Bone fixations are made to stabilize the bone fragments after a fracture or after corrective surgery. Thanks to this, it is possible to provide appropriate conditions for bone union. When the doctor confirms the bone union on the basis of X-rays, no further maintenance of the anastomosis is necessary. The removal of a screw or plate from the bone is usually associated with the reopening of the body integuments, hence many patients fear complications and discomfort associated with wound healing. However, the surgery to remove the anastomosis is a simple procedure, so if you need to perform such an operation, you should not worry about it.
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Types of bone anastomosis
Anastomosis can take the form of screws, plates, staples, intramedullary nails or Kirschner wires. They are made of materials that should not interact with body tissues (they should not cause allergy). Currently used materials are high-quality metal or titanium alloys. Most of them allow you to use magnetic resonance imaging (MRI). Older types of metal bone anastomoses may, however, be a contraindication to MRI, and therefore often limit the possibility of diagnosis in a patient. Limitations may also apply to the use of certain treatments in the field of physical therapy, i.e. electrotherapy or ultrasound. People who have metal elements of the joints in their bodies should have a certificate of the type of material they are made of. If in any doubt, please consult your doctor.
In what cases is it advisable to remove the anastomosis?
The orthopedic surgeon decides whether to remove the anastomosis or leave it in the body. Ideally, it should be the same doctor who performed the bone anastomosis. The factors supporting anastomotic removal include:
Restriction of joint mobility by the screw / plate - in some cases it is advisable to remove the screw from the distal end of the tibia and fibula to allow full range of motion in the ankle joint,
Traces of damage or loosening of the anastomosis or irritation of soft tissues by the protruding part of the anastomosis - especially in young people with an active lifestyle,
An old generation metal plate or screw that prevents the use of magnetic resonance imaging diagnostics or physical therapy procedures,
Frequent travels and problems with control at airport gates.
The protruding Kirschner wires in the finger of the hand or the foot are obligatorily removed after the bone union is achieved (about 6 weeks after the initial procedure). If the Kirchner wires were left in the finger, there was a risk of infection, inflammation or damage to the bones of the phalanges while walking. Anastomoses that do not need to be removed include intramedullary nails, e.g. in the femur. The final decision on whether to leave or remove the screws from the bone is always made by the attending physician and should not be questioned.
What is the optimal time to remove the screw from the bone?
Bone fixation can be removed after complete bone union after fracture is achieved. The optimal time to remove the anastomosis depends on the type of screws or plates used, the location of the fracture, the course of convalescence after the procedure, as well as the age and comorbidities of the patient.
The safest solution is to remove the ankle, e.g. from the ankle joint (after an ankle fracture) after 3 months - this will avoid unnecessary blockage within the forks of the tibia and fibula, which could disturb the biomechanics of the ankle joint. At the same time, it should be remembered that the types of anastomosis are different - some are more "stiff" and others "work" with bones. When the doctor specifically orders the removal of the screws, the procedure should not be postponed, because leaving the anastomosis in the body may expose the patient to complications in the future.
What is the procedure of removing metal anastomoses?
Removing the protruding Kirchner wire from the finger (e.g. after corrective procedures of the hammer toe in the foot is an obligatory activity after confirming the fusion of the bone phalanges of the finger. Removal of the Kirchner wire takes only a few minutes and often does not require an anesthetic. There is no need to cut the skin during this operation - the wire is pulled out by the protruding part through the fingertip, and there is no need for stitches - only a small hole (up to 2mm) remains, which heals very quickly.
Removal of internal anastomoses requires access to the anastomosis to be removed and involves cutting the skin. The patient is under local, epidural or general anesthesia - the procedure is therefore completely painless. The surgeon cuts the skin to an extent that allows him to completely remove all screws and plates. After removing the anastomosis, the skin is sutured and secured with a dressing. Removing the anastomosis after a fracture is usually a much shorter procedure compared to the initial operation of its insertion. The duration depends on the location, type of anastomotic to be removed and whether the anastomosis has been hypertrophied with bone tissue. The duration of the procedure is usually around 30 minutes. If the small screws are removed, the patient leaves the hospital on the same day. If the removed anastomosis was larger and required special anesthesia or was located in a delicate area, discharge from the hospital takes place the day after the procedure.
Procedure after surgery
When the anesthesia stops working, slight pain may occur, which is normal due to the disruption of the tissues and the beginning of the healing process. The operated area may also be slightly swollen and this condition may persist for several weeks after the procedure. Cool compresses can be used to reduce swelling.
Rehabilitation after removal of the anastomosis consists mainly in the mobilization of the postoperative scar to reduce its visibility and improve flexibility and displacement in relation to other tissues. Management may also include range of motion exercises in an adjacent pond. There is no need for crutches after the tibia or other leg bones are removed. Return to activity is possible after the postoperative wound has healed - it is usually 3 weeks after the surgery.
Important info
| Duration of the procedure (depending on the method) |
20 minutes - 2 hours |
| Tests required for surgery | basic - preparation for surgery tab |
| Anesthesia | location dependent |
| Hospital stay | 3-8 hours |
| A period of significant dysfunction | 3-5 days |
| A period of limited dysfunction | 14 days |
| Removal of stitches - first visit | 12-18 days |
| Change of dressings | every 3-4 day |
| Contraindications to the procedure | depending on the type of surgery |
Frequently asked questions about bone anastomosis removal:
Kirchner wires are held only until bone fusion in the finger is achieved. Kirchner wires are removed during an orthopedic check-up, usually about 6 weeks after the procedure. Kirchner wire removal takes only a few minutes and often does not require an anesthetic. During this operation, there is no need to cut the leather - the wire is pulled out by the tip of the finger with the protruding part. There is also no need to put on stitches - only a small hole (up to 2mm) remains, which heals very quickly.
The orthopedic surgeon decides whether to remove the anastomosis or leave it in the bone. The factors supporting the removal of the anastomosis include:
Limitation of the mobility of the joint by the screw / plate,
Traces of damage or loosening of the anastomosis or irritation of soft tissues by the protruding element of the anastomosis,
An old generation metal plate or screw that prevents the use of magnetic resonance imaging diagnostics or physical therapy procedures,
Frequent travels and problems with control at airport gates.
