Metalwork removal is an operation to take out plates, screws, nails, or wires that were used to fix a fracture, once the bone has fully healed. It is usually performed because the metalwork is causing discomfort, prominence, or other problems.
An incision is made over the existing scar or directly over the metalwork. The plate, screws, nail, or wires are identified and removed. In most cases the procedure is straightforward, though occasionally screws may be difficult to remove if bone has grown over them. The wound is closed and a dressing applied. The operation typically takes 30–90 minutes depending on the type and location of metalwork.
Metalwork removal is considered when implants cause pain, prominence, or irritation (particularly in areas with thin soft tissue such as the ankle, elbow, or clavicle), when they restrict movement, or occasionally for specific reasons such as planned future surgery or in young patients who have completed growth.
If the metalwork is not causing problems, it can safely be left in place permanently. Most orthopaedic implants are made of titanium or stainless steel and do not need to be routinely removed.
Standard pre-assessment. This is usually a day-case procedure.
Removal of prominent or painful metalwork usually provides relief from local symptoms. However, not all discomfort around a fracture site is caused by the metalwork — some pain may persist after removal.
Pain may not be fully relieved, as the discomfort may not have been caused solely by the metalwork.
The existing scar may need to be extended or a new incision made.
The bone may be slightly weakened where screws were removed. Restrictions on activity may apply for a few weeks.
The bone may fracture through the screw holes after removal. This risk is small and can be reduced by restricting heavy activity for four to six weeks.
Screws may be stripped, broken, or overgrown with bone, making removal difficult or incomplete.
Wound infection.
Scar tissue from the original surgery may make nerve identification more difficult.
General or regional anaesthesia depending on the location of the metalwork.
Recovery is usually quick. The limb may need protection for four to six weeks while the screw holes fill in with new bone. Activity restrictions during this period reduce the risk of re-fracture. Return to normal activities at four to eight weeks.
Wound check at two weeks. Further follow-up only if needed.
No. Most metalwork can be left in permanently if it is not causing problems. Removal is only recommended when there is a specific reason.
A small risk exists, particularly with large plates. Activity is restricted for four to six weeks after removal to allow the bone to strengthen.
Usually not. Metalwork removal is typically a shorter, simpler procedure than the original fracture fixation.