my shoes the "lazy way" and even that was occasionally and tolerable.

Couple concerns. Does this surgery cause ligament problems? I would have the hardware removed if I thought it would fix the problem but the problem seems to do more with surgery sight than actual hardware, is that the case?

Love soccer but do not want to go through a ligament tear and I am considering moving to recreational soccer versus competitive soccer (I'm 38 years old anyway). I really would miss the game though and thought I had four or five more years at a competitive level.

Please let me know if anyone has overcome this problem with PT or building leg muscles, or if hardware removal resolved knee pain and discomfort.

Thanks!
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replied February 25th, 2012
Especially eHealthy
JtChez,

Placement of a tibial IM nail does not cause any ligament damage. It does not come close to either the collateral or the cruciate ligaments.


Unfortunately, it is not uncommon for patients to have problems around the insertion side. Some patients have continued aching and soreness by the patellar tendon or around the patella (kneecap).


Removal of the nail will not help that type of discomfort. In fact, when taking the nail out, the surgeon has to reopen that same incision. Then dissect away the soft tissues to find the proximal end of the nail. After the interlocking screws are removed, the nail is hammered out of the bone. The wound is then closed in layers.

So, it usually just causes more scarring and soft tissue damage around the incision site, to take the nail out.

If the hardware is causing problems, then it usually helps to remove it. But, if it is just the problem in the knee you are having, removing the nail will not help that and may make it worse.


Except for the use of antiinflammatory medication, a neoprene sleeve for the knee, and keeping the quads strong, there is not much else you can do about the discomfort around the knee incision.


However, if you have not seen your surgeon recently (since returning full time to playing) you may want to have an evaluation, just to make sure there is nothing else going on in the knee.


Good luck. Do hope you can return to playing.
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replied March 13th, 2012
Nail removal
Hi
Was the operation ok to do after four years of having the nail in place? I borke my leg 4.5 years ago, and the Dr advised me not to have the nail removed, but as I am in constant pain now I feel that it should be removed, but didn't think it could be because the bone fuses to the nail after 2 years?
Thanks Joel
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replied March 13th, 2012
Especially eHealthy
Joe,

It depends upon the type of nail. Titanium nails tend to undergo ingrowth. However, stainless steel and chrome-cobalt nails usually do not have that problem.


Removal of a nail, "just to see if it will help the pain", is usually not a great idea. These surgeries have a very low success rate.

If, however, it can be shown that the nail is actually causing the pain, then the success rate is pretty good.


While it is up to you, usually, again, just removing the nail because you are having pain is not a good idea. It is a major orthopedic operation. While it is easier to rehab after removal, than it was when it was put in, it is still a surgical procedure.

The incision at the knee has to be reopened. The interlocking screws are removed (if there are any). The soft tissues are moved out the way and the end of the nail is identified. Sometimes, the end of the nail is overgrown with bone, and if this has occurred, the bone will need to be removed. Once the end of the nail is found, the threads are cleaned and the slap hammer is attached. Then the nail is hammered out of the bone.

Again, titanium nails tend to ingrow and as such, are sometimes difficult to remove. If fact, sometimes, the tibia is actually broken trying to remove the nail. Thankfully, this is very rare.

With the titanium nails, since the endosteal tissues tend to ingrow into the nail, removing the nail strips this endosteal tissue out of the inside of the tibia. This usually does not cause any outward problems. It can affect the nutrition of the bone for a while, but again, this it usually not noticeable to the patient.

If you have a stainless steel or chrome-cobalt nail in place, these tend to slide out fairly easily. They do not have the problems with ingrowth.


But, again, unless you can show that the nail is actually causing the pain, removing it will probably not provide you will much relief.


Good luck.
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replied January 21st, 2008
Thank you!
I appreciate your reply. There's a major shortage of information on this on the web. Only about 10-20% of people that get the IM rod have it removed.
But after talking to quite a few people about their nail removals. I've decided to do it, the consensus is that it does give major pain relief and after 15 months of living with the constant throbbing in my leg. That's all I really want.
I made the mistake of watching a video of the surgery on Youtube, OMG its so violent!!

Thanks again for replying
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replied March 30th, 2011
Possible nail removal?
HI

I broke my Tib n fib completely and two other fractures higher up the tib have got a tibial nail and after 6mths still got a throbbing across main break site which comes and goes. Am contemplating having it removed but am a little scared that the bone wont be as strong I am in a dilema. I am very active and ride horses. Are you able to run with it taken out I cant imagine being able. Can you offer me any more advice? Thank you.
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replied June 9th, 2011
My son had Tib/Fib fracture a few years ago with IM nail and 4 screws. Within 15 months time, had to have bottom screws removed, then top screws and finally the nail removed! The hardware removal was def. the way to go! The ongoing problem for him now is the chronic knee pain, which from what I've read can be an issue with these injuries!!
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replied September 28th, 2011
what happens when a tiblia nail is removed?
I've had a tibia nail for 3 1/2 years. It's been nothing but pain and limitations for me. eventually I had the 4 screws removed and healed from that....but more pain and swelling in the ankle area. The doc says I can get the rod removed....with a maybe it will heal and maybe break again. maybe it will make the pain better and maybe not.He also tells me without the screws it's possible for the rod to slip a little. A big help....after they remove the rod do they tell you how long they think it will take to heal or what it consists of (cast, crutches, etc)?
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replied August 14th, 2008
rod removal
I just had my rod removed yesterday. I am so nervous. What should i expect in terms of recovery time.

Does it hurt to walk? Help
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replied February 11th, 2009
rod removal
I've been thinking of getting the rod removed from my leg, I just want to thank everyone for sharing and all. Your past experiences have really helped me out in my decision. Thanks.
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replied March 25th, 2009
Nails out
hi everyone,my name is Naresh. want to share my experience with you guys. I met with an road traffic accident on aug 21 2008 broke my right tibia&fibula(exactly in the midle).doctors mentioned it Compound grade 1 fracture.They inserted a Rod and 4 Nails, still I am on bed rest. Doctors removed the upper 2 nails on march 19 2009, and asked me to take bed rest for 15 days more. Could you guys please tell me when can I expect walking ? atleast with a stick(crutch). many thanks for any responses...
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replied April 17th, 2009
nails out to tnaresh
I had it all removed last tuesday. They told me to stay off my feet for a couple of days. I have been walking without my cruthes the past few days. my knee area hurts butit's part of the heeling process. When I had the upper 2 screws removed, it took a good 2 weeks to start getting around with the ctrutches. Keep me posted.
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replied May 11th, 2009
Tibial IM Rod Removal
I had a tib/fib spiral fracture skiing last January. I had an IM rod and 2 screws (one by the ankle, one below the knee) put in. An avid skier and soccer player, I was disappointed to find that I could not run without pain through my Tibia and could not ski properly. I was told getting the rod out was my best bet by my orthopedic surgeon, and went in for this procedure on friday. I was told that i would be on crutches for 2 -4 weeks, but could come off the minute I felt ok. To my surprise, I was off crutches 3 hours post-op! Though i have been staying off my feet and keeping my leg elevated, I haven't need crutches at all and my leg is feeling better by the day. I am 4 days post op and can almost walk completely normally. My leg feels less stiff already, though admittedly, with pain through the knee (the surgery requires the doctors to shave a bit off the patella, which gets sore for the first week or so post-op). All in all it is not even a fraction as bad as the process of having the nail put in, and if you are having any discomfort at all I would highly recommend it. Good luck! - Steph
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replied November 24th, 2011
tibial rod removal follow-up
It is now Dec 2011. Could you follow-up on the procedure? Was it worth getting the rod removed? Are you at 100% with the bad leg? Mine was installed in 2009.
-Danny
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replied May 18th, 2009
tibial nail removal
After having them in for 15 months, I had my Tibial Nail & 3 screws removed about 3 weeks ago. I was walking without a crutch within 2 days, however I have experienced a fair amount of discomfort in my knee. I realize that it has only been a short time since surgery, but I am anxious about losing flexibility as it is difficult to bend my knee completely. I am a 23 yr old male...can't imagine having these kind of limitations permanently. Would those of you who have had this surgery recommend PT? Or am I just being impatiently paranoid?
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replied August 2nd, 2009
Tibia Fibia IM Rod ISKD Muscle Flap and Skin Graft
I had an M/C accident in Dec 2004 which required major surgery. I had a TB3 break (compound, shattered tib & fib and loss of skin and muscle) apart from breaking all toes and the keystone of the foot. I had an IM rod installed in Jan 2005, Muscle flap and skin graft in Jan 2005, a bone graft in April 2005, and after a non-union and an infection the IM rod was removed and I had a Taylor Spatial frame fitted in Feb 2006. The relief from having the IM rod was measurable during the week between the rod removal and the fitting of the Frame (which is another story in itself). The TSF was removed in August 2006 with my left tibia about 32 mm shorter than the right. In March 2008 I developed a Syndenosis on the fib/tib, and elected to this treated because of the pain, and have an ISKD and osteotomy on the tib/fib to establish correct leg length. The fitting of the ISKD was painful in the knee, but 3 days postop all good. After 18 months I started developing severe pain in my ankle and lower leg, and have just had the lower ISKD locking screws removed to dynamise the new bone growth, another two screws removed that remained from Jan 2005 surgery, and an ankle athroscopy to see if there was anything that may be triggering the pain. So far after 4 days there is still pain in the lower leg but less. Also because the tibia is now fully loaded it hurts after a while of walking, (I walked out of the hospital, however went onto crutches for 2-3 days to get used to the tibia taking a load). The ankle pain is about 50% of what is was. I will be getting the ISKD and the remaining hardware removed in about 6 months when the tib has consolidated fully. After 17 operations over almost 5 years I reckon I may be as good as I am going to be. So in a roundabout way, I would recommend getting all the hardware out of your leg when you can. There is no doubt that every time I had hardware removed their was a significant difference in pain levels. Good Luck with everything
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replied October 18th, 2011
IM nail removal
Hi PJ I can relate... I have been on crutches 8 years and had 10 major operations, bone diseases on left tibia that resulted in loss of 22cm of tibia. I have had an osteotomy and bone lengthening procedure in 2005 and plenty of grafts since then including human and artificial bone grafts. Now 36 months post IM nailing and I have severe ankle pain. The doc recommends removal of IM nail but I worry that the bone is too weak... not sure what options I have but am very worried.
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replied October 18th, 2011
IM nail removal
Hi PJ I can relate... I have been on crutches 8 years and had 10 major operations, bone diseases on left tibia that resulted in loss of 22cm of tibia. I have had an osteotomy and bone lengthening procedure in 2005 and plenty of grafts since then including human and artificial bone grafts. Now 36 months post IM nailing and I have severe ankle pain. The doc recommends removal of IM nail but I worry that the bone is too weak... not sure what options I have but am very worried.
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replied February 23rd, 2010
I suffered a compound fracture in January 2008 from a snow ski accident. It crushed my fibula and tibia in what they called a "boot fracture." I had 4 surgeries. I have a titanium rod (inserted a larger one in last surgery...June 09) and several nails/screws. They removed the two nails up close to my knee, (inside of leg)at my request. Now, from time to time, and for no apparent reason I have bad pain in that very area. It can be so intense that I cannot even walk! Anyone experience this before or have any idea as to why it is happening?
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replied December 10th, 2011
tibial rod - spiral break
I had spiral break of tibia/fibula 2 years ago. Titanium rod and 4 screws in tibia. Had a lot of knee pain after surgery, but no sensation in most of knee now. Had upper and lower tibial screws removed 8 months ago, and have had periodic mid-tibial pain since. Some days, I can hike, bike, do aerobics class without pain, other days, walking at all is very painful. Surgeon says removal of rod is the answer due to its rigidity. But wouldn't pain be more consistent if that's true? Could it be hairline fracture started when locking screws were removed? Could physio help? I'm 60, so not sure whether that's a disadvantage for the healing process if I get the rod removed.
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replied December 10th, 2011
Especially eHealthy
gogogogdm,

It is possible for the holes left behind by the screw removal to cause stress risers, thus making it easier to fracture through them. But, if that did occur you would have had the acute pain from a fracture directly at the screw location. You would have known it if you broke the tibia again. Plus, the treatment for it would be an IM nail, which was already in place. After 8 months, any new fractures should have also healed by now. And again, the pain would have pain around the screw sites, not the midshaft.


The use of titamium was selected for orthopedic implants, not because it is some space age metal, it has actually been around for a long time, but because its bending modulus is almost identical to that of bone.

When the screws were removed, the nail went from a stress shielding to a stress sharing construct. As such, the fracture site is now having more stress go through it than before.


You also have to remember that when you break a bone, not just the bone is injured. All of the soft tissues around the bone are also hurt. The periosteum is ripped apart, the muscles are torn from their attachmets, the fascia, ligaments, tendons, blood vessel, and nerves are all stretched and twisted in the injury. All this soft tissue injury has to heal and it heals with scar tissue. Scar does not stretch as well as regular tissue. So, around the fracture site, there is a lot of healed soft tissues, which could be causing some of the discomfort also.


As to removing the IM nail for occasional pain, is controversal. If hardware is causing problems, if it is proud, broken, rubbing, etc then its removal usually takes care of the problem. But, to remove hardware that is buried in the bone, well, the outcomes are not as reliable.

To remove the nail, the original incision at the knee has to be reopened. Removal is easier than putting it in of course. But, the knee has to be violated again.
But, you should be able to walk immediately after the procedure, taking it easy for a week or so, till the surgical wound heals.

Will it take your pain away, maybe, maybe not. A big thing to make sure of, before removing the rod, is that the tibia fracture is absoluately, completely healed. Once that nail is no longer there, the tibia is going to have to be taking all of the stresses. And pain at a fracture site, not coming from the soft tissues, is worrisome for at least a partial nonunion. Something is causing the pain and it is often too easy to blame the big piece of metal seen on x-ray.

This is one of those decision you will have to make, depending upon how much the pain bothers you and if you want to go through another major operation.

You will find patients that thought removal of the hardware was the best thing they did and others that say they should have just left it in, that they are worse off afterwards.


Being 60 is not as important as your overall general health. If you have diabetes, significant heart problems, etc then surgery would, of course, be more dangerous. But, if you are healthy, don't smoke, limit alcohol intake, then your age is not a really big factor.


You should discuss all of yours questions and concerns with your surgeon. Then, once you have all the information, make an informed decision. Good luck.
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replied December 14th, 2011
Gaelic,
Thank you for the additional information. You've given me some new possibilities to consider. I will be trying physio next week, and hope to get some relief then. I'm usually very active, and have no heart/sugar problems to contraindicate surgery. My surgeon gets mad if I ask questions - thinks I should just blindly do what I'm told. So I really appreciate your taking the time to respond. Thanks again.
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replied May 18th, 2010
removal of rod
I had a spiral fracture of my tib/fib back in 2005, at that time I was 12 weeks pregnants with my first child... was in a wheelchair for 6 months, as my bone never healed because the baby was taking the calcium.. I have been in discomfort since then, not able to run at all.. they removed the screws back in 2006 and in two weeks I am removing the rod.....the rod goes of course from the knee to the ankle... can anyone tell me how long is the recuperation?? when can you walk? I have two little ones 4 and 2.. so this is very hard buy my surgeon says that it is not guarantee but hopefully i will feel better after the rod is removed!!!
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replied May 18th, 2010
removal of rod
I had a spiral fracture of my tib/fib back in 2005, at that time I was 12 weeks pregnants with my first child... was in a wheelchair for 6 months, as my bone never healed because the baby was taking the calcium.. I have been in discomfort since then, not able to run at all.. they removed the screws back in 2006 and in two weeks I am removing the rod.....the rod goes of course from the knee to the ankle... can anyone tell me how long is the recuperation?? when can you walk? I have two little ones 4 and 2.. so this is very hard buy my surgeon says that it is not guarantee but hopefully i will feel better after the rod is removed!!!
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replied June 10th, 2010
reply to intramedullary nail removal question
I had the rod removed from my leg February 25, 2010. I was told I'd be weight-bearing the next day and "sore" for two weeks. That's not the adjective I'd use. I did have bone pain for a couple of weeks and stayed on crutches during that time. My experience may be difference from yours. I had a severe spiral fracture sustained during a 40 mph motorcycle wreck and have a lot of nerve damage in my ankle and foot. When the leg swells, the pressure irritates those nerves. The removal surgery caused a return of the swelling, and I had to elevate my leg for several hours every afternoon. That may not happen to you. I'd say prepare for six weeks, and maybe you'll be fine in two. Regardless, I'd say it will likely be a couple of weeks before you're ready to chase kids around. The knee where they took the rod out has continued to hurt, but just in the past few weeks, I have actually been able to kneel on it. Before the rod removal, I was getting tibial shaft pain at the site of the worst part of the break and all the way up the front of the bone, which was brutal on cold, damp days this past winter. That pain is gone, and I'm no longer in mortal fear that someone will bump into me in Wal-Mart. The medical literature is mixed on whether removal is a good idea. I have less pain and am glad I did it.
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replied July 28th, 2011
Thanks for your post. My son was riding his bicycle when a car hit him breaking his tibia. The IM rod, placed in early December of 2010. He had metal staples, the rod n' screws and pain. He has been doing well, the Ortho saying that bone has healed, but my son is in excruciating pain every 4 or 5 weeks and on pain meds. The Ortho is unsympathetic and because it was an auto accident acts like my son is malingering. Which, I know is not the case. About 2 months ago, one of his scars opened up a bit and the area around it was hot and reddish. At the ER, he was given antibiotics, just in case it was Cellulitis. He recovered from this and the scar closed up. But now a couple of months later, he has significant pain. He says it hurts most where the bone broke, the area is somewhat lumpy.

Thanks to this forum I am learning a great deal about the real complications this type of surgery can cause. What is the best time frame to get the rod removed?

In retrospect, for his type of injury, it might have been better to have it cast, instead of the IM surgery.
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replied July 28th, 2011
Especially eHealthy
tara5,

The nail can be removed once the fracture is completely healed. It is usually suggested that it be left in place for about a year, just to make sure the bone has healed and most of the remodeling the body is going to do, has occurred.

The lumpiness around the fracture site is usually from the callus formation. Callus is the bone that the body uses to heal fractures. It will remodel some, but usually, most patients can feel at least a little irregularity at the healed fracture. This would occur no matter how it is treated.

There is also always some soft tissue swelling and edema around the fracture site. The bone is not the only thing injured in the accident. The periosteum is sheared off the bone, the muscle attachments are torn, tendons are stretched and twisted, the fascia is also injured, and are the nerves and blood vessels sometimes. So, the edema that has formed in the soft tissues around the fracture will often consolidate and become firm, called woody edema. This can often take many months to resolve.


Before removing the nail, for pain only, the patient should be evaluated for a indolent infection. This can cause continued pain, and would require a different treatment plan.


Also remember that removing the nail is a major operation. It requires opening the original incision, taking out the interlocking screws (if they have not already been removed), finding the end of the nail, removing any bony overgrowth, attaching the slap hammer removal instrument, and hammering out the nail. The patient is usually advised to take it easy until the bone has recovered (about 6 weeks). One big risk in removing the nail, is breaking the tibia. If that occurs, a new nail is placed, and the patient starts again at zero. So, it is not just a simple little hardware removal.


In removing the nail for pain only, the patient has to go into the surgery with realistic expectations. It does not have as good of a track record in relieving pain, than if the nail is removed because it is causing objective problems (the nail is broken, it is proud, the interlocking screws are rubbing, etc). As long as the patients understand this, then, if the pain doesn't go away, they are not surprised.


So, if the patient wants the nail removed, it should be done after complete healing and remodeling of the tibia. That is usually at 12 to 18 months. However, it can actually be removed at anytime. If the bone has not healed, the patient may have to go into a long leg cast for awhile, followed by a short leg cast, or brace. But, this is usually not recommended, unless the problems the nail is causing are so severe that it just has to be removed.


Go into the surgery with realistic expectations, and things should go okay. Wishing your son the best. Good luck.
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replied October 18th, 2011
Gaelic, I found your reply very comprehensive and very informative. My case is rather complicated as I lost 22cm of my left tibia and have had osteotomies and bone lengthening and grafts over a 6 year period. 36 months ago I had an expanding intramedullary nail inserted in Dec 2008. In Jan 2011 I had more grafts from iliac crest and seemed to have been doing fine until May 2011 when I developed ankle pain that has continued to become more severe. My doctor says the nail is migrating into my ankle and he suggests removal but my bone looks very weak am not sure if it will survive the removal without fracturing... are their any suggestions you may have that we could explore in the interim as we give the tibial shaft more time to form hard bone? I was thinking maybe shortening the nail so that its at least an inch or two from the ankle joint as currently its sitting a bare few millimeters from fracturing the ankle joint. Any ideas are welcome.
Thanks, Sylvia
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replied October 19th, 2011
Especially eHealthy
Sylvia,

Yes, your problem is much different than the majority of the cases here. You have sustained such a severe injury, followed by very delicated surgeries.

The expanding nail is acutally a fairly new construct. They have been used in children for a while, but there the expansion was due to the child's growth, rather than the nail expansion causing the bone to lengthen. In the kids, the nail was just a long for the ride.


If it is possible to back the nail off a centimeter or so, that would be great. Some of the nails can do that, but others, the ratchet mechanism only moves in one direction. So, once it has been extended, it can't be shortened. If yours is a type that can be reversed, then yes, that sounds like a good plan. Then, let the bone consolidate more.

About the only other option would be to place a thin wire external fixator, around the nail. But, this may have unintended problem such a stress shielding. However, it is a very strong construct and would prevent the bone from breaking under stress.


You are really in sort of the experimental area here in terms of trauma reconstruction. In the past, you would probably have ended up with an amputation. But, hopefully, the surgeons can do something with the nail. Maybe, just reducing your weight bearing may help reduce the pain in your ankle, while allowing the bone to heal.

But, again, this is such a novel treatment, that there really isn't much information out there. You are helping to build that information.

Do hope you find a solution to your unique problem. Wishing you the very best. Good luck.
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replied June 10th, 2010
thaks
thanks for the reply, I had the surgery last Thursday so it has been a week now.. i am not swelling that much, but yes I am in a lot of pain still, I am not even weight bearing at all... i have to go next week to remove the stiches... I think you are right this will take around 6 weeks...
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replied July 3rd, 2010
IM tib/fib rod removal
I was hit by a truck last May while cycling and sustained 16 fractures, a few of which were in my left tib/fib. Had an IM nail and 6 screws (4 proximal and 2 distal). Had a replacement IM nail along w/a bone graft and autologous leukocyte injection this past Jan. and removal of distal 2 screws and 1 proximal screw. STILL lots of lower tibial pain and patellar inflammation and pain. REALLY want to get the rod removed but will have to wait around a year I guess. Has everyone had great success w/rod removal? My history is professional duathlete/triathlete and elite cyclist and runner. I am not looking to return to professional status but still want to run which, right now, causes me great pain.
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replied July 6th, 2010
Fracturing Tibia removing rod
Ask if there is much of a chance of fracturing your tibia when are are trying to get the rod out. They fractured mine in three pieces.
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replied July 11th, 2010
Intrameduallary (IM) rod placed in tibia
My dad had an Intrameduallary (IM) rod placed in tibia yesterday for a minor fracture. He is 65 and very active. His orthopaedic surgeon told that he has 95% chance of good recovery with the IM rod and 35% chance without rod.. Can anyone please advice if the decision taken was right? and what next? should we wait for sometime and ask for rod removal or should we leave it in there? There are so many questions. I talked to the ortho and he said he has done a good operation and there is nothing to worry about. My concern is that my dad is diabetic and I have read over many places in internet that diabetic patients have high chances of infection. Any suggestions or advice? Many thanks everyone.
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replied July 28th, 2010
30-yr old female. Ski accident February 2009, ski boot tibia fracture - had IM rod and 2 screws near ankle and one below the knee on tibia put in. Relatively smooth recovery, but once in a while had intense pain in the lower tibia (felt like bone pain where the fracture could have been) Also slight discomfort with the two screws near my ankle, very close to the skin surface and sometimes chafed when rollerblading or wearing too tight boots. Decided to get the 2 screws near ankle removed 13 months after initial fracture as the doctor said "it will not burn any bridges and 80% of your problems should be solved". The removal surgery of the second screw was extremely painful for about 5 seconds (although the first screw they removed I managed without even flinching). 4 months later, I now have a chronic ache in the same lower tibia area - Cannot walk, run without pain and can definitely not jump on the one leg. Has anyone else experienced this?

Also, I had very hard scar tissue develop where the screws were removed - it feels like another knuckle! The physio said I should have started massaging this area 3-4 days after surgery Sad I'm not sure if this is why I'm experiencing the tibia pain. Doctor can't answer it and neither can physio - they suggested wearing orthotics, but I doubt that it will help.
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replied May 27th, 2011
My daughter has this exact pain 5 years after fx. She is limited in her ability to walk more than a moderate distance, cannot run etc. We are going to try removing the rod and releasing a small muscle in the lower leg. No one knows if it will help. Low grade chronic infection might be a consideration although blood work is normal
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replied May 27th, 2011
Especially eHealthy
SBOWERS,

At five years, the fracture should be healed. So, if there was a indolent chronic infection, a bone scan may be helpful. The fracture would not show up "hot" any more, so if the bone scan was "hot" the chances of infection go way up. Either that, or a chronic nonunion of the tibia.

The surgeon will be taking cultures of the nail and deep tissues, hopefully. If there is an infection, the bone may be weakened, and as such has a higher risk of refracture. Which would require external fixation, most likely. But, you can keep your fingers crossed that it is not osteomyelitis. That would be a devestating diagnosis, as even with antibiotics, it is still very difficult to treat.

Unfortunately, removing hardware for pain only, doesn't have too good of a track record. But, as long as the patient understands the possible risks and benefits, and goes into the surgery with realistic expectations, it is usually worth a shot.

Of course, removing the nail is not as easy as it sounds. Any locking screws that are left have to be removed. The original incision at the knee has to be reopen (which can cause knee pain if the joint is violated), then any bone that has grown over the nail threads has to be removed. The removal hammer has to be screwed into the nail and the nail slapped out of the tibia. If the nail is staniless steel or chrome-cobalt, it is usually not too difficult to get out. Titanium nails tend to ingrow more than others, thus they can be a bear to get out.

The biggest risk (besides not taking the pain away) is that the tibia could rebreak. It doesn't happen very often, thank goodness. The next risk, is that the surgeon may not be able to remove all of the hardware.


But, again, if the patient's expectations are realistic, it is worth a try, as some patients do get, at least some relief from the hardware removal.

Wishing you the best.
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replied December 10th, 2011
I had spiral break of tibia/fibula 2 years ago. Titanium rod and 4 screws in tibia. Had a lot of knee pain after surgery, but no sensation in most of knee now. Had upper and lower tibial screws removed 8 months ago due to rubbing/bruising while wearing hiking and winter boots, and have had periodic mid-tibial pain since. Some days, I can hike, bike, do aerobics class without pain, other days, every step is very painful. Surgeon says removal of rod is the answer due to its rigidity. But wouldn't pain be more consistent if that's true? Could it be hairline fracture started when locking screws were removed? Could physio help? I'm 60(female), so not sure whether that's a disadvantage for the healing process if I get the rod removed. I'm on the fence.

Read more: Orthopedics Forum - nail removal after tibia spiral fracture http://ehealthforum.com/health/topic122319 .html#b#ixzz1gAQHsTRr
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replied August 20th, 2010
knee pain and IM rod removal
I have a tib/fib fracture from 1/2/2010 and have an IM rod and one screw left on top. I am debating the removal of the rod. I have chronic anterior knee pain (pain below and to the side of the knee) and cannot run or squat without pain. I do hike but it gets more painful as I go. My fractures are fully healed. From the research I have done on the web the studies show that removal does not significantly reduce the knee pain. I am curious if this rod removal helped any of you??
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