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Material removal (removal of metal such as intramedullary nail, plates, screws)
To a Bone healing in fractures To ensure this, foreign materials are often introduced into the body for stabilization (osteosynthesis). These include, among other things plates, Screws, Intramedullary nails, Wires as well as more specialized devices such as Internal fixator and external fixator. Once the bones have grown together completely, the materials can often be removed.
When should the metal be removed?
The material used is routinely removed in 65% of cases. In general, the stabilization device can be removed after each complete healing of a bone fracture. However, there are reasons where removal is particularly indicated. These include the weakening of the bone tissue due to the presence of the material, infections, effects on the metabolism from released substances, loosened materials and protruding from the outer skin, which can be the case especially in older patients. In children, the material should always be removed so as not to disrupt growth. Even with younger people there is a tendency to remove the material so that there are no complications if it breaks again. Likewise, if the metal remains in the body, it can put the immune system at risk and make it more prone to infections and fractures.
How does metal feel in the body?
Normally there are no complaints from the materials. Sometimes the patient feels bothersome pressure or pain. If there are complications from the osteosynthesis material, particular complaints arise.
How do you prepare for metal removal?
A medical history (patient survey) and physical examination are routinely carried out. The position of the structures and the stability of the more or less fused bone can be shown on an X-ray image. Sometimes a bone scintigraphy is also recommended, an imaging procedure with the administration of a weakly radioactive substance. In most cases it is known that the respective fixation material is available.
How is it treated?
The intramedullary nail or other material can often be left in place. In particular, the foreign material should not be removed if the benefits of the procedure are less than the risks involved. This is the case if the operation necessary for removal is complex and involves high risks, the respective structure is already firmly attached or if an operation is dangerous due to the patient's underlying illnesses.
The operation is performed under local or general anesthesia.
Basically, the later the metal removal takes place, the more difficult the operation is. Ideally, the material used is removed quickly, but not too quickly. It is therefore important to determine the perfect time so that the bone is stable enough and it does not break again. In children, the foreign material is removed after a few weeks. In adults, the material is removed after 12 to 18 months, depending on the location.
The removal of the metal is a minor intervention than what was necessary in the original operation. In many cases, only a small incision needs to be made. Otherwise, the access required for insertion can normally be reopened. It may also be necessary to open the bone. Depending on the type of material, this is then removed.
In the case of larger removal operations, a drainage tube is placed that drains off wound fluid. The hose can be pulled out again after a few days.
In many cases these days, metal removal can be done on an outpatient basis without having to stay in hospital.
Possible extensions of the operation
If a chronic infection around the material is likely, antibiotic carriers or a special irrigation-suction drainage system are inserted.
If, contrary to previous assumptions, bone healing has not progressed sufficiently, the body can, for example, implant fragments of bone or bone substitute material from its own or foreign body, or a new stabilizing structure can be used.
Corrective surgery for the old scars can also be combined with the removal operation.
What complications can arise?
The procedure can cause renewed fractures or splintering of bones. It is possible that the bone from which the structure was removed is not very load-resistant at first. Bleeding, secondary bleeding and bruising (hematoma) can have further consequences. Infections, wound healing disorders and excessive scarring can occur. In rare cases, vessels and nerves can be injured. Allergic reactions cannot be ruled out either.
What is the prognosis?
The prognosis after the removal of the stabilization material depends on the extent of the previous injury, the extent of the intervention, possible complications, the age and the general condition of the patient. Complicated fractures can still be painful after metal removal. This is often due to the misalignment caused by the injury sustained. In such a case, it makes sense to go through rehab and physiotherapy after the metal removal.
Before the operation
Medicines that adversely affect blood clotting, e.g. Marcumar® or Aspirin®, often have to be discontinued. Consultation with the doctor is necessary for this.
The patient should not smoke for two weeks before to a month after the operation, as this can hinder healing.
After the operation
In the case of an outpatient operation, the patient must be picked up and should not drive a car, operate machines or make any meaningful decisions for a day.
It is usually necessary to protect the part of the body that has been operated on for some time. Wound treatment or physiotherapy can have a positive effect on the healing process.
If there are any special features that could be symptoms of a complication, the doctor should be informed at short notice.
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