Patients often ask, “Will the plate have to be taken out?” during our discussions about fixing bad wrist fractures or fractures in other parts of the hand and arm. Some patients ask this after a successful surgery when the bone is healed.
The purpose of a plate and screws (or any metal hardware) in fracture treatment
A plate is a flat piece of metal made of titanium or stainless steel that has holes in it. The plate fits on the surface of a fractured bone and screws are placed through the holes in the plate to hold the plate to the bone.
All the plate does is hold the fractured bone pieces together while they heal. After the bone heals, the plate and screws serve no function at all. All the strength of a healed bone comes from the bone itself. In fact, if the bone never heals, a strong plate can easily be broken in half if the patient uses the hand in a careless way!
Reasons to take out a plate and screws
Surgeons leave plates and screws in most of the time, but there are some situations that may make the surgeon or patient more willing to take out the hardware:
- irritated tendons (can happen from a screw or the plate edge rubbing on a tendon)
- prominent screw or hardware too close to a joint (removing the hardware may make the joint function better or be less painful)
- a broken plate or screw (this rarely happens normally – broken plates or screws usually means something is wrong with the way the bones healed)
- a loose screw (occasionally a screw will back out, or un-screw and irritate tendons or a nerve)
- continued pain (sometimes pain after fracture healing can be blamed on the hardware – this is rare in my practice, but is a possibility)
- metal allergy (this is exceedingly rare)
- “Just get this thing out of me!” (there’s nothing wrong with this reason – most people who can’t stand to have a plate attached to their bone wouldn’t let the surgeon operate in the first place!)
The surgery
Plate removal surgery is done through the same incision as the original surgery. Here are some criteria I use for taking out hardware:
- the fracture must be healed
- at least three and preferably six months have passed since the original surgery
The risk of surgery is slightly higher in some ways because of the scar tissue present over the plate – it can make dissection slightly more difficult.
Recovery time is usually quicker than the original surgery, but wrist surgeons usually protect patients with a splint or limited activities for six weeks to lessen the risk of re-fracturing through the screw holes. The screw holes fill in with bone over a period of several months.
For more help
I receive many requests from people with questions about removing their plate, screws, or other hardware. I can give you more information about your situation using Google Helpouts – click on the button below to find out more information:
manabendra mahanta says
In the year 1990 i go through an operation on my left hand because i had broken my dual bone. During operation doctor set one steel road and another steel plate. Now is it necessary to remove the two steels. In a year i have little pain for some time.
First Aid Lessons says
This is actually the second time I have run into your blog within the last couple weeks. Seems like I ought to take note of it.:)
sarah walters says
i broke the humorous on my left arm. it was a spiral fracture and took a long time to heal. I had a plate fitted and some screws. 2 years on I am quite a bit of pain and it is going into my forearm and wrist. should I go to the doctors or just put up with it?
thanks, Sarah
thomasburnett says
i was involved in a auto accident.which i broke both ankles. tibia, pelvis, and shoulder.at a quick glance at x-rays, i’m carrying alot of hardware. because of 9/11, is there an id that i could carry,to make life easier by explaining why the bells and alarms are going off.i know that all i have to do is show my legs. scars do not go away! i’d rather not be harassed in this manner. it’s hard enough just getting around as it is. i prefer to appear normal as much as possible. HELP!
Roz Walters says
I was involved in an RTA in August last year. My right thumb was almost severed and the bone badly crushed. I had a skin graft which has now healed, and a bone graft that same evening. K-wires were inserted, one was removed after eight weeks, but the other remained as the bone was still unstable.
After another five weeks another bone graft was preformed. The second K-wire was removed and replaced by a plate and pins. This was seven weeks ago, and yippee the splint was finally removed last Wednesday. Yes I am doing a happy dance, full function is still a long way off, and my thumb feels more like an iceberg than a thumb, but things are at least progressing in the right direction.
I see my consultant again in just over five weeks time. At that point we will be discussing the idea of him removing the plate and pins. Apparently where the plate is situated could rupture something or other. He also says if the plate is removed it should give me some bendability in the joints. Sounds good to me. 🙂
I did ask if it would be a general anaesthetic, he said probably, but perhaps a blocker could be used instead. As we were leaving the room he said in passing that maybe even a local. Lead on sunshine, I’m all in favour of that. Though if he has a word with my original consultant he will probably want to use a general, anything to shut me up!
Andrea Latchman:Durban South Africa says
Hi Fellow Bone Breakers…
I had wrist surgery in Apr 2011 due to a fall;the thought of which makes me cringe to this day. I was fitted with a titanium plate and 9 screws.(~^_)
I would like to have it removed but just can’t find useful information relating to the actual surgicial procedure!
I count myself lucky as a colleague broke both wrists! Yep, she has 2 titanium plates! She has since recovered! (^^,)
Jonathan Smith says
I punched a wall and suffered a fracture of 5th metacarpal bone (neck). I had surgery to repair bone and hand surgeon put plate and several screws in to align bone properly so it would heal correctly. It’s now about 5 weeks after surgery and I can’t move my pinky at the knuckle. It is as stiff as a board and when I try to push it, there is severe pain in the hand and forearm. Doctor says I need occupational therapy so I start that next week. I am skeptical it will work though. My hand feels awful. How long before a surgeon will consider removing the hardware? I think it’s obstructing my abilty to bend my pinky. I can’t make a fist! Typing is very difficult as is writing and I do that for a living. Been out of work for 6 weeks and really need to get back.
Dr. Henley says
OT is very helpful in almost all situations like yours. Most modern plates are smooth enough to let tendons glide over them, so therapy can be done even with plates and screws in there. It sounds like your doctor has a reasonable suggestion.
It’s not uncommon for therapy to last for three months.
Sometimes hardware removal is necessary – up to the surgeon, but usually consider it around 3 months from surgery or more.
victoria haselden says
Hi Dr Henley,
I fractured my rt wrist Feb.23rd,12. In A+E it was reduced and a POP splint applied.
OR 24th Feb.12 ORIF attended and split POP insitu.Nerve block removed all sensation until approx 18 hrs later.
Saw surgeon one wk later. All that post op week I had noted a numb sensation rt thumb from outer lateral thumb to base and below thumb. I was informed by the surgeon who saw me this would recover.
An unsplit fiberglass splint was applied.
By 22oohrs it felt uncomfortably tight and could not move the wrist into a comfortable position.Not good.
Following day another splint applied. Still not enough padding.Following day S/B PT who applied an American double metal inch wide rod top and bottom material splint with velcro adjustable straps.Felt 100% better.
Q.Why do I have residual nerve numbness which has not altered since I first realized there was a problem?
Is this caused by pressure on the base of the thumb nerve from the POP splint which because of the nerve block [which lasted for 18hrs post op]
I was not aware of until late the next day?
The PT suggested this might be a cause in which case I feel applying splints should be done by staff properly trained who know where the nerve danger points are.
Incidentally having a block was a horrible experience
which is when I think the damage was done.I wonder how many anaesthetists have experienced complete absence of sensation in a limb. Is this lack of sensation really desirable because there one has no control or connection.Theoretically the absence of feeling is good but more work should be done on this aspect of anaesthesiolgy in my humble opinion.
Given you have not seen the xray, I would appreciate your comment, thank you.
mary plantier says
It has been 6 months since I fell and broke ulna and radius. Plate and several screws. Long painful process. Never play basketball with a teen when you are 59! any way-now it seems the pain is all from the plate and screws. i want them out but like most people I can not find the medical info. I know my surgeon would rather leave it in. why? if i could get an answer from him i’d know. he said the break is completely healed. who wants surgery? no one. but if i could get more use of my wrist and the pain to be gone I of course would go for it! It is hindering having the screws and plate.
LUISA says
I had surgery in November for broken wrist. I am trying to decide whether or not to remove plate and screws. I have constant aching and pain over the area where the plate is and is worse when I try to pick things up over a couple of pounds. I have spoken to some people who have had it removed, one person just wanted it out and he said his wrist felt much more comfortable after. Another was 7 years later has constant pain now and cannot be removed because bone has grown over. I am 41 and I don’t want to have problems in ten years and can’t do anything about it. Please let me know your opinion.
I have a appointment in a couple of weeks with my surgeon and I am not sure how forceful I should be about wanting it out. I believe he tries to discourage removal.
Lesley Greenwood says
I broke my wrist in 2008 and had a plate inserted with 6 screws. In 2010 significant scar tissue had built up and i had lost the feeling in most of my hand and had restricted movement. I had an operation to remove some of the scar tissue and free up the nerves which were trapped in it! Got most of my feeling back but still suffered some discomfort and stiffness. Then one week before Christmas 2011 the tendon in my thumb snapped and I have limited use of my hand and virtually no use of my thumb. A scan showed that the screws were protruding through the bone and had cut through my tendon!! I am now awaiting a further operation to remove the plate and to have a tendon transfer operation followed by intensive physiotherapy (I have been told). I am extremely nervous about the op and whether it will cause any further scar tissue build up and nerve damage. To be honest there is no easy answer to these problems except try and avoid breaking any bones!
Harley says
I broke my right humorous 2 years ago whilst in a boxing match, i had a plate and 9 screws put in to fuse the bone together, i feel the bone has healed but my muscles dont feel as strong which is getting fraustrating. They cut through my tricep is there any chance they have damaged it to the point it will never be back to normal? As its been 2 years my faith in full recovery is gettin dull. Also i would like to compete in MMA (mixed martial arts ) do you think i could with the plate in?
Dr. Henley says
Talk to your surgeon. Your bone must be healed to compete.
Dr. Henley says
This sounds like a bad problem, but the steps may be necessary to restore function.
Further surgery always causes some scar tissue.
Therapy is critical to recovery after these tendon transfer operations.
Thanks for commenting!
Dr. Henley says
Luisa:
There are risks with taking the plate out. Sometimes bits of screw even have to be left inside if digging it out will destroy part of the bone.
Pain just from the plate being in there is unusual, but possible.
Questions to ask your surgeon:
– What are the risks?
– What do you think the chances are that my pain will completely go away after plate removal?
– What are some other things that could be causing the pain?
Dr. Henley says
Conscientious surgeons sometimes feel this way because we know that every surgery is not minor, and can cause further scar tissue or muscle/nerve injury (even though the chances are low).
Only you can decide whether you’re more fearful/aggravated by the risk of surgery or the risk of continued pain/discomfort with the plates. Most surgeons will take out the plate if you make it clear you understand the risks.
Dr. Henley says
Impossible for me to say what the cause was.
It’s a tough balance between pain control and safety after surgery like this.
Surgeons have to choose between patients feeling more pain right after surgery, but at least knowing about it; and feeling no pain afterwords, but not knowing there’s too much pressure on the arm for 12 hours or so…
Some patients love blocks, others would never have another one.
You’re right that more studies should be done, but there’s enough variation in patient opinion that there won’t be a black and white answer.
LUISA says
Not sure which reply was the answer to my question?
Safieh Meyrick says
I had a plate on my ulna after a fracture seven years ago. Recently after my normal moderate activity in the yard and gym i have terrible pain at the point of the fracture. What could be causing this. Even with rest it is still fairly painful , especially if i lift anything of 1 lb or more.
Akshay says
Hi, I had broken my wrist in 3 places. It’s has been exactly 3 months from surgery where they inserted metal plate and screws. I didn’t have any physical therapy sessions. My doctor just told of two exercises he wanted me do. One, was to do the “namaste” hand thing where you put your palms together and the other, was the exact opposite. That’s all. I’m concerned on wether I should be going to actual physical therapy sessions because my wrist still hurts very much when I put my palm on the floor and lift myself up. I simply cannot do it because of the pain. But if I were to use my fist on the floor instead of my palm I can easily support myself. so what should I do? I am concerned I that will never be able support myself with my palm and never be able to push up and all.
Dr. Henley says
Akshay:
If you’re not happy with how things are going, go back to the doctor who put the plate in.
Dr. Henley says
Safieh:
Pain where you had surgery is a good reason to see your surgeon, or one who specializes in hands and arms.
Dr. Henley says
Luisa:
Sorry – I need to add names as I reply.
James says
I broke both bones in my forearm (did not break the skin)in June 2007. I re-broke the same forearm just a lil higher this time 1 year later while playing football. I have plates and screws in my arm. Since then I’ve been perfectly fine minus a little short on full wrist rotation which was to be expected. Recently over the past week or so I’ve had sharp pains in my right forearm randomly when moving or rotating my right forearm. This is when holding and not holding something. Is it possible that a screw is loose or a tendon is irritated?
Prakash says
I fracture my right hand middle finger – proximal spiral tear in a freak accident that happened on the golf driving range. I underwent surgery and had 3 pins inserted. The ortho reckons that it will take 3 months to heal with therapy and thereafter pins will have to be removed. Do I really need to take them out and if I they are how long will it take before I can start playing golf again post removal?
Brian says
Hello,
I broke my 4th and 5th metacarpals? in my hand in early march, had surgery march 8th and had a plate put on both bones and a total of 13 screws. Slowly, I have been able to move my fingers more and more. I just went to a new docor (I moved away for the summer) for my two month post-op checkup and he said my bones are 100% healed and cleared me to do all activity, and encouraged me to push the hand a little bit. As Ive gone to the gym and lifted and tried to bend my fingers more, my pain has really increased quite a bit. I am supposed to play college baseball in september. The Dr. said he thinks I will be able to swing a bat and play by july, but my hand seems to hurt more and more every day I use it. Is this normal? Should I just let it rest more until the pain is gone or should I fight through the pain and stretch it and work it out?
Thank you,
Brian.
Beth says
Hi Dr.,
I had a spiral fracture of the fib/tib in January and had a plate and 9 screws put in my ankle. I had a pre-existing leg Lymphedema that though did not cause surgical complications, it did and has caused a slower rehab because of the swelling existing, on top of the new swelling from post surg. My ankle, though I am moving on it pretty well for 4 months out, playing light tennis, and light bike riding, I feel unusually sensitive pain along the scar line. I can feel the plate when I cross my ankle or touch the scar line and it’s almost as if the plate itself is causing a nerve reaction. I cannot WAIT to get this out. I would get it removed now if I could, but I am assuming I have to wait longer? Why would I have this pain along the scar line? from pressure against the plate? I can’t have that area have any contact with anything.
Stella says
My daughter who is 15 has a plate in her arm.. The Outside bone. (sorry not good with all the names) It has 6 pins in the bone holding the plate. The bone has healed from the accident that happened in December 2010. She has a HORRIBLE scar they say is because of the type of skin. It looks like a 12 inch bubble line. She complains some but not everyday! I normally give her ibuprofen. She is so self conscious of the scar so I took her back to the Dr. and (please forgive me) he was indifferent about it. He did X-ray, said the bone was healed, and she was experiencing mild discomfort from the plate. We decided yesterday to let her have the surgery if it was causing pain BUT it is not scheduled until 07/06/2012. I have time to back out of it. I am just not sure the risk is worth it and since she is 15 the decision is mine. I am worried sick about the complications of blood cots, heart attacks and Death from a surgery I am not sure is necessary. Also he gave her 0 encouragement about the huge scar being reduced. (that is the real reason I think she wants the surgery) They talked about some type of shots to reduce the scar tissue, some mesh that can be put over the area after the operation and of course Vitamin E oil. Can you give me any peace in my decision to allow this to proceed?
michelle says
My daughter who is a very competive long distance runner had broke her ankle and required 2 screws to be placed. This happened in Oct 0f 2011. She has taken the spring season off but continues to do some light training. She does complain of (mild)discomfort when running(2-4km) and has a little swelling that we ice down after. We think that maybe where her shoes hit may be the cause of that swelling as her track spikes seem to give her more comfort. The question is by taking the screws out would it be more benificial for a competive runner and how long does this take to heal. Her goal is to be back to full competive x country running the fall of 2012. Her surgeon said there would be no reason to remove them but…she seems to think it would be better to have them out.
Kathy says
what is the recovery time for having plates removed around the rotator cuff and upper arm
Dr. Henley says
James:
Tendon irritation is possible depending on where the plates were placed on each bone.
See your original surgeon and get an x-ray. If you see another surgeon, bring your old records including x-rays.
Dr. Henley says
Prakash:
Please ask your surgeon. I can’t give an informed answer without a ton of more information.
Most surgeons in America see their patients several times after surgery. Ask the next time he sees you.
Dr. Henley says
Brian:
Increasing pain doesn’t sound normal to me after a bone is completely 100% healed.
1. See your doctor again – you may need an x-ray
2. Ask about seeing a hand therapist
Dr. Henley says
Beth:
I recommend asking your surgeon to take it out if he thinks it’s causing problems.
Dr. Henley says
Stella:
Did you see a hand surgeon?
Most hand surgeons know about treating scars like this or have plastic surgeon colleagues who can manage the scar if you’re nervous about it.
Scars cannot always be corrected, and predicting whether a 15 year old will be happy with the final situation is probably impossible.
Talk to the anesthesiologist before the surgery about your worries.
Get a second opinion from a hand surgeon.
Dr. Henley says
Michelle:
You’re entitled to get another one or two opinions from other surgeons if you don’t agree with the first one.
I don’t know much about ankle fractures. I’d seek another opinion from a foot/ankle orthopaedic surgeon in your area.
Dr. Henley says
Kathy:
Taking out plates and screws usually requires avoiding heavy lifting for six weeks while the screw holes fill in.
Liam says
Dr. Henley,
Two and a half years ago I had an ORIF with 2 plates and 8 screws of the 4th and 5th metacarpals. Slowly, I started to lose feeling in my fingers. Finally, I went back to my physician and complained of the possible nerve damage. The hand surgeon removed all of the plates and screws with full recovery of feeling in my hand.
Today, there is still a large lump on my hand, 6 months post-op. What could it possibly be and what should I do? Are they cysts, new bone growth in the holes, scar tissue? I really do not want more surgery, but it is uncomfortable.
Joan says
Had a tib/fib fracture 5 years ago with pins, plate and screws. What would cause pain, redness and swelling after this much time?
gaurav saxena says
I have the titanium rod placed on my right hand shaft bone.It has been placed for more than 4 years.I am very eager to know weather this thing should be removed immidiately or it should not be removed(no side effects).I have done all the xrays and all were good.Its seems that broken bone is already got fixed and supporting rods are useless.My age is 23 currently.
People are advising that there is no need to remove it, perhaps it would invite operation cost etc.
I don’t have any complications at work.But still i fell, there is lack of confidence from my side during gym and other excercises.
What would you suggest to me.
If removing the rod is an only option left and its too urgent then i am ready to undergo for a surgery.
Please also let me know,if some wrong could happen if i don’t get it removed, as i am not too old.
Please suggest me
Thanks for your time
m.lawson says
I fell and broke my wrist in May 2007. Dr Barton in Lakeland,Fl did the surgery and inserted plate and screws. It healed up fantasticaly, small scar, no pain and I am leaving the plate in there. Why mess with something that is doing perfectly? I did not have PT on it either. I did my own ROM exercizes. End result was excellent.
Gina says
In January 2011, I broke my 2nd, 3rd, and 4th metacarpals due to a snowboarding injury. I had 3 plates and 27 screws put into my left hand. I wore a cast/splint for 4-5 months and have undergone 2 months of physical therapy. Thanks to therapy, I have most of my range of motion and strength back. However, I notice if I use my hand often my hands swell and my knuckles bruise. I also cannot make a tight fist. My hands are very small and the doctors originally wanted to take the metal out after 6 months, but decided not to since my therapy was going well.
I wonder if taking out the metal would increase my range of motion and rid myself of the pain and swelling that occurs after use of my hand. What do you think?
Any advice would be helpful.
Thanks,
Gina
Moses says
I fractured my lower limb in the month of April,went through the normal internal fixation of plates and screws,the doctor warned me not to place the leg on the ground till it fully heals,I’m confused and I want to know why.Thank you.
CHRISTOPHER says
Dear Sir
After a motorcycle accident last year i end up having 13 screws (with 2 thin hole plates between) in my left part of pelvis and 3 in my left leg at the top.i dont feel any pain from the screws or plates and i walk normal. Is it necessary to remove them?My opinion was to stay like this forever and only remove them if they heart or something.I am 30 years old and my body will not grow more so hopefully they will not move from their place.What do you thing?if you want me to send an xray foto from email let me know.I’m from Cyprus and the surgery was done in Israel
C. Noel Henley, MD says
Christopher:
I doubt removing them would be wise if they do not cause pain or problems.
An orthopedic surgeon who specializes in trauma (broken bones) could give you a better opinion. First ask the surgeon who put them in.
CNH
C. Noel Henley, MD says
Moses:
Putting weight on a bone that’s not healed will break the plates and cause difficult problems with healing. Your surgeon should be able to tell you when it’s healed and discuss strategies for dealing with a bone that isn’t healing properly.
CNH
C. Noel Henley, MD says
Gina:
It’s possible that it would help. You have to be mentally very committed to starting over in therapy, being very aggressive with range of motion and swelling control techniques, etc. Results will not be immediate.
CNH
C. Noel Henley, MD says
m.lawson:
I agree – no reason to remove it if you’re doing well.
CNH