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Is Hardware Removal From Tibial Plateau Fracture Advisable?

Posted on Mon, 12 May 2014

Question: Need advice on whether to pursue hardware removal from tibial plateau fracture 2 years ago - have posterior plate in proximal tibia which is symptomatic (pain down anterior tibia with knee flexion/weight bearing), but would require posterior surgical approach through popliteal fossa - local surgeons say too risky (nerve/vascular injury)

Answered by Dr. Dr. Praveen Tayal (1 hour later)

Brief Answer: Surgical removal is needed. Detailed Answer: Hello, Thanks for posting your query. I have seen the X-ray attached. The implant needs to be removed for the pain relief. This can also aggravate mild arthritic changes in the knee joint. The removal of the implant is possible through the posterior approach only. Every surgical procedure is associated with some risk of complications. Nerve and vascular injury can be avoided by an expert surgeon and if done with care. I would advise you to get the implant removed from the same surgeon who placed it inside. He would be able to approach the implant with minimal damage to the surrounding soft tissues. I hope this answers your query. In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out. Wishing you good health. Regards. Dr. Praveen Tayal. For future query, you can directly approach me through my profile URL http://bit.ly/Dr-Praveen-Tayal

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Praveen Tayal (7 hours later)

Thanks for the reply. I have uploaded the frontal X-ray as it didn't seem to go through initially. Unfortunately the surgeon who did my initial surgery refuses to remove the plate as he feels it is too risky. There is a younger surgeon in town who is willing to do it, but less experienced. Or I may need to find a surgeon at a larger centre. Does this sort of surgery need an EXPERIENCED surgeon or just a good one? Would weight loss help with pain (~ 50 lbs over ideal BMI)? What are chances that removing plate WOULDN'T ease the pain (i.e. Pain may be due to "stress risers" - not sure what this means but was given as reason to not remove plate)? Does it make a difference how long I wait to get the plate removed (given that it is already 2 years out from initial surgery)? Thanks.

Answered by Dr. Dr. Praveen Tayal (11 hours later)

Brief Answer: Experienced surgeon. Detailed Answer: Hello. Thanks for writing again. It is best to find a surgeon at a larger center as it is better to get it done from an experienced surgeon. An average surgeon might not be experienced enough to save the nerve or vessels from the scar tissue. Weight loss will decrease the pain but the removal of the screws will help you more. Your pain will decrease considerably after the removal of the graft. If you plan to remove the plate then it is best to get it removed now. The more delay means more inflammation and scar tissue and more difficult it will be to remove. Hope my answer is helpful. Do accept my answer in case there are no further queries. Regards.

Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar