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!)
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.