What is removal of internal fixation?

As part of the original operation to your foot or ankle, you had some metalwork (e.g. wires, screws, staples or plates) placed inside your body to hold the bone stable whilst it healed.  This is called internal fixation (because it’s inside the body and it fixes the bone back together). Once healed, bone is strong enough to support itself, but the metalwork is normally left in place to avoid you needing to have more surgery. Unfortunately, for some people, internal fixation can become loose and/or prominent and it can start to irritate when you walk and wear shoes.

Why is internal fixation removal performed?

The aim of the surgery is to improve comfort. People consider having internal fixation removed because it is becoming problematic and irritating when carrying out daily activities.  Fixation that has become irritating or loose is unlikely to resolve on its own and surgery is advised to remove it once and for all. However, some people choose to live with it. Other reasons people have internal fixation removed are:

• Loose fixation can sometimes migrate from the area it was originally placed.
• Prominent fixation can potentially protrude through the skin, increasing the risk of infection.  
• Deep infections involving the fixation.
• Metal allergy.
• Non-union of bone (meaning bone fails to knit together fully so fixation is removed and then replaced).

What are the limitations / risks of surgery?

Sometimes, only some or part of the fixation is able to be removed, often because it has become deeply embedded in bone or it may have broken or become broken during the procedure. In this case, the surgeon will endeavour to make the fixation as flush to bone as possible. In rare circumstances, during surgery, there may be a re-fracture of the bone and it will need to be fixated again, with new metalwork. Fixation that has migrated can be difficult to locate and may mean your surgery takes longer than expected or is more invasive than previously thought.   
If possible, the original scar line will be used to access the fixation, but you may have additional scarring if this isn’t possible. Scars can become thickened and sensitive and be slow to heal. There may be some numbness caused by damage to tiny nerves – this can improve with time or can be permanent.
Other risks of surgery include: infection, blood clots, chronic pain and bleeding.

What does the operation involve?

This procedure can be performed as a day case operation, using either general or local anaesthetic. If done using local anaesthetic, you can eat and drink as normal. You will have a small skin incision Followed by some stitches and a dressing to cover the wound. You do not usually need to have a plaster cast.  You will have a post-operative shoe and crutches. You must have a responsible adult at home to support you afterwards.

What will happen after the surgery?

The first 1-3 days are the most uncomfortable.  You will receive advice on how to manage pain and will be told how to take painkillers. You should spend a restful few days with your foot elevated as much as possible. You should drink plenty of fluid and move around the home only to use the toilet and fetch refreshments. You will usually be able to weight bear on the foot, using your post-operative shoe and crutches, unless you have been advised otherwise. If you do too much at this stage, your wound will become more painful than expected and may bleed and increase the risk of infection.  

Between 1-2 weeks following surgery, you will have your dressing changed and stitches removed. You can usually bathe again once stitches are removed and start to gradually increase your activities, depending on how comfortable you are. Time from work varies depending on occupation, but an average recovery time is 3-4 weeks, providing you have no complications. You may be able to fit into a normal shoe and be able to drive again by this point. Recovery may be longer if your surgery was more extensive.

You may have some swelling in the foot and ankle for 3-6 months after surgery. This is normal and can be affected by the amount of activity you do. By 12 months, you should have made a full recovery.

Further information

www.bofas.org.uk/patient/home