Overview
Metal hardware placed during fracture surgery (plates, screws, rods, pins) holds the bone in line while it heals. Once the fracture has healed, the hardware has done its job. Most hardware can stay in for life without causing problems, and routine removal is not recommended. Removal is offered when the hardware is causing you symptoms. The most common is pain over a plate that sits close under the skin, often at the collarbone, the outer ankle, or the tip of the elbow. Screws near the surface can also irritate the soft tissue.
One special case is a syndesmotic screw, a screw placed across the two leg bones to hold the ankle joint snug while its ligaments heal. That screw needs to come out before full ankle motion is restored. In rare cases, hardware is removed to make room for a future surgery, such as a total joint replacement where the metal is in the way. Some younger patients also prefer to have the metal out before more bone grows around it.
How the Procedure Works
Your surgeon typically reopens the previous incision. Each piece of hardware is then removed in turn. Screws are backed out, plates are lifted off the bone, and rods are pulled back out the way they went in. Once in a while a screw head is damaged, or a screw has bonded to the plate. Those screws take special tools and a little more time to remove. The screw holes are left to fill in with bone on their own, which happens over weeks to months. Your bone will be temporarily weaker at the screw holes. For that reason, activity is restricted while the holes fill in. Your surgeon will tell you how long to limit activity, based on what was removed and how your bone looks. The wound is then closed and dressed.
When to Consider Hardware Removal
Symptomatic hardware
Pain, metal you can feel under the skin, or soft tissue irritation from a plate, screw, or rod that gets in the way of daily life.
Required for another procedure
Hardware that must come out before a total joint replacement or other planned surgery.
Syndesmotic screw removal
Syndesmotic screws placed during ankle fracture surgery. They come out to restore the full upward bend of the foot (dorsiflexion).
Treats: Adult Fractures (post-fixation)
Physicians Who Perform Hardware Removal
Risks & Why We Still Recommend It
Every operation carries risk. This procedure is offered because the condition, when left untreated, can cause ongoing pain or irritation from prominent or symptomatic hardware that outweighs the small risks of removing it. The decision to proceed weighs the risks of surgery against the limitations the condition places on daily function. Surgery does not remove risk; it addresses a problem that is otherwise progressive. Whether it is appropriate is determined for each patient in consultation with the surgeon.
Risks include a new break through the screw holes (refracture), which is the main reason activity is limited after removal. Other risks are infection, nerve injury (scar tissue around the hardware can hide nerves), incomplete removal (a damaged or in-grown screw may have to stay), and the general risks of anesthesia. We recommend removal when the symptoms the hardware causes outweigh the risks of the procedure.
Frequently Asked
questions we hear in clinicDoes the hardware have to come out once my bone heals?
No. Most hardware can stay in for life without causing problems, and routine removal is not recommended. Removal is offered when the hardware is causing you symptoms.
How do I know my hardware is the problem?
The most common symptom is pain over a plate that sits close under the skin, often at the collarbone, the outer ankle, or the tip of the elbow. Screws near the surface can also irritate the soft tissue.
Will my bone be weaker after the screws come out?
Temporarily, yes. The screw holes are left to fill in with bone on their own, which happens over weeks to months. That is why activity is restricted after removal of large implants, and why a new break through the screw holes (refracture) is the main risk we watch for. Your surgeon sets how long the limits last.
Can every piece always be removed?
Once in a while a screw head is damaged, or a screw has bonded to the plate. Those take special tools and a little more time, and a damaged or in-grown screw may have to stay.
What is a syndesmotic screw, and why is it different?
It is a screw placed across the two leg bones to hold the ankle joint snug while its ligaments heal. Unlike most hardware, that screw needs to come out before full ankle motion is restored.
Further Reading
External patient-education references and related OSI pages for additional background: