A guide for patients on the removal of screws, wires or plates

When do screws, wires or plates need to be removed? These are used in your operation to hold the cut pieces of bone together. The fixation screws/wires etc rarely cause problems and are perfectly safe if left in the body.

The screws serve a purpose while the bone is healing; after that they become redundant. Sometimes, they can get pushed out of the bone and cause discomfort to surrounding soft tissues or be felt beneath the skin and lead to footwear irritation. If this is the case, they require removal.

Very rarely, the metal in the screws or wires can cause tissue sensitivity.

How surgery can help?

Removing the screws stops irritation to the surrounding tissues or footwear.

About day case surgery under local anaesthetic

Surgery is carried out under local anaesthetic as a day case. This means that you are awake during the operation, but a screen will prevent you from seeing what is going on.

To numb your foot, you will either be given some injections around the ankle, or occasionally at the site of the screws, wires or plates.

You can eat and drink on the day of surgery; there is no need for fasting.

Depending on the amount of fixation to be removed the operation time can vary considerably, but you should be ready to be at the hospital for longer than this to allow for preparation and recovery.

Where possible, removal of the screws, wires or plates is carried out through the original incision. You must have a competent adult at home with you for the first day and night after surgery.

If you decide on surgery, you will be invited to attend a pre-surgical clinic. A member of the nursing team will take your medical history. If you are on any medication, please bring a list with you. This is a good opportunity to ask questions or raise any concerns you may have.

Recovery after your operation

The first two to three days

• You must rest with your foot elevated to hip level.
• You should restrict your walking to bathroom visits only. If you have been given crutches, you must use them in the way shown.
• You should take the prescribed painkillers. If you experience pain, it is usually worse for the first two days.
• If you are still experiencing pain after three to four days that is not relieved by the painkillers, you should contact the department directly.
• If you have any concerns over your foot you should contact the department directly.
• The department is closed at the weekend. Out-of-hours, you should contact your GP or go to your local A&E department.

Following removal of the fixation, the type of dressing and the post-operative protocol can vary.

You may have a very light dressing over the incision or a more bulky dressing. You may be able to return to work as soon as three to four days after the operation.

Specific information will be provided to you by the podiatric surgeon.

It is important to remember that there will be stitches in the foot and you will need to keep the foot clean and dry. Avoid irritating or stressing the operation site.

Between three and seven days

Depending on the site of the screws, wires or plates, you may be allowed to remove the outer bulky bandage and return to normal footwear after three days. You will be advised by the surgical team if this is possible.

Two weeks after surgery

The dressing and stitches are removed.

You will need to keep the foot dry for a further two days.

Frequent or serious occurring risks

All operations carry a small risk of complications. Complications following foot surgery are uncommon and  most are resolved without permanent disability or pain.

Complications from fixation removal can include:

• infection (two in 100)
• delayed healing of the skin (eight in 100)
• non-compliance of patients (four in 100)
• prolonged swelling post operatively (four in 100)
• thick or sensitive scar formation (four in 100)
• blood clot deep vein thrombosis (DVT)
• failure to relieve the pain/discomfort.

Complications following foot surgery are rare, but can happen. It is important to remember that if there is a complication, you will need to visit the hospital more frequently and there could be a significant impact on your recovery and return to work time.