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Hardware removal questions

post #1 of 27
Thread Starter 
I'm now going to be faced with the question of do I remove the ti Rod in my Femur.

Does anyone have any experience with removal of such hardware?

Any good information sights where I can read more about it. Pro and con.

Talking to my Ortho and other ortho's and PT's I respect I am leaning towards removal.

The next question is how long is the rehab, Since they are not rebuilding any thing as far as tendons, etc I expect the recovery to be a lot faster than say an ACL reconstruction, but how long can I expect to be on crutches, cane, limited activity, etc
post #2 of 27
dchan,
My son has a IM rod in his tib/fib. He has decided that it would be more trouble to remove it than to just leave it there.His removal would require that the kneecap be moved over and it could cause problems down the line.He still races motocross and tries not to think about breaking the same leg.His friend also has a rod in is femur and still rides.Many motocross riders face this same thing. But I think the majority of them leave their hardware in. I know this doesn't answer your questions but I thought you might like to hear about others like you.

Terry
post #3 of 27
I think everyone I know of has opted for removal, including the herminator. Don't really know much more than that aside from i suspect it ain't pretty.

There is a thread at TGR about 'rodding the tib' but it hasn't quite got to much on removal yet.
post #4 of 27
Sorry that I'm ignorant, but could you tell me the reasons for removing the rod?
post #5 of 27
I think if you break the same bone again the rod bends making removal and replacement quite ugly.

Terry
post #6 of 27
Thread Starter 
Quote:
Originally Posted by tcarey
I think if you break the same bone again the rod bends making removal and replacement quite ugly.

Terry
This is only part of the problem.

Most Ortho's say Athletes find it's more comfortable to have it removed. Because ti or any other metal flexes/stretches at different rates than bone (yes bone flexes) there will always be some discomfort when you "push" the bone that has the implant in it. In recent weeks I've noticed a new discomfort in the mid thigh. Somewhere I had not felt before. Maybe because I wasn't pushing it as hard. I am wondering if this is what they are talking about. Also at the ends where the rod ends there will be changing pressures in there every time you step down or in the case of skiing or other impact sports pound on it. Casual athletes or weekend warriors often don't push their limbs to the same extent so leaving the hardware in place doesn't seem to cause much discomfort but my Ortho says if I intend to continue to be very active, it will probably be more comfortable.

DC

A
post #7 of 27
Quote:
Originally Posted by dchan
This is only part of the problem.

Most Ortho's say Athletes find it's more comfortable to have it removed. Because ti or any other metal flexes/stretches at different rates than bone (yes bone flexes) there will always be some discomfort when you "push" the bone that has the implant in it. In recent weeks I've noticed a new discomfort in the mid thigh. Somewhere I had not felt before. Maybe because I wasn't pushing it as hard. I am wondering if this is what they are talking about. Also at the ends where the rod ends there will be changing pressures in there every time you step down or in the case of skiing or other impact sports pound on it. Casual athletes or weekend warriors often don't push their limbs to the same extent so leaving the hardware in place doesn't seem to cause much discomfort but my Ortho says if I intend to continue to be very active, it will probably be more comfortable.

DC

A
I would agree with the ortho. As long as you are well healed and with good result in terms of the repair, I think most active individuals do better with removal. This is quite a deep rod so it may not be an issue, but many people with more superficial hardware (plates and screws on bone surfaces etc.) complain of problems in the cold. If the harware is close to the surface, it can have a chilling effect in colder temp. I would listen to your Orthopedist.
post #8 of 27
dchan,

my right ACL recon involved some hardware that provoked me to consider the same issue. my orthopod at the time suggested leaving the hardware alone UNLESS it provoked an allergic/rejection response (which it hadn't) or UNLESS he had reason to go back into the knee to do post-op cleanup.

the latter happened and 1.5 years after the original recon, he opened me up, removed the hardware, and shaved some cartilage and scar tissue.

however, if that never had occurred, I'd have left it alone.

my left ACL recon has hardware still residing in my femur or tibia, don't recall which. I'm leaving it there.
post #9 of 27
Thread Starter 
Quote:
Originally Posted by gonzostrike
dchan,
my left ACL recon has hardware still residing in my femur or tibia, don't recall which. I'm leaving it there.
I'm assuming you are talking about a small piece of hardware.

When its 390MM long I'm guessing rate of movement would be quite a bit more.

DC
post #10 of 27
When they take it out be sure to get it and mount it on a plaque. You earned it and you paided for it.
post #11 of 27
I broke my fibula in 3 places about 15 years ago (the result of dislocating my ankle) and acquired a 7" piece of what looks like "erector set" along with 3 screws to hold everything in place. It only bothers me if I do something (stupid) involving a lot of pounding; running around the bases in softball is OK, basketball isn't. I have no weather problems and with the exception of some easily corrected boot fitting issues, skiing has never really bothered it.

Way back when, I asked about removing the hardware, but my surgeon said that as long there was no adverse reaction to it and no significant discomfort, it just wasn't worth the trouble. It would involve anywhere from 4-8 weeks of downtime, some of that on crutches. Having already been out of commission for 12 weeks (about half of that on crutches), it wasn't tough to convince me. Of course, it's quite possible the medical community has changed their thinking over 15 years.

For what it's worth, they probably won't let you keep the hardware. There was a 4th screw through the ball of my ankle which was removed 4 weeks after the original surgery. I wanted it but they insisted on sending it off to the pathology dept.
post #12 of 27
I've got a rod in my right tib that can't be removed. My bone canal is too narrow. So far, it hasn't given me too many problems but the break area is still sore so I may not be noticing the rod. (break happened Dec 03) I did have to have one pin removed so far since the tendon on the front of my foot was dragging over it and that was no problem. In and out of surgery in under an hour and I was able to walk out of recovery (even though they didn't let me). A little bit of bleeding and weeping for the next few days, but the tendon started feeling better in recovery. Oh. And I got to keep my screw.
post #13 of 27
Rod is in femur (as stated above) & is 39 cm long.... the real issue you face w/ the rod in is that if you have another spill where your femur would/should break...all that metal is going to shatter the bone (long lever arm) around it. Plus you run the risk shreading the knee (bad) or breaking the head/neck (top) of the femur (v.v. bad) b/c you can do damage to the blood supply to the bone & damange the nerves in that area.
The orthopods i spoke w/ agreed :young, active, likely(sorry) to reinjure..out

as for the rehab it is not as bad as the original, but some bone healing does need occur. best to ask about this & discuss w/ MD
post #14 of 27
Thread Starter 
So the decision has been made. I met my ortho on Monday, had the x-rays and it looks like the bone is healed. I go for surgery on June 3rd to have the rod removed. The surgery co-ordinator tells me it's a 1 hour proceedure done outpatient. I get to go home right after surgery and recovery.

The proceedure involves an orthroscope proceedure that they do first to remove and clean up scar tissue. Then they take the screws out. next they go into the knee and back out the ti rod. No contact sports, no skiing or skating for a month or so but they want me to try to start walking on it as soon as I can. 100% weight bearing, comfort and pain are my only restriction.
Also wound care for the incision locations means no bath's and I need to keep the wounds clean and dry until the staples or sutures come out.

I have not asked yet if I get to keep the rod.

I guess this ends my season. It was a pretty good one. Now to start rehab and training for next season.

DC
post #15 of 27
Good luck, David! And for what it's worth, we let all of the kids keep their hardware here in Denver- we even clean the blood off, too!
post #16 of 27
Dave,

I was impressed with your form at Squaw. Royal form. As this rod is close to the knee, I hereby dub you "ROD KNEE KING"

post #17 of 27
David, I broke my left leg, both the tibia and fibula, in 1970 while skiing in Davos Switzerland. The tibia was broken in two places six inches apart but my knee and ankle joints were not affected. A foot long plate was placed over my tibia in front and eleven screws held the bones, the fibula was left alone to heal.

Though the surgeon here did not want to take the plate out, the Swiss doctors insisted it come out within six month saying that, like in a broom stick, the bone where the screws go though is less strong and should another break occur it would be a real mess, but with the screws and plate out the bone will fill in the holes and it will be as strong as before the break.

So I had it out and a funny part of this story is that the doctors in Davos sent along a letter as to how it should be removed, they sent x-rays, but the screw are hex socket screws and are metric and no allen wrench here fit and as the Swiss neglected to send a metric wrench, the surgeon had to sterilize a vise-grip to remove the screws, the nurses said they never heard such language from the doc before.

And oh, I got to keep the plate and ten screws, so I made a 30 inch long prints of the x-ray, framed it, drove a big nail into the mounted print and hung the plate and the screws from strings of various length from it, it made a nice conversation piece.
....Ott
post #18 of 27
Thread Starter 
Quote:
Originally Posted by Ott Gangl
but the screw are hex socket screws and are metric and no allen wrench here fit and as the Swiss neglected to send a metric wrench, the surgeon had to sterilize a vise-grip to remove the screws, the nurses said they never heard such language from the doc before.
As I talked to the ortho about my options he asked me where I had the rod put in. I told him Mammoth and he said he would need to call the hospital to get the make and model of my implant. I reminded him that he had the OP report from the surgery. with that info.. Together we found the info on the rod and he commented "it would be nice to make sure we have the correct bits to remove that rod before we open you up". Hopefully we won't be hearing swearing while when he sees the screw heads!

Quote:
Originally Posted by Ott Gangl
And oh, I got to keep the plate and ten screws, so I made a 30 inch long prints of the x-ray, framed it, drove a big nail into the mounted print and hung the plate and the screws from strings of various length from it, it made a nice conversation piece.
....Ott
Nice, I'll have to think of something for mine if I get to keep them.

I do have lots of old skis I'm thinking about mounting on the wall... hmmm.

DC
post #19 of 27
Thread Starter 
Quote:
Originally Posted by Jim S
Dave,

I was impressed with your form at Squaw. Royal form. As this rod is close to the knee, I hereby dub you "ROD KNEE KING"

Thanks. it was fun.. I guess I should have taken MTT up on the offer to video tape me one last time.

Oh well, next year...
post #20 of 27
DChan - we had one of the kids in our pack break her femur in Mammoth about 3 years ago. When the docs at UCLA took the rod out they were VERY impressed with the work the Mammoth OS did. I guess they've really upgraded their skills up there over the years. My OS said 10+ years ago patients from the Mammoth hospital looked like they'd been treated in a field MASH unit under attack

Good luck w/ your re-hab.
post #21 of 27
Thread Starter 
RE Mammoth Hospital,

They probably do a great deal of "IM Nail" implants so they get lots of practice.

Also two of the three Ortho's at Mammoth are on the US Ski and snowboard team staff.
post #22 of 27
Thread Starter 
I just got the call from the Surgery nurse. I asked about keeping the hardware. She say's that should be no problem. They even sterilize all the hardware for you if you ask to keep it. Now all I need is a project.

DC
post #23 of 27
dchan,

My ex-wife had some hardware put in her ankle. Due to muscle spams, one of the screws worked loose. We had the x-ray to prove it. She was very proud to say she had a screw loose. Hopefully all your screws stayed tight.

As for mounting. A nice wooden plaque with an engraved plate with the dates of the injury, and the time you "wore" the hardware should be nice.
post #24 of 27
Thread Starter 
Surgery went well, I'm back home. the joints and muscles are a little tender and sore but I'm moving around. Slowly but managable.

The surgery center would not give me the Rod, but they mentioned that I need to talk to my surgeon to get it back. I did tell him I wanted to keep it so hopefully he still has it and will give it to me when I have my post op. appointment.
post #25 of 27
If it's long enough you might want to use it as a shaft for a putter.

Congrats on getting all the junk out. Now you can fly without explaining everything to the TSA guys.
post #26 of 27
Thread Starter 
3 days post surgery and still no strong pain killers, except for an aleve to help with the inflammation. I'm walking (or hobbling is probably a little more accurate) without cane or crutches around the house and using a cane on the street. There is a little pain when I flex and extend (mostly from the suture sites) but I'm on the way back !!!
post #27 of 27
Quote:
Originally Posted by dchan
I just got the call from the Surgery nurse. I asked about keeping the hardware. She say's that should be no problem. They even sterilize all the hardware for you if you ask to keep it. Now all I need is a project.

DC

Good woodworking task to go along with the other stuff you've done already, Dave. Something to keep you busy during the recovery period. Good luck!
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