The most common question asked by post-operative patients is: Doctor, do I need to remove the implanted plate or not? If so, when will they be removed? Why is his plate removed and mine not? Why do I need to remove his plate?
Doctors mostly judge based on experience, you need to take this one, but not his. As a result, some doctors say yes, some say no. Patients are confused, whether to take or not to take? Here we will talk about whether to remove the implanted plate or not. There is a lot of content, so I will tell you about this plate in several times.
To answer the opening question, we must first explain the material of the steel plate.
The so-called steel plate, in fact, to put a quotation mark: “steel” plate.
What is steel? Speaking of steel, you can not say his ancestor – iron. The explanation given on Baidu’s encyclopedia: steel, is the collective name for iron-carbon alloys containing between 0.02% and 2.06% carbon by mass. The chemical composition of steel can vary greatly, and steel containing only carbon elements is called carbon steel (carbon steel) or ordinary steel; in actual production, steel often contains different alloying elements depending on the use, such as: manganese, nickel, vanadium and so on. The definition is so complex, but in a nutshell: steel is an iron alloy mixed with other elements. So is the steel plate implanted in the body for orthopedic surgery made of iron alloy?
In fact, the so-called “steel” plates used in orthopedic surgery are actually very complex in composition, far from the simple iron alloy, and with the development of biomaterials, new materials are emerging, and more and more materials with better properties will be used in the future for the benefit of patients. The “steel” plate implanted in the body for a long time immersed in blood, lymphatic fluid, joint lubricating fluid and other body fluids, and body fluids contain organic acids, inorganic salts, Na +, K +, Ca2 +, Cl- and other complex components, the use of time up to several years or even decades, these are to the material put forward strict and even demanding requirements: first of all, to have Good compatibility with human tissue and body fluids, followed by corrosion resistance and chemical stability. In addition to withstand a variety of mechanical action of the human body, and thus should have the appropriate mechanical strength, toughness, wear resistance and fatigue resistance. For production, but also easy to process into a variety of complex shapes, cheap and easy to use.
So many demanding conditions, the current requirements can be met and commonly used orthopedic endophytic materials are three: stainless steel, cobalt alloy and titanium alloy.
Let’s start with stainless steel. Although all iron alloy, but the stainless steel for surgery and our usual life with stainless steel is still very different. Orthopedic stainless steel is mainly mixed with nickel-chromium stainless steel, the advantage is low cost, cheap, strong, the disadvantage is the same strength under the volume, more heavy, corrosion resistance is not as good as other titanium alloys, so in orthopedics is mostly used for muscle-rich parts of the fixation, such as the thigh, upper arm, etc.. Because it is cheap, so it is good to use. At present, the most used material is stainless steel, in this sense, it is also correct to call it a steel plate.
Silver shiny steel plate shine!
Next, the cobalt alloy. Cobalt alloy composition is cobalt-chromium-molybdenum, because it has the best wear resistance and is widely used in the manufacture of artificial joints. Most of the artificial joints we usually use are made of this material.
Artificial hip joint
Finally, titanium alloy. Titanium is favored for its excellent histocompatibility and high strength. Pure titanium is rarely used alone because it is too soft, while titanium alloys have significantly higher strength. The titanium alloy “steel” plates currently used are thin and strong (under equal volume) and are mostly used for fixation of superficial fractures, such as distal radius and tibiofibula.
The patient said: I just want to know whether this thing should be taken out or not, can you answer directly?
The doctor said: This is indeed a question! The answer is very simple, summarized in eight words: specific problem, specific analysis!
You will say, this is also the answer? Don’t worry, listen to me slowly.
The first thing you can do is to look at the literature and see what foreigners have to say about the problem. It’s disappointing to see that foreigners don’t seem to be too keen on this issue and generally have only two choices: must take and can not take.
Because of the special conditions of traditional Chinese culture, “the body hair and skin, the parents”, Chinese people always feel that the original good body more parts are always uncomfortable, so the original simple problem to China has become complicated, I summarized the five cases: must take, try to take, can take can not take, try not to take, must not take.
Is it dizzy again? Because there is not much research available, only combined with their own clinical experience, you patients to the number, if you have different views welcome to pat!
First of all, the first case: must be taken! When there are more obvious endophytic complications and several special areas of the plate screw, I will advise patients to remove as soon as possible.
Commonly seen are.
1, foreign body reaction: Although most people can live peacefully with the endophyte, but there is always a small percentage of people’s bodies to these endophytes views are very big, there is a significant foreign body rejection reaction, manifested as skin redness, swelling, incision healing difficulties, repeated breakage, etc.. I had a patient who was allergic to titanium and had a rash on the surface of the skin where the plate was placed! If this happens then don’t hesitate to contact your doctor to remove them as soon as the fracture heals.
2, endosseous failure: not much to say about this, if there is a broken plate and nail, serious infection, etc., doctors will often consider removing the endosseous fixation. There is also an extreme case: the endosseous run off to other parts! You will say, what? That’s possible too! Some time ago, the media reported a rare case in the world: a patient did spinal surgery, the internal fixation wandered into the chest cavity, which tells us: the world is so big, anything is possible!
3, serious psychological foreign body reaction: although there is no clear clinical manifestations, but there is an extremely strong psychological reaction! Constantly worried and anxious, imagining various extreme possibilities, speculating on various adverse consequences. In the face of such patients my advice: must be taken!
4, several special sites: the tibiofibular joint screws in the ankle joint, must be removed before going down to weight bearing; spinal fracture surgery if not done fusion, there will be repeated micro-movement between spinal segments. Stronger steel nails cannot withstand repeated bending, and the endophyte is prone to fatigue fracture. Therefore, patients should be advised to remove them as soon as possible even after the fracture has healed.
Based on my experience, I have divided it into the following cases: must take, try to take, can take or not take, try not to take, must not take. Last time I talked about the cases that must be removed, today I will talk about the following cases.
What kind of steel plate to try to take it?
1. Young people. How old is young? Generally, I take 60 years old as the boundary, special circumstances can be floating up and down in turn. Young people have a strong metabolism and a high level of activity. Although the material technology is now very advanced, the steel plate can coexist peacefully with the body for a long time, but also can not resist decades of wear and corrosion ah. Years and years of corrosion of the steel plate release a variety of metal ions into the body, the ghost knows what will happen, there is a real lack of research reports on this. According to my experience, when the body of the steel plate age of more than five years, there has been more obvious corrosion, the process of taking will be more difficult. Young people are in good physical condition and recover quickly from surgery, and the wounds will heal quickly after the plate is removed, so it is better to remove it early. Children should be taken early, will the plate affect the development of children’s bones? To tell the truth: doctors do not know.
2, affect the function. Near the joint parts of the plate can sometimes be the culprit to affect joint movement. For example, the clavicle hook steel plate in the shoulder lock joint area will affect the patient’s ability to lift the arm, so it should be removed as much as possible. Of course, the degree of impact is up to the patient. A thousand people have a thousand Hamlets, and the same applies here. The same situation is accepted differently by different patients. A fitness enthusiast’s functional needs are certainly not the same as a geek’s.
3, special parts. In a nutshell is the skin and bones of the place. Steel plates in these parts are easy to touch, one is uncomfortable to touch, another steel plate and repeated friction with the skin is easy to damage the delicate skin. The common is the plate near the joint parts, such as the ulnar hawk’s beak plate, the outer ankle plate, not to mention, I have really seen the plate to wear the skin of the patient!
4, there is a part of it has to be said separately, is the clavicle plate. A good clavicle is half of a good figure, indicating that the clavicle is superficially located. For thin people this part of the plate is sometimes particularly obvious, a touch on that, very uncomfortable. Therefore, from the point of view of perception, I recommend this part of the patient to take. However, since the clavicle is thin, the strength of the clavicle is greatly reduced due to the linear nail path after removal, and the risk of re-fracture of the clavicle in the short term is higher than that of patients who do not have it removed. Therefore, for this group of patients, after the removal, I often repeatedly advise them to avoid weight-bearing on the arm for three months and to avoid falling and injuring themselves!
According to my experience I have divided into the following cases: must take, try to take, can take or not take, try not to take, must not take. Last time, I talked about the cases that must be taken as much as possible, and today I will talk to you about the following ones.
What kind of plate can be taken or not?
1.Intramedullary nail. In addition to the development of children (more with a different kind of elastic intramedullary nail than adults), no matter how old, as long as there is no obvious discomfort caused by the internal fixation is desirable or not to take da.
2, muscle-rich parts. Such as the femur, the distal radius and other parts of the muscle is rich, the plate formed a good protection, in general, there is no obvious discomfort, can be taken or not.
In summary, as long as the implanted plate does not cause special discomfort, and does not belong to those special cases mentioned in the previous article, it can be taken or not.
Then what kind of plate should be left out as much as possible? Many patients are prone to take the bull by the horns here, so let’s talk about it.
1, a long time. General steel plate in the body more than three years, the corrosion of body fluids on the metal is very obvious. Take the process due to the screw and the anastomosis between the steel plate change, the adhesion between the bone and the screw easy to cause the screw slip wire, will greatly extend the operation time, increase the surgical trauma, titanium alloy steel plate especially so.
2.Age. Age over 60 years old will try not to take it. If there is no discomfort, why do you need to take a knife and suffer again when you are older?
3, forearm cadre fractures, including the radius, ulna. The plate fixed after the forearm fracture sometimes affects the rotational function of the forearm. If the forearm rotation function is not particularly affected or do not take. This does have a research basis. A study published in the journal Arch Orthop Trauma Surg in 2014 showed a 12.9% re-fracture rate in patients who had plates removed for forearm cadaver fractures, compared to 2.77% in patients who did not have plates removed! That means nearly one in ten patients will fracture again after removal of the plate!
4. Radial trunk fracture. Minimally invasive surgery for radial stem fractures is not recommended. Originally minimally invasive surgery, small incision, small trauma, but there is a very delicate nerve – radial nerve. When implanting the plate, you can stick to the bone and pass under the radial nerve, but when taking the plate, you dare not draw it out directly. Why? What if there is an adhesion between the nerve and the plate? There have been cases where the radial nerve was injured and disabled because of the plate removal. So in order to avoid hurting it, the doctor has to make a very long incision, which is not worth the loss.
What circumstances must not be taken?
1.The elderly
2.The screw is broken in the bone
3.Some specially designed screws: Herbert screws, for example, can not be taken out at all
4, the spine surgery plate screws, in most cases do not need to take out
But everything is not absolute, or according to the situation specific problems, specific analysis.
There is good news, the current absorbable plate screw technology has become more and more mature, the previous criticism of the strength problem has been solved. The implantation of such plate screws will eliminate the need for future removal.