# To Remove the Hardware...that is the question...



## snowgypsy (Jun 5, 2011)

I have a three screws and two pins in my ankle/leg following a nasty fall five months ago. 

They aren't a big bother, but they are, well, annoying; I can feel them - especially when in my ski boots or when doing certain movements with my ankle while on the bike - especially when my ankle is flexed downward and slightly to the right. And it's not just a "grandpa" ankle feeling - there's an awkward pain associated with them.

The PT says to take them out. I've already met my out-of-pocket max for the year, the surgery would be free, recovery would be nothing compared to what I have already been through, and I'll be a much happier rider for it. I could bike another week, get them out, recover for 2-3 weeks, and be skiing aggressively by xmas.

The doc says it isn't really, super necessary to put my body through another surgery considering the trauma that it's still recovering from. And nothing sounds worse to me at this moment than going under the knife again for the forth time in 2.5 years.

So the big question for those of you have bionic legs, arms, as well. Did you keep your hardware in or did you take it out? Was it the right choice? And, if you did decide to take it out, what was the recovery like?

Thanks loves :thumbsup:


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## shellshocked (Jul 9, 2011)

Not me but my daughter had plates in her arm from a bad break. Like you they bothered her. She had them removed - not a major surgery just a couple of small incisions. Without a doubt the right thing for her.


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## mtnbikej (Sep 6, 2001)

When the plates and screws were put into my ankle....I asked the Ortho about removing them once I am healed....he said to just leave them in UNLESS....they start to bother me. Such as feeling the screw heads rub again my work boots.

I have chosen to leave them in for the time being...really not causing any problems. Yes, I can feel them....bone/plate/screw/skin....no extra meat there to cover them up.


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## evasive (Feb 18, 2005)

I have two friends who each have a bunch of screws and a plate in their elbows. One just got his 2 weeks ago. The other is coming up on 2 years in December. He still has his in and is still working to build muscle over it. His dad and I think that's just likely to make it worse when he eventually has to get them out. Tough question.


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## WillTheGreat (Aug 26, 2010)

I'm not sure how relevant this is to your ankle, but I had a hook-plate and screws removed from my collarbone, and the recovery was really quick and easy. My hardware was all right below the skin, so the procedure was minimally invasive and they only had to cut the skin a few inches which was smaller than the original incision.

I definitely appreciate the extra comfort with the hardware removed.

My doc told me to avoid any big falls until the screw holes fill in with bone.


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## Spdu4ia (Aug 6, 2009)

Still have my screws in place and rod in my leg from surg 5 years ago. I can feel the screws but I don't get significant enough pain to go through surg to remove them. Its more annoyance than pain and it doesn't hinder my riding at all. If it did I would remove them (screws , not the rod). Seems really subjective and individual from person to person wether to remove them.


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## bryan_d (Mar 16, 2009)

Man that is nutty stuff there spd.

I had the hardware from my elbow removed (pin and loop) because it was definitely a bother; even dress shirts caused discomfort. The plate and screws in my collarbone I am still debating the removal. It causes discomfort from driving, wearing a bag, and direct contact, but the removal might be as traumatic as the original surgery (screws both on top and bottom).

The year long healing and p**sy footing ride policy is also a downer.

What to do?...

Bryan


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## mtnbikej (Sep 6, 2001)

I have been told that if hardware is removed, that the incision itself heals quickly....it is the holes in the bone that take time to fill in. Depending on how many, this is where the down time/recovery, then taking it easy to avoid reinjurying that bone comes into play. Was told it could be 6-8 weeks for the bone to reheal. 

I have hit the plates on each side of my ankle at different times.....kinda give a piano tuning fork feeling. After 4 years I am not looking to remove them. 

Plates and screws in my shoulder are there for good. Too invasive to have them removed.


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## snowgypsy (Jun 5, 2011)

bryan_d said:


> The year long healing and p**sy footing ride policy is also a downer.
> 
> What to do?...
> 
> Bryan


That is the question...If it was serious pain, I would have it removed, but I feel my tolerance for pain has gone up and my tolerance for gimping around has definitely gone done. Even if slightly painful, awkward, and not "perfect," I'm having a hard time justifying putting myself down for another 4-6 weeks...decisions, decisions...kind of hearing the same thing - it's worth it but there's a lot of fear in putting yourself through another surgery, another healing time, another round of crutches when it's not absolutely, totally necessary.

Still, it's really annoying to feel it up against my ski boots...it hits rights there in the sweet spot, like a little burning needle of hate and anger.


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## IP_Ale (Mar 14, 2011)

This is what the inside of my ankle looks like after an MTB crash and surgery in February 2014:










All the hardware is still in there, except for the one screw going across the fibula and tibia, which was removed back in May. Going on 9 months later, for the most part, the hardware doesn't bother me. The two screws on the inside of my ankle (the tibia side) are the only ones that are a potential problem. I definitely can relate to the "burning needle of hate and anger" feeling with those two screws. There are a couple of positions I can put my ankle in where that is the only way to describe the feeling. A couple of months ago (when after a lot of activity the screws were really bothersome), I asked my surgeon about taking just those two screws out; he said it would be best to wait a full year before making that decision - he said it would really take a solid year for my injury to heal. As each week passes, I still can feel it getting better and better, so maybe he is right for me to wait it out.

However, if you are having a problem with pain caused by hardware physically rubbing against your boots, and there isn't a different style of boot availble, that likely isn't going to go away. Depending on what your particular hardware situation is, the surgery could be quick and relatively easy, with a short recovery, and a lifelong benefit. When I had that one screw removed in May, they didn't even have to put me fully under, they just "twilighted" me, and I was off the operating table in less than 20 minutes.

Good luck!


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## snowgypsy (Jun 5, 2011)

Thank you everyone!

My surgeon had said he would rather wait a full year - just to see - but he wants me to feel 100% ready to come back into the downhill scene next year. And he understands the complexities of insurance.

I've already met my out of pocket max, and my deductible is something ridiculous, I wouldn't be able to afford to get the surgery after the 31st. I really, really hate making medical decisions based on insurance, but I'd rather get it out December 30 (the first date Griggs will feel comfortable taking it out), than need the surgery a year later and not be able to afford it because my deductible reset.

I don't yet have an image that I can upload, but there are 2 screws and three pins that I would have removed and a few bone spurs that I would love to get cleaned up. My surgeon was actually amazing - Dr.Rhett Griggs is amazing, amazing. I can't say enough about him. He's probably the best human being I've met in a while and he really, really gets it and isn't afraid to take risks. Rather than a plate, for example, he was able to use surgical thread to "tie" my tib/fib back into place - saving a plate and about four more screws. 

After looking at everything I've been through, though, what's four-six more weeks to feeling back to normal? With my knee, I settled for 80% for years. Not this time. Luckily I have a surgeon who agrees. He's not settling for anything less than 110%, rampaging down the mountain, and neither am I. 

I think that I'm going for it! My original break/operation was July 4, so it's a little soon, but I think it's the right call. I'm getting a mri on Dec. 1 to make sure that everything is healing well and if it looks solid, I'll be going under Dec. 30ish. I'll keep the thread updated just in case someone else in this position. 

I'm looking forward to the end of my burning needle of anger and hate!


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## mtnbikej (Sep 6, 2001)

Here is mine......the hardware that I sometimes feel in my work boots are the 6 on the left side of the pic(right side of ankle).

However you can feel them by just running your finger over the skin.

The one on the left side of the ankle at the bottom of the hook, I tend to hit on the crank arm....not painful, but reverberates through the bone.


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## snowgypsy (Jun 5, 2011)

And so...update! Had surgery yesterday to remove two screws, three pins, a lot of surgical wire, and several little "buttons" that held the wire and thus my tib/fib in place. Also, cleaned up several bone spurs and removed a piece of bone that wasn't healing properly.

I'm on crutches today and perhaps tomorrow, but am already toe-touching. The only thing holding me back are the stitches which I must not rip out (must not rip out!!). Compared to how I felt after the last surgery, this is a dream - a walk in the park - floating on carbon rims through miles and miles of flowing, sexy techy chunk. 

I haven't needed any pain medication. Today, when I woke up, I realized that, for the first time in a long time, my first thought wasn't about my achy ankle. There is pain - but it's the normal, "I have stitches" pain - a very, very big difference from the pain I've grown accustomed to.

I should be skiing again in about three weeks, running in six, and on the bike trainer tomorrow. 

Getting the hardware removed was a tough decision, but it was absolutely the right decision. While skiing yesterday (and it was a cold one!), I felt those screws and those wires every turn, every jump, every bump. It actually made it nearly impossible to jump turn and ski hard - the fear of pain was worse and more limiting than the actual pain.

It's unreal to wake up and not feel them there - I actually can't stop smiling.

I'll post more updates and pics as the days progress. But, I can say that getting the hardware removed was the absolutely right decision for me. Why live in pain if you don't have to?


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## Spdu4ia (Aug 6, 2009)

Awesome ! I'm stoked for you and if I had that much pain from mine I'd remove it too.


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## horizontallyopposed (Mar 10, 2013)

Any updates snowgypsy? Currently laid up, 2 weeks post surgery from a messed up right ankle knowing that I have a long road ahead of me before they remove any hardware. However all some good info to ask my surgeon when I meet with him later this week.


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## snowgypsy (Jun 5, 2011)

horizontallyopposed said:


> Any updates snowgypsy? Currently laid up, 2 weeks post surgery from a messed up right ankle knowing that I have a long road ahead of me before they remove any hardware. However all some good info to ask my surgeon when I meet with him later this week.


I hope your recovery is as fast and painless as possible! Stay strong, stay positive, and take it one minute at a time :thumbsup: You'll be shredding single track dreams in no time.

This is going to be long, but I think telling the whole story is important. It is a big decision and I want to stress that my choice was mine and explain the reasons why I decided to go under the knife again.

And thanks guys for your words and stories and encouragement! It really meant the world and made that decision easy.

We took the hardware out on Dec. 30. I woke up from surgery and, I don't remember this, the nurse says I shouted, "this is f&[email protected] awesome!" and tried to leap out of bed.

I woke up (consciously this time) with restraints on 

After surgery, it felt amazing. I didn't need any pain medication after the first day. I was on crutches for a day. The third day I went out to celebrate new years. Down to one crutch, I started crying as we all walked to the bus. It was 10 degrees out, and I couldn't feel anything. Nothing. Sure, there was pain from the stitches...but nothing...my ankle was moving. It didn't hurt. It didn't creak. It didn't stiffen in cold. The joy was...indescribable.

It's been a day over two weeks. The stitches are out. I'm able to bartend a full shift (8-9 hours on my feet) without pain and each yoga session just gets better and better. Balance is still a bit off, but that's to be expected. I'm about a week out from skiing and two-three weeks out from running. Twisting the ankle is a big no-no as is jumping until the four week mark.ROM is coming back quickly and getting better every day. The pain that had held me back before isn't there. I still need to be careful and wear a brace when I'll be on my feet for a while, but it just gets stronger. There are times (and this is the big thing) that I walk and don't even think about my ankle. If you've gone through this, you know how big that is.

For me, taking the hardware out was the right decision. The difference is night/day. The recovery is minimal. It's worth it. If you can, do it and do it as soon as possible. There's a reason why pro athletes who experience breaks like this always have the hardware removed as soon as possible if at all possible.

If you have any specific questions or just need someone to talk to, definitely reach out to me. The recovery is hell, but you have your leg and you have a lot to look forward to. It gets better and those small victories lead up to big ones down the road as long as you keep rocking it. You got this. Just make sure that you do the right thing for you and your body. No one knows what's best for you except you. :thumbsup:


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## horizontallyopposed (Mar 10, 2013)

Thanks so much for the kind words. I haven't seen my post surgery X-rays yet, so all told I don't know how much hardware is in my ankle, but I will see on Friday. Your thoughts are insightful and appreciated.


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## 749800 (Jul 14, 2013)

I know this is kind of a difficult question to answer objectively, but how annoying is the hardware? I am trying to calibrate... Mine never lets me forget, but only very occasionally really hurts. I think part of the problem is the flexing properties of the metal differ from bone, so when you do certain movements that flex the bone, you feel the screws pulling. The idea of a second surgery seems far worse than sucking up the occasional discomfort, for me at least.


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## snowgypsy (Jun 5, 2011)

wgscott, I think it's a personal choice. As an athlete, the last thing I wanted to be thinking about before dropping a line, beginning that race, etc. was my ankle. I could feel the screws when I flexed, when the weather shifted - and, at times, that discomfort was incredibly painful and limiting. I wouldn't push my ROM or recovery as far as I needed to because I could feel those screws in there - that reminded me that was I injured which, mentally, was a big hurdle.

A close friend of mine, J., broke both his ankles in a bad dirt biking accident. Because of his doctors and the nature of his injury, he is still unable to get the hardware removed. It's been a couple years. Yesterday at work he was doubled over in pain after being on his feet for 6 hours, leaning on anything he could. He still needs to take pain medication a few times a week to get through a shift and sleep. In his words, he can feel the metal grinding every time he steps, every time it flexes. 

Having gone through the surgery, it was absolutely minimal, easy with a brief recovery time and a life time of benefits. Definitely read my story up top for info on that recovery time. Why be in pain, even if it is minimal, for the rest of your life if you don't have to? One thing that I learned from this is that pain, even slight discomfort, when constant, will dramatically decrease your quality of life and has the potential to drive you insane.

Here I am now, 11 months after the initial injury, sans metal and with bones in tact. My risk of arthritis is next to zero (thanks Griggs!), I'm back on the bike training hard, running, swimming, skiing (where there is still snow), walking, hiking, yoga-ing...and most importantly, doing all these things without pain. ROM is fantastic, and here's the big thing, I don't feel my ankle; I don't think about my ankle - it just works.


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## ric426 (Jul 13, 2007)

Thanks for this thread and for the updates. I busted up the end of my right tibia on 5/4/15 in a weird crash that wasn't that fast or hard,but my foot came down in a bad spot and hyper flexed my ankle,then I came down with all my weight on it. After recovering from two other surgeries since December, I've been pretty bummed out about the additional setback, but after looking at the x-rays some of you posted, I got away with relatively minor hardware. I've still got 3 weeks before I can even start putting weight on it and don't really know how long it'll take to get to the point where I can try riding again. How much rehab time did you guys require to get back to that point?
My surgeon assures me that I should make a full recovery and probably won't be bothered by the screws, but he said that it'd be a simple procedure to remove them if they bother me. I was concerned about the projecting heads of the two more vertical screws causing problems, but he said they'll be buried in enough other tissue that I probably won't notice them.


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## 749800 (Jul 14, 2013)

snowgypsy said:


> A close friend of mine, J., broke both his ankles in a bad dirt biking accident. Because of his doctors and the nature of his injury, he is still unable to get the hardware removed. It's been a couple years. Yesterday at work he was doubled over in pain after being on his feet for 6 hours, leaning on anything he could. He still needs to take pain medication a few times a week to get through a shift and sleep. In his words, he can feel the metal grinding every time he steps, every time it flexes.


Thanks for the reality check. I have nothing to complain about, by comparison.


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## 749800 (Jul 14, 2013)

ric426 said:


> I was concerned about the projecting heads of the two more vertical screws causing problems, but he said they'll be buried in enough other tissue that I probably won't notice them.


I have those two vertical screws. I never feel them at all. The ones I feel a bit are the bunch of screws through the plate.

Do you worry about the heads of the horizontal ones snagging on anything?

Excellent avatar. (Mine is one of the puppies that did it to me.)


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## ric426 (Jul 13, 2007)

wgscott said:


> I have those two vertical screws. I never feel them at all. The ones I feel a bit are the bunch of screws through the plate.
> 
> Do you worry about the heads of the horizontal ones snagging on anything?
> 
> Excellent avatar. (Mine is one of the puppies that did it to me.)


That's good to hear about the screws in the medial malleolus.

I got the impression that the heads on the horizontal screws were recessed more into the bone, so hopefully they won't be a problem. I'm another one who's met my out of pocket maximum with my health insurance, so if they do give me trouble I'll get them removed before the end of the year. That is unless Blue Cross sends out a secret hit squad to take me out and cut their losses. I've been a big expense to them this past year or so.

Like your avatar too. Since this was the first time I'd had a break that required hardware I posted my x-ray as my avatar, but after seeing some of the others, mine is pretty minor, so I changed my avatar back to my best bud, Jake the wonder dog.


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## 749800 (Jul 14, 2013)

Here's mine:









Interesting -- I now see that mine has a crack right along the same pathway you have outlined with the orange dotted line (but two fewer screws).


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## 749800 (Jul 14, 2013)

ric426 said:


> I changed my avatar back to my best bud, Jake the wonder dog.


Mine is one of the two puppy participants in my ankle break. However, tragedy struck a couple of weeks later, which took all the fun out of having them break my ankle. While I was incapacitated, she managed somehow to ingest an amanita mushroom and died a particularly horrible death. Her brother is still with us, but the avatar helps keep her memory alive Watching helplessly while the vets tried unsuccessfully to save a 7 month old golden puppy was a true low point.


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## ric426 (Jul 13, 2007)

Oh man, that's heart breaking. I'm really sorry you (and Polaris) had to go through that. I've lost enough pets over the years to know what that kind of pain is like, but I've never lost one at such a young age. That's gotta be even worse. I'm sure you gave her a good life for as long as you could.


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## 749800 (Jul 14, 2013)

Thanks. It was not a happy time, to say the least. I managed to keep their great great uncle goig for 15 years.


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