IM Nail Removal – Your Experiences


It’s been 2 years since I had an operation to have an IM Nail inserted into my left leg, and although I don’t get really get any pain, just niggles here and there, I have been pondering whether to have it removed? Having the metal in my leg does not stop me doing anything but feel maybe I have become a little reluctant to put myself into situations that might damage the leg. Also, there is a concern if I had another accident, there is no way to predict how the metal in my leg would react? Would it help or make the situation worse?

I am going to see the consultant and run through the options and risks as although it seems having the IM Nail removed is far less traumatic than having it put in, it would mean having a general anaesthetic and being on crutches again for a few weeks. There is always a possibility of complications with a procedure like this and if I’m basically fine now, then maybe it’s not worth the risk?

There is very little on the internet about the recovery from IM Nail insertions and even less about the recovery and process of having them removed. A few people have very kindly shared their experiences on this blog, but may not be easy to find as are hidden in comments way down the page. So, I thought I would make some links to the comments to make it easier to find and perhaps encourage others to share their experiences too.

Carl
Carl had his IM Nail removed in August 2012. He has very kindly shared his experiences, including photos, here.

Nick
Nick had his IM Nail removed in Feb 2011 and was very kind enough to provide several updates  with a lot of detail of what happened:
1st Update
2nd Update
3rd Update (May 2011)

Andrew
Andrew had his IM Nail removed just over 10 years ago.

Emily
Emily had her IM Nail removed in April 2011 as her consultant said the nail was a little too long and was damaging tissue:
1st Update (Just after removal)
2nd Update (Dec 2011)

Becs
Becs has an IM Nail in both tibias and after 15 years had them both removed in April 2012. You can read  the reasons she gave to the doctors to persuade them to remove the nails and her experience of recovery 3 weeks after the removal by clicking here.

Caz
Caz had her IM Nail removed after 3 years in August 2012. The doctors did not seem too keen for her to do it, but after one night in hospital she was back home and her knee pain has gone.

Also, please read the comments made below.

If you have had your IM Nail removed or are about to, it would be great for the rest of us to read about your experiences as there really isn’t much information about this and it is so useful and supportive for others to read.

Jake McMillan



49 responses to “IM Nail Removal – Your Experiences

  • johnsonterry

    Hi Jake,

    I had my nail removed beginning of August 2011 after breaking my leg in March 2010. Had the operation in the morning and the next day I was walking around without crutches. Although I had my crutches with me the doctor said I didn’t need them. I spent 4 days in hospital and in total 4 weeks on sick during which I walked regularly every day about 5km. by the fourth week I was jogging slowly again. This time I had no physio because I knew all I needed to know from the first time. Anyway nearly 6 months on I’m running like mad, like I was before, thank God.
    Only bugbear at the moment is kneeling on hard surfaces. I had this problem the first time, but this time the scaring on the knee seems to be more sensitive.
    All in all don’t regret having the nail removed.

    Regards
    Terry

  • Steven

    Hi Jake, I had my my IM nail removed last wed 11/07/2012. No one seemed to be able to give me a definite recovery time frame. The registrar told me before the op that I would be going home that afternoon and would probably not need crutches. Well I found out soon enough that NHS staff do not communicate with each other effectively.
    I was kept in until saturday afternoon, once the consultant was happy there was no infection present.
    I was partially weight bearing the day after removal and told to do so until further notice (two weeks until next appointment).
    Leg is very swollen and my knee and ankle joints hurt like hell for about 5 mins when I start walking about but when I free them up the seem to get better.
    Just reading Terry’s comments make me feel a bit jealous that he was walking around without his crutches the day after! But hey everyone’s different I suppose.
    I had the nail removed because my leg had started causing me pain after 11 years of being fine! After seeing a specialist who studied my x-rays, it turned out my leg had actually had a curve to it. whether this was caused by the nail itself or I had just overdone things at an earlier stage the consultant was not sure. But the nail was to come out and if the pain was still there, re-breaking the leg and possibly putting in another IM Nail may be on the cards further down the line.

    Great blog, really good to compare experiences. I related to a lot of what you went through and found myself nodding along as I read.

    Steven

  • ange

    Hi jake, just an update on my 15 year old son, he had his rod removed on mon 16th july ,12 months after having it in. He wanted it removed because he wants to play rugby again. He was discharged the following day tuesday, without seeing a doctor, just physio. Hes been told to partially weight bear with crutches for 4 weeks but couldnt at first due to alot of swelling. Just like steven, nurses didnt communicate at all, the ones who came to give his medication didnt even know what surgery he’d had done! we were sent home with no dressings, i had to go back and ask for some! Its now 4 days after surgery, still abit of swelling around the knee and the thigh but its gone down quite alot, not too much pain anymore, only taking paracetomol now, he said the first two days were worse. He had some squelching in his knee yesterday but none today. Hes been partial weight bearing today also. He sees physio in 3 days and his surgeon in 7 days. I hope this helps you and anybody else thinking of having their rod removed, i’ll update you in the future, good luck with your decision.

  • Alan Telfer

    I’m 6 months down the line from having my I’M nail put in. I really want it out as soon as possible BUT my question is…. Is there any way of keeping it as a momento after having it removed. I have been told its an absolute no due to infection control.

    • jakemcmillan

      Ooh, this is an interesting question! I do not know the answer to this, but if I were to have mine removed I’d want to keep it too. Does anyone else know if this is possible? I’m guessing it can be sterilised and cleaned afterwards, but whether a hospital would want to make the effort to do it?

      • Me Phwj12

        I had mybrod and screws removed this past Wed. I was able to keep the rod and screws. I had to sign a consent form and had to go back and pick it up the next day because it had to be sent tobthe pathology lab to be cleaned. But it is impossible to keepbit, my doctor was actually the one who recommended I ask for it. He said with all the pain I went through with it, I would want to see what it looked like.

  • Pete Williams

    After breaking my left leg in April 2009 (rugby) I had a tib nail inserted, the initial healing process was good and over a period of 12-18 months I had built up the leg and was starting to run again. Within a few months of this I started to get a dull pain in my left buttock area, after numerous visits to GP, Sports Specialists, Consultants and having had a number of MRI’s and xrays of the hip there was nothing to indicate that there was a problem. Over a period of months the pain in my lower leg became worse and my concern was that the earlier hip pain was some how a transfered pain which was actually coming from the tib. It got so bad that I felt pain with every step and on long walks needed to take pain killers… I spoke with my consultant and decided to have the nail removed (3 year 4mths after it was inserted). The op involved being in hospital overnight and being discharged the following day. I walked out of the hospital the day after the op with no crutches and have walked with no pain over the past few days (4) since the op, again with no crutches. My experiance (so far!) is that the pain is nothing compared with the initial break and life gets back to normal pretty quickly, im hoping that recovery continues….

    • jakemcmillan

      Hi Pete, many thanks for sharing this … sounds like the nail removal has gone well for you. Also good to know that you were able to walk around without crutches so quickly! Hope that this procedure has done the trick for you regarding the pain you had previously.

    • Pete Williams

      1st Update – 5 mths after removal

      The recovery from the removal of the nail was almost immediate in the sense that the pain I was getting with the nail in vanished. The recovery from the surgery took a little while as a few of the wounds didnt want to heal properly and it meant that I had about (3) courses of antibiotics. All in all it took about 6 wks for the wounds to heal but I was perfectly able to walk about without a limp or pain. I do get a bit of stiffness just below the knee (especially when I kneel on it) but have been told thats scare tissue due to them reopening and old incision – its improving however and hopefully that will go in time.
      I have been taking regular exercise in the gym to build the leg/s back up and have also done a few runs without a problem, I think the most important thing to do is to ensure that you get full movement/rotation back in your ankle/knee which means regular movements instead of long period of sitting/driving etc (speak to a physio and get their suggestions – its worth it)
      The removal process and the recovery was pretty straight forward and theres a nice feeling about not having a lump of metal in your leg!!

  • sullivanbishop

    My 14 yr old daughter broke her tib /fib in March 2012 due to ski accident.
    Inserted IM rod and 4 screws in tibia. Yesterday (December 2012) she had rod and screws taken out. Operation about 1 1/2 hrs. Doc said the titanium rod was difficult to remove — took more time than they anticipated. Released her from hospital that night, her leg wrapped in huge ace bandage. Once home – noticed bandage soaked with blood at ankle incision site (screw removal). Doc said that was “normal”. Next morning leg swollen like a balloon and could barely walk — so much knee pain.
    Med prescribed is norco. Had operation done at Hospital for Special Surgery NYC..hope recovery is swift.

  • Ken

    I had work injury in November 2011. I have a IM rod and 3 screws. I was always told that I be back running and normal activity’s in a year. I have complained of knee pain and weekbess from day one. After ultra sound MRI and 3 doctors saying nothing is wrong, I finally found a trauma surgeon that recommenced to work comp company to remove my hardware. I have surgery 6/28/13. I will leave updates after surgery.

  • Me Phwj12

    I had IM Rod and Screws removed feom my femur 5 days ago. I had it inserted about 10 months ago. The doctor stated he usually wants to wait at least 12 months to remove but I had bursitis from the rod and a partial tear in my gluteus medius and developed a labral tear as well. He figured since he was going into repair the labrum he would remobe the rod the same day and not wait the 12 months. The procedure has already caused me relief from the pain. I started physical therapy and I am on crutches weight baring until I can walk without a limp. I’ve also started riding a stationary bike for 20 min a day with no tension and seat as back as far as possible to prevent the hip being flexed too much but I think that is because of the labrum not the rod removal. I was only on pain meds for the 3 days and it was an outpatient procedure. The majority of my pain came from my lower back than my hip and leg and I believe it was from the position I was in fkr the removal and the force behind the removal. I can move and rotate my leg in certain directions that caused pain previously with very little pain now. Best decision I made was to get the rod removed! Also I was able to keep the rod and screws. Not exactly sure what I will ever do with them but it was interesting to see exactly what was in my leg, how big it was and how much it weighed, especially from the pain it caused, I really wanted to see the beast.

    • GWYNFOR WALTERS

      Hi there,
      I am currently waiting to have the rod/nail removed from my roght femur,my consultant has told me that because I need a replacement knee he HAS GOT TO REMOVE the nail/rod first.
      My main concern is that I have had some surgery over the years but never had a very high success rate e.g.failed surgery on both knees which was intended to stop them dislocating so frequently, I’ve had both shoulders replaced,again not very successful as I have got quite a bit of muscle wasteage,so no strength in my back & shoulders to really lift my arms above my head. The consultant who originally inserted the nail/rod in my femur tried to remove it at my request,but after the op he told me, quote “we couldn’t get it out,so we’ve hammered it further in!!!!!”I couldn’t make any sense of this at the time,I was only 17years and consultants didn’t really feel they had to discuss the why’s &wherefores with a”youngster” as they do now,so as you can appreciate I am scared sh**less that if this is unsuccessful I may never walk properly again, if at all,I could maybe end up in a wheelchair!!!!
      Now for the crunch,I am 67 years old,and this nail/rod has been in my femur for 50 YEARS!!!!!! so I am realllly not looking forward to another consultant having “a shot” ,if you like at removing it. Having had a sneaky peek at my hospital notes a few years later while waiting alone in a consultants room,It turns out that they couldn’t remove the nail/rod previously due to my being incorrect-
      -ly placed on operating stretcher?!? whatever that supposed to mean,so maybe now you will understand my concern,as I feel that they tell you what they want because you don’t have the medical knowledge to know any different.That’s my own honest opinion.
      ANY HELPFULL REPLIES/RESPONSES WOULD BE MOST WELCOME.

  • Mitch

    Hi

    I’m due to have my nail removed tomorrow morning. Reading all the comments below have put my mind at ease. My leg was broken in 2009 playing football (the player that did it pre-warned he was going to do so 5 minutes before he did, but that’s a story for another day). I managed to start running again around 9 months after the break, played football after a year and recently did a Tough Mudder event in June. My nail doesn’t hurt, but I’m very aware of it being there – dull ache and very sore at the supportive screws. My biggest concern is not waking up from the anaesthetic as I’ve been reading NHS reports and scaring myself…but I’m hoping it will be fine. Seems a mixed bag recovery, so I’ll ensure to let you know how mine went.

    Have a great week, I’m off to try get some shut eye

    Mitch

  • Naomi

    This blog is fantastic! I wish I found it when I had my IM nail put in 18 months ago! It would have really helped put my mind at ease. I am quite the worrier 🙂

    I sustained a spiral fracture to my right distal tibia at the end of Jan 2012 on a skiing holiday in Bulgaria. Like someone else mentioned above, I also had my leg re-positioned, except they didn’t believe in pain relief, so when they pulled my leg I didn’t have any gas/air/morphine, anything! Least to say, the most painful thing ever. They also only put my leg in a cast that covered half of my leg (I know because of the worry of compartment syndrome), and as my fracture was unstable I could feel it move every time I lifted my leg. It was similar to you Jake, having to count to 10 but then panicking, stopping and re-starting just to get any courage to stand up! I asked them for more pain relief and I got told to drink vodka, haha!

    I had my IM nail and screws placed a week later back in the UK. I was relieved to get some codeine as I had been surviving on my own ibuprofen and paracetamol that luckily I had taken on holiday with me. I stayed in the hospital for 3 nights in the end, it would have only been 2 but I was a bit too painful after they stopped my morphine drip. My stay in the hospital was not enjoyable at all. The first night was horrendous. I have never used a bed pan before. I think with the fact that there were other people in the room, I thought I was going to pee on myself and the awkwardness of holding myself over it made me have a panic attack. I did not feel that the overnight staff were very compassionate or caring 😦

    I was so lucky to have my amazing mum to look after me at home. I think I have blocked out of my mind quite what the pain was like but it was quite bad. I didn’t sleep well for about a month. I know it got easier as the weeks went on though, but I definitely recall dreading having to move from the sofa those first 2 weeks. My days were bed-shower-sofa-bed! It was incredibly boring and I struggled to motivate myself and had many a day feeling rather sorry for myself. It also didn’t help that the combination of opioids i.e. morphine, codeine etc. made me completely constipated, so that added to all the other issues!!

    I suffered a huge amount of muscle wastage and quite a severe degree of reduced ankle/knee flexion. I think I slipped through the loop with regard to physio. I didn’t have any physio for the first 6 weeks despite harassing my consultant/GP/local physio as to whether I should be having any, they all said no, wait. Then at my 4 week post-op check they said why had I not been having physio. I was quite annoyed!! I also found that at all my check-ups I never saw the same doctor! They never seemed to answer my questions and they all told me different things!! I didn’t even see my consultant until 1 year post-op.

    The first 6 weeks I was non-weight bearing, just with toe-touching using the crutches. I developed a stair phobia!! I tried to go to the cinema and literally fell up the stairs onto my leg, I started crying and embarrassed myself in front of the whole cinema! I tried to go to a beauty salon to have a manicure, I slid over on the floor!! I felt that I should just stay indoors and not do anything! Also Jake, similar to you, without a cast on my leg people were really oblivious to the fact I was walking with crutches. The number of people who would almost knock into me was surprising. it was really upsetting to see how people did not care at all. People wouldn’t even get out of their seat on the bus/train to let me sit down. There are obviously some people that do care, but I was shocked by the majority that didn’t.

    When I started seeing a physio at 6 weeks post-op they put me onto a hydrotherapy programme. I had 4 sessions of this, which hugely helped! Then a few more physio sessions. Total 10 weeks of physio treatment in the end I think, which overlapped with me going back to work.

    I think the lack of physio is a big reason why my recovery was quite slow. I had 3.5 months off work in the end, which as being only 1.5 years out of uni, is not ideal! But I am a vet which means my days are long, always on my feet and very unpredictable. Animals don’t keep still when you are lifting/restraining them. And ideally you should operate on both feet 😉 When I went back to work I tried to be really careful and I felt very fragile for a long time!

    I had a rehab programme at the gym. I think this helped me to get back into exercise but I never felt completely back to my usual self. I stuck to low-impact exercise. I did get into weights training at some point too but struggled with some exercises e.g. lunges, squatting with 50kg weight etc. I would often find I would get quite a lot of discomfort around the screws. One of my proximal screws was incredibly prominent, people loved it!! I didn’t ever attempt to start running or dancing again. I found that if I walked that bit too fast I still had a limp. I also found that my knee didn’t feel quite right and I was worried about this.

    I had a 12 month post-op check and at this point I actually saw my consultant!! The last doctor I had seen told me that I would have the IM nail out at 12 months. When I saw my consultant firstly, he said that my ligaments were fine and that it could be scar tissue from when they placed the IM nail. He thought that the screws were very prominent and said I could have them taken out. When I asked about having the IM nail removed he said that it was completely up to me. I was a bit thrown by this because I had assumed it was just going to happen. I didn’t know what the best thing to do was! In the end I said what do most people do my age (26 years old), and he said they have them removed, so that was the decision made! I was warned that the discomfort I felt may not actually go away but I decided I wanted to have everything removed so at least then I would know. He told me that they wouldn’t do this till 18 months post-op anyway. Plus even a year after the IM nail was put in, even though there was good bone healing, the fracture was not completely healed! This I found a bit strange as I thought surely it would be, but he reassured me that it was all fine.

    So then here I am just over 1 week after having my IM nail and screws removed, 18 months after having it put in. The organisation for this op to happen was appalling. I won’t go into detail but in the end I had it on the original day intended and on the ‘elective’ list anyway.

    It was a day case, phew, but I did suffer weird low blood pressure/nausea this time but still I’m glad I didn’t stay in!! First 2 days were pretty painful, nothing like after the first op though!! Apparently the IM nail was really difficult to get out, they had to get another surgeon in to help! I got constipated, again! My ankle flexion massively reduced again, which I noticed after day 3. I was pretty much knocked out for 3 days post-op from the GA/codeine mix. So I didn’t really do much walking. I was told I was able to fully weight-bear from day 1, with the aid of crutches if I felt I needed them. I stopped the codeine at day 4 but carried on ibuprofen and paracetamol, reducing the frequency. I have a huge amount of bruising on my leg, slightly less now at day 9. I think I did too much walking 2 days ago without the crutches, even though I feel I hardly did anything, but yesterday I was in a lot of pain. I am meant to be back at work on Monday. Not sure how that is going to go…. But I don’t have any choice in the matter!! I have some pain along the cranial aspect of my tibia, near the fracture site, which is concerning me at the moment. I know I am probably over reacting here. My ankle is still very tight. I am meant to not do any exercise for 6 weeks and am due a post-op check then. So I will see how things go…… I am just hoping that things will hugely improve and I can get back to dancing and everything again 🙂 And I won’t look like a freak anymore with screws poking out my leg 🙂 I am going to be seeing a physio regularly this time to ensure I rehabilitate myself fully!

    Something’s I have learnt through this whole process:
    1. When seeing the doctor/registrar/consultant, always have a written down list of questions to ask!
    2. If you know in your gut that you should be having physio, be more demanding
    3. Early on after an op find out realistic recovery times so that you can let your work know in advance! Don’t be optimistic with this there is no point!
    4. Find out who stitched your leg back up and tell them you could do a better job 😉 Hehe
    5. Always have laxatives on board if you have had any opioids and will not be moving around as much
    6. Have a friend on the anaesthetic team who can give you real updates and read your notes for you 😉
    7. Have friends that come round to visit you and bring you chocolate
    8. Invent a method of carrying cups of tea whilst using crutches
    9. When in public have a fragile sign on you and point it at the poorly leg
    10. I also really feel that hospitals should give you proper discharge instructions. I feel we treat our animals better! With all my patients after they have had anything done, be it just blood tests/xrays and especially an operation. They all go home with a discharge sheet and on this are post-operative instructions. This details if they need any exercise regime. For example, a dog that has had a cruciate ligament repair has instructions for week 1 only 5 min slow lead walks to go to the toilet 3 times a day and then week 2 etc etc. Anyway I just think this would be a great idea. I expect it could potentially reduce unnecessary phone calls and visits to hospitals and GP’s, maybe 😉

    Thanks for everyone’s stories. I have no idea if mine will help but it’s nice to know that people have gone through very similar things!!

    Naomi xx

  • Naomi

    Oh my that is seriously long, sorry about that!!

  • Lindsay

    Just a quick update, I had my Im rod removed 3 weeks ago, all went amazing, was walking without crutches after a few days. Swimming etc after a week… But went on a 4 hour car journey last week and now I have a suspected DVT, I’m on blood thinners and have a scan tomorrow to determine. My leg feels like I’ve pulled a muscle constantly and keeps cramping up for no reason, it’s swollen slightly but feels very tired, is the only way I can describe it!! Gutted, as I thought this was going to be plain sailing!! I will update after my scan tomorrow.

    Apart from this problem, I would highly recommend removal, it was painful for a few days and then a pretty straight forward recovery. Wish I never went on that long car journey though!! X

  • Lisa

    I am thinking of having my IM Nail removed. I had it done almost 10 years ago and was told that removal was not recommended at the time. I am just having so much pain from it and wish I could live a pain-free life! I am 26 years old and can’t imagine that the pain will get better with it in. I can’t live the next half of my life in increasing pain.

  • Richard Salmon

    Jake would really appreciate a reply. How are u kneeling on hard surfaces now? Am five months post opp and having real trouble with this. Like everyone else am finding no info on the worldwide web. Thanks.

    • Jolene

      Hi Richard
      I’m very curious as to whether you had your nail removed and how it went? I’m 7 months in amd I still can’t kneel. I get pins and needles and it’s really uncomfortable. Some days my leg is extremely painful and swells a lot, other days it’s fine. The surgeon said its all from the nail and to go back in 3 months to talk about getting it removed.

  • Andy

    Hi,
    Great site, learned a lot here, I’m 6 months on after shattering tibia & Fibia in a motorcycle RTA, I broke tibia into 4 pieces + schrapinal. I got a tibia Nail & 4 screws, im only getting full power back now and was told its be at least 18 months after a full heal is declared and before they will remove the hardware, I still have a larger fracture gap and the surgeons are planning on removing distal screws first if healing does not continue., I have a lot of pain in knee & calf all the time since accident so looking forward to getting it out

  • bill

    i have a 2 in brad nail in my thigh and its near the bone and am having it removed in January and these post put me at ease for im afraid my nerves wont go back to normal for im very active and thanks

  • Sue from Adelaide

    Hi guys,
    I had IM nail and ankle plates and screws removed on 11/12/14. I decided to go ahead with removal as I had not had a pain-free step since tib & fib fracture and tri- malleolar ankle fracture (all 3 ankle bones) in August 2013. I just slipped in the street on the way to work one rainy morning, it’ s been a very painful time since. Now 2 weeks post removal of all metal, I am hopeful the pain will be gone when I am back to full speed. Kne pain is the thing at the moment as the surgeon had to remove some bone from the top of the tibia to remove the nail and of course he had to move the kneecap to one side. Stitches are out, I will post agin further done the track. Good luck to all considering removal,not an easy decision given the memories of the pain from the original break!

  • Jenn

    Hi All-

    Great to find this blog!! I had a terrible soccer accident June 2014 and completely displaced my tibula and fibula. Luckily a clean break for both, but they put in an IM nail and 4 screws. I just made my appointment for June 12th to have everything removed-I hope I am making the right decision!! I have had issues/pain with the hardware, though tolerable, it bothers me. I used to be SO incredibly active, but this past year I haven’t been able to do much because of the constant pain. I’ve read people’s experiences on here and it looks very positive. I’m so scared because of the experience I went through last year with getting the IM nail inserted, but I think I have to keep my head up and know that this will make me feel better! I will let everyone know my progress with this after June 12th! Wish me luck. And also good luck to everyone else that is dealing with an IM nail.

  • J S Rogers

    Hi Jake and everyone,

    I’m about to have my IM nail removed after nearly five years. I had a motorbike accident in 2010 and ended up with a spiral fracture of my right tibia – twelve bits! Plus butterfly fracture of the fibula, which none of the medics have ever seemed interested in.

    I had the knee fixing screws removed after few months due to non-union, and the ankle screws taken out six months later, and then I was told the nail could stay in for life. I had no problems at all till a month ago, when I suddenly started getting quite severe pain at times just below my knee. This has accelerated, and now I am in pain most of the time, can’t walk without a heavy limp and don’t feel safe to drive.

    I’m due to have the nail removed a week today, and feel reassured by all your blogs. At 58 and with the nail in for five years, I’m told it could be quite tough to get out, so I’ll report back, hopefully without too many bruises!

  • Independent1

    I would enter this as a new heading “Removal of interlocking screws” but I don’t know how to.
    My interlocking screws were put not just through my tibia (shin bone) but unusually because my break was so bad, at least one of the two was put through my fibula as well. So these two bones which had functioned independently were now bolted together at the shoulder. After three years I began to have increasing discomfort and sometimes pain doing some activities. I was able though to successfully dinghy sail, play tennis when it wasn’t very cold; go for long walks when the terrain wasn’t too rough. Because of the discomfort and sometimes pain, it was decided to remove these screws. I am one of a minority percentage with no tenderness in my knee and for me this was the deciding factor in deciding that I didn’t want the actual rod out because the chances are then I would have had a tender knee. The rod wasn’t causing me any problems anyway. My leg had achieved a 100% mend. Now after 3 years of bone growth it would have been very difficult to extract the IM nail.
    So on Friday morning I had the two screws below my knee removed. I had the operation as day surgery. I probably went into theatre around 9.30 am and I had come round from the general anaesthetic by 10.30. The anaesthetist had given me a local anaesthetic too, intraveneously, for when I came round. When I came to I was very soon asked to walk by the physio. As the screws had come out easily and the holes were small I was still able to fully weight bear and as soon as I was reassured that my leg was working properly I was able to walk better than before because my leg is looser. I was very surprised to be discharged just on paracetamol and ibuprofen but this is actually all I’ve needed. I haven’t really felt any pain, only occasional discomfort and the odd twinge. Nothing to compare with the pain I started to get doing some things with the screws in for which I was on much stronger pain killers. The surgeon thought the pain was caused by the screws moving around.

    The only downside re my operation, is that my regime for a fortnight is 50 minutes in each hour spent with my legs elevated and the remaining 10 walking. How does that fit in with cooking etc? I’ve been advised not stand still, so I now sometimes spend the 10 minutes walking on the spot by the cooker.

    The ‘stuture ends’ from my dissolving stitches come out after the fortnight at which point I can do anything that my leg feels comfortable with.

    The risks I was warned about before the operation were:
    one of the screws could break and that would cause problems;
    I could lose a lot of blood;
    there could be continuing pain.
    there could be stiffness in which case I would need physio.
    I know that when one has one’s bone(s) operated on there is always a risk of infection where there is a wound in the skin. A bone infection can be seriously bad news.
    I’m delighted that these things did not happen, fingers’ crossed. I’m very pleased that I went ahead.
    I may add another entry to the blog later on about how the rest of my recuperation goes. Certainly worth thinking do you want the rod out as well as the screws or would taking just the screws out solve your problem?

    • J S Rogers

      I had an IMN with locking screws at ankle and knee fitted five years ago, following a motorbike accident in which I suffered a spiral comminuted fracture of the tibia and butterfly fracture of the fibula. Healing was very slow, but after twelve months the locking screws were removed and I was walking without crutches. The IMN was left in, I was told because British surgeons are more conservative and don’t remove metalwork unless it causes a problem.
      This turned out to be the wrong thing to do. After four and a half years (in June this year) I suddenly started getting acute pain just below the knee. A major three hour operation failed to remove the nail. My surgeon tried everything, including twisting the nail from the end which left me with a badly sprained ankle as well. Apparently the titanium nail had encouraged the healing bone to stick to it up and down the shaft. The surgeon did cut away a chunk of overgrown bone, and also removed a bursa. The recovery from this has been slow – I’m still using crutches and unable to drive after 7 weeks. I’m now awaiting further very specialist surgery to remove the nail at the end of October. Had I known the difficulties leaving the nail would create, I would have had it removed years ago.

  • JiAMuN

    Hi guys,

    I had an intramedullary interlocking nails fixed to my neck of femur after the neck of my femur bone fractured from a run (yes, only from a run, not a fall) on the 17 September 2013. I’m active person hence, the nails are getting in my way, I can’t lay on the side where the nails has been inserted and lost some of my flexibility. Hence, on the 1 December 2015 I went for the removal of the IMN. The first 2.5 weeks was terrible, I couldn’t sleep because there weren’t any position which are comfortable for me to fall asleep. My thigh swell and bruises was all over my thigh. Now I’m over 1 month after the surgery, I still cannot walk w/o my crutches because I feel there are sharp pain at my hip and knee. The physiotherapist said my muscles are very tight and I think my tissues very badly injured from the surgery (the doctor scheduled for a 1 hour surgery but turn out to be 2 hours). I think recovery depending on age (I’m 30), and to what extend the tissues very injured and how complicated the surgery was. I think I will take 2 months to properly start walking without the pain. At current, the pain is really sharp and swell hasn’t gone done 100% yet.

  • justindroulers

    Just wanting to share my experience. I had an open femur fracture from a motorcycle accident. They installed a im titanium rod with 3 screws. They said I would be walking in 3 months. It took 8 months for the doc to let me start applying pressure and an additional 3 before I was allowed to stop using crutches. Throughout the 4 years i had very little pain unless I over stressed the leg. Once overstressed I couldnt walk the pain and swelling was so bad. I would rest and pain and swelling would go down after a few days. so I didnt think much of it. One flare up was bad enough I went to the hospital. They performed emergency surgery drilling a hole to relieve the pressure. They would have took rod out then but I had a severe infection throughout the bone and nail. The nail I had was hollow allowing no blood flow and perfect spot for the infection to live. The doc said I probably got the infection when they put the nail in. Possibly from debris because of the open fracture. It took 8weeks of daily iv antibiotics to remove infection. Then I had the choice of leaveing the old one. Installing a new one or removeing completely. I dont like the idea that the rods are hollow so I chose to remove the nail completely. The operation took 2 hours longer than expected but I was home the same day in a ton of pain. Again the healing was suppose to be quick at 2 months but again I was in a walker for 8 months till I could fully walk again. I dont have any swelling now but im in constant pain haveing the nail out as opposed to hardly any pain with it in. Just my experience. I also broke my radius and have a stainless plate and six screws still installed and no problems. My accident was in 2008 I had nail removed in 2012 .

  • Sarah Bishop

    I had no problems with the rod except I couldn’t sleep on my side because the screws were uncomfortable, Had the rod out exactly a year after having it put in. Found the op v amusing – epidural and some kind of sedative – and a lot of banging and filthy language from the dr. Went to the pool after I had the stitiches out and 6 weeks after removal went skiing for a week. No probs. Only area that suffers a bit now (2 years later) is my knee. Not much kneeling and still swollen tendon but electromagnetic sessions have helped a lot. Hasn’t stopped me doing anything and better out than in I always say…

  • Jo

    Hi IM nail friends! Just want to post and say that following having both, yes that’s both femur’s and tibia straightened with IM nails nearly two years ago, I had all metal work removed from the left leg 4 days ago. Spent 2 days in hospital, as opposed to the 12 and 9 day stay needed for them to be inserted.
    I have to say, compared to them being inserted, removal has been a walk in the park (so to speak) so far. I’ve only had two paracetamol and can hobble about without crutches-having needed them for nearly a year and a half.
    Ok, its early days but just wanted to report that early post-optative prognosis looks very promising! Will update again soon. 🙂

  • CookSister (@cooksisterblog)

    So back in February 2014 I had a massively unlucky fall on a ski slope in Les Gets, France. I had just come down a mogully black slope with no problem at all and I was skiing to my friends waiting at the lift at the bottom, I made a hard turn at the edge of the piste in far deeper powder than I thought and my skis got stuck as if in concrete. I had all my weight on my right leg to turn and with my feet stuck, my body just continued pivoting over them until I heard something snap. I thought it was my ACL but within seconds after falling I knew it was my femur – I was moving my hip but my knee was not coming with it… urrrrrgh.

    Cue a LOT of pain, swearing, drama, stretchers, skidoos, paramedics, helicopter evacuations and ketamine (!). At the hospital in Thonon, once I was splinted and on morphine, they took X-rays and diagnosed a mid-shaft spiral fracture of my femur with a butterfly fragment for added excitement…). That night, about 8 hours after I fell, they operated to insert a titanium IM nail and 4 screws. Surgery went well and I had a regional anaesthetic catheter left in for 2 days afterwards, so no pain from the fracture site but excruciating shooting pains in my groin whenever I moved – I now think from the awkward position I was in on the traction table for 3 hours during surgery. Spent 8 nights in the French hospital, most of it severely anaemic and with the travel insurers refusing to fly me back to the UK until that got sorted out; then a flight home with my own nurse (!).

    Recovery was uneventful but I was on 2 crutches for 3 months and on one crutch or a stick for another 3 months. Walked unassisted almost exactly 6 months after the accident and only started feeling more like myself again almost a year later. I had loads of physio and it took a very long time to feel remotely confident in my leg’s ability to carry my weight, and to get rid of the annoying Trendelenburg gait that characterises hip surgery patients. At the time of the fall, the French doctor had said I could leave the nail in for life but that I was “too young” to leave the screws in (I was 44 at the time) and they should come out after 18 months. So I always contemplated having at least some of the hardware out.

    But the UK doctors seemed to be of the school of thought “if it ain’t broke, don’t fix it!”. When I went to talk to a surgeon about removal, he asked if I had pain and when I said not really, he said he recommended leaving it as it was. The French doc had done an amazing job, zero rotation, zero leg length discrepancy. But every day I worried about the nail. I worried about infection years down the line; I worried about whether the bone would be weaker as it carries less load because of the nail’s reinforcement (and I have osteopenia); I worried about breaking the leg again in future with the nail still in (aaaargh!); I worried about having to remove it one day if I need a hip replacement and being far older and less able to recover by then; and I worried about implant-related sarcoma, a rare but aggressive cancer that can start in the tissue surrounding orthopaedic implants like IM nails. So I mailed the doctor a long letter explaining all this and he said I should come and see him again – I feared we would have another fruitless debate with him saying “why?” and me reciting all the same reasons again – but as it turned out he said that he could see that I had given it a lot of thought and was serious about removal, so he agreed to to the operation.

    So 2 years and 3 months after breaking my leg I had surgery to remove all the metalwork. It took longer than planned (nearly 3 hours) – the 2 hip screws came out without a problem. but both knee screws were covered by a cap of bone. After chiselling that away, he found that the top one was totally loose in the bone; and the bottom one’s head had been stripped during insertion so he had to drill into the centre of the nail to make a new thread for the removal tool to engage with and got it out that way. The nail also had bone overgrowth that had to be chiselled away but once that was gone, the removal tool engaged well and it came out easily. So I came round and heard that I was metal free!!

    As the anaesthetic wore off I was v uncomfortable – not agony, but could not really concentrate on anything other than the pain, so I got some strong painkillers. By the following morning, I was on nothing more than a codeine-paracetamol combo pill and ibuprofen, and I stopped all pain relief 3 days after surgery as I had no more pain. I needed no morphine after the operation. Having had to use bedpans for most of the first week after the original fracture, I feared having to do that again, but about 4 hours after the op I was able to get up with crutches and use the loo myself with the assistance of a nurse. The following day the surgeon came to remove the hilariously padded pressure bandages on my leg and check the wounds. The hip wound had seeped LOADS of blood and the dressings looked like raw steaks, at which point I nearly fainted. He said this was normal though and the incisions looked clean (I could no look!). But he sent me home with clean dressings and padding in place and antibiotics as he said wet wounds are more prone to infection. Also, because the operation had lasted longer than 2 hours, I had to go back on self-administered Clexane (anti-coagulant) injections for 2 weeks – but this was a lot better than the 6 weeks after the initial fracture!

    I went home with crutches about 24 hours after coming out of surgery with instructions to use the crutches for 2 weeks. I could weight bear as tolerated and so climbing stairs with the crutches was a lot simpler than last time. The following day I managed to walk about 500 m outside with my crutches; and on the 3rd day after the operation I could comfortably do that distance with only 1 crutch. By day 4, I could walk 1km with 1 crutch and by a week after surgery I could do 2km with 1 crutch. I went back to the doctor after a week for a dressing change – thankfully no more seeping from the hip incision – and he was very happy with the progress but reminded me not to throw the crutches away too soon as I have holes in my bone where the screws and nail came out which are stress risers and can fracture with an impact, Although I had no pain my leg was hilariously bruised at the hip, buttock and behind the knee, but all of this looked worse than it felt. The sorest thing was how incredibly tight and stiff my quad was, especially down by the knee incision.

    2 weeks after the surgery (that is, 3 days ago!) the doctor took the stitches out and all three the wounds are healing nicely and neatly. He took X-rays and I nearly cried with happiness when I saw my metal-free femur. Such a weight off my shoulders! Although I have walked outside every day since the surgery today, 16 days after surgery, I went to the gym for the first time. I rode the stationary bike for 30 mins with no resistance and did some arm work on the machines – no point in pushing things too far too fast! My quad felt so much looser afterwards! At home now I can get around without a crutch almost all of the time, and although I have a little limp still, my gait is almost normal and improving every day. I will still use a crutch outside the house until mid-June and I am not allowed any impact exercise like running for 4 months, but overall, recovery is a breeze compared to when I broke my leg.

    If anybody reading this has metalwork in them at the moment and has considered removal, I would say find a doctor who is actually willing to listen to your concerns and have a sensible conversation with you about the relative risks and merits of removal – not just somebody who fobs you off with “oh, we don’t remove that as routine any more”. For me, the risks were very controlled and I was mentally and physically in very much the right place for a good recovery, plus I hated how heavily the metalwork and potential future problems weighed on my mind. Having it out has been the best thing I ever did for my own peace of mind. If you are hesitant to have yours our because of the pain and recovery time, trust me – it is a thousand times easier than after the fracture! Remember, you won’t be healing a broken bone – you will have just the soft tissue injuries of the surgery. Also, you won’t have any other injuries to deal with, as most people have when they fracture their femur. Removal is not right for everyone and yes, sometimes the risks outweigh the potential benefits, but don’t be put off exploring all avenues that might provide the right outcome for you personally.

    Best of luck to everyone reading this!

  • Rachel

    I broke my femur in April 2015, splitting it in half and it was fixed with a femoral nail, a screw in the head of the femur and a wire loop around the body of the femur where a part of the bone had split off.

    The bone healed well and a year on I had recovered well. However the femoral nail was too long, meaning it protruded beyond the head of the femur and into my hip muscles. This caused pain and prevented certain types of exercise. So in June 2016 I had the metal work removed.

    This involved an operation under general anaesthetic and three incisions where there were the originally scar sites. I stayed in hospital two nights. I woke up with some swelling and pain, however this was insignificant in comparison to the original injury. I was up on crutches and independently getting around on the first day and only remained in hospital an additional day due to low blood pressure.

    The leg was sore and very bruised for a week or so. I used two crutches for a week, one crutch for the second week and by the third week I was only using crutches outside of the house. 4 weeks post surgery I was no longer using crutches and danced the night away at my sister’s wedding! 7 weeks on I no longer have a limp and whilst the leg is weak and will require a lot work to rebuild the muscle, it causes me minimal pain and does not feel vulnerable.

    I should probably mention that I am a fairly active and fit person and I definitely pushed my rehab and discarded the crutches as quickly as possible. I have also been advised that I tend my body repairs wounds particularly quickly. However all in all, my personal experience is that having the nail removed was the right decision.

    Rachel. Age 33. UK.

  • Neil Miller

    Hi guys, I have only just had my incident, breaking my tibia on New Years Eve, playing football. All of the information is fantastic and seems to be the one stop shop for IM nails. Just a quick one really to say thanks to Jake for starting and everyone for posting, I have spent about three hours reading as much as I can 🙂 It has also helped me set realistic goals for the next year, although a long way off. Cheers again. Neil

  • Karen

    Hi Jake and all the rest of you brave people who have had nails etc.
    I broke…well someone else broke my tib. and fib in Feb 2014 on a ski slope. The pain was well as we all know – very horrific. Especially when after my helicopter flight to hospital the a and e staff took off my ski boot without cutting it off. Yes it hurt and yes I did scream with pain. One thing I learnt was try to move it when you wake up from the op and do not allow your foot to droop when you are in bed. One of the most important things is to get the ankle movement and bend in order to be able to walk again. I propped my foot up with a cushion at the bottom of my hospital bed.
    It’s nearly 3 yrs since my break and I am due to have the nail out this spring 2017. I am petrified but I think the prospect of complications in the future and when I get older are telling me to be brave and have it removed. I have researched surgeons and fingers crossed my knee wound is better than it was first time round.
    One other tip for breaks I found was get some comfrey oil to rub on or even make a comfrey poultice and put it on your leg. This natural remedy is the miracle ‘knitbone’ cure it says it is. Good luck everyone. Thanks for the blog Jake.

  • samanthacoe2013

    Dear Jake. Thank you so much for this blog. Your site has been a great help. I am very much in appreciation to all. I had a butterfly fragment spiral fracture to Tib and broke fib 23/12/15 jumping from runaway horse drawn carriage in Austria. I am due to get my metal work removed on 2Oth Feb 2017 – a week tomorrow.
    At moment my achilles tendon on my non broken leg is inflamed. It might benefit from the enforced rest! I think this achilles injury comes from the imbalance and lack of flexibility in my nailed lower leg. Has anyone else experienced this? I know you had shin splints Jake. I highly recommend yoga for rehab. Have you had your Im nail removed as yet Jake?

  • Jess

    Hey all!
    I had my IM nail removed 11 days ago, 2 years and 2 weeks post it’s initial insertion.
    My rod was inserted quite deep, and due to the size of my bones, even the smallest of nails was a tight fit.
    The surgeon had to remove a portion of the top of my tibia to access my rod a little easier.
    I am on strike instructions from my surgeon not to hop or jump, defiantly not run, until he tells me so – this is to allow the bone and bone marrow to regenerate.
    Recovery has been ok – I’ve been struck with a lot of nausea & fatigue (mainly due to pain meds), and have had a bit of pain around the knee itself and the skin surrounding the tibia has been tender to touch.
    I’m hobbling around the house without crutches but take them when I go out – mainly to keep people away from me, and also I do get fatigued with walking.
    I’m struggling with the fact I am so limited and dependent on people around me. I was doing 3-4 F45 gym sessions, 3 pilates sessions and walking the dog daily leading up to the op, now can’t walk 50m before feeling fatigued and sore. I know I will get back to normal within 6 months
    My reasons for having my rod removed – discomfort. As I mentioned earlier, the smallest rod available to the surgeon was a tight fit. My fracture had healed nicely, but the rod was rubbing on the bone – causing irritation and pain when walking, running (on grass) and some activities in my F45 classes. The screws under the knee were also irritating me – they seemed to catch on muscle fibres or tendons.
    I had the ankle screw removed 6 months post initial op – that too was irritating me.
    For those people who are considering having it removed – liaise with your surgeon, physio etc and weigh up the benefits and cons for you of having it removed. The fact is was impeding in my daily tasks was the deciding factor for me.
    I am very lucky to have great relationships with my surgeon, sports physio, pilates physio and sports podiatrist – all have been supportive and open in their suggestions along my journey.
    Going in to have your initial surgery – you are going in blind, unaware what lies ahead of you. Going in for removal of your metalwork – you know what is ahead, and the prospect of having to undergo the knee rehab again was holding me back. However i am sure when I run my first kilometre pain free in over two & a half years, I know i would of made the right decision.

  • Jess

    Oh and one more suggestion – don’t google and watch videos of the nails being removed before you have your surgery! wait till after….

  • Denise

    I read all of these experiences and they helped me so much when I decided to have my tibial rod removed. Nov of 2015 I was kicked by a horse while ON my horse, had an unstable fractured tibia. Had no idea how painful that surgery would be until I woke up from it. Anyway, have had discomfort first from screws and had all 5 removed one year later. About 2 weeks later my shin had pain. I went back to PT, saw a physiatrist, even started acupuncture, nothing helped. Finally had rod take out June 15, 2017. I am 11 days post surgery today and that pain in my tibia is gone. I had Day surgery and I was sent home with crutches and an immobilizer. By day 2 I realized I could put weight on it and use 1 crutch. By day 4 I stopped using immobilizer and crutch and hobbled around. I’m 49 and the atrophy on my leg was bad. It shrunk so much in a matter of days, I wanted to start using it asap. At 11 days out I’m walking slowly and trying very hard not to limp. I cAn go up stairs normally but down stairs one step at a time. Hoping knee pain subsides in few weeks. Dr. Says that some people have permanent knee pain, praying that’s NOT me! Will update in a couple weeks.

    • Denise

      Oh, and I agree with Jess. I did not watch the YouTube videos until AFTER the surgery!

    • Amy Archer

      Hi Denise.
      I also had mine removed on 14 June 2017. One day before you. Are your cuts staples or stitched up? Mine are stapled on the sides and stitched on the knees. How are you doing? I still haven’t quite got the feeling back in my shin and knee area yet.

  • Amy Archer

    Hi Jake,
    Have you had your nail removed yet? I just had mine removed recently.

    I must say your blog have been very useful to me when I broke right tibia and fibula last year 30March 2016. I broke it while skiing in France. My x-ray looks like yours:1 screw on top and 2 at the bottom. It took me 12months to be able to go up and down the stairs 1 leg on each steps. Scars from the screws just about faded but i still get a weird numb pain sensation along the scar on my knee and on the right side on my knee cap. My knee and ankle have been giving me pain if i walk too much and was not comfortable to kneel on my knees when doing yoga. I had been very determined to get my muscles back into shape on my right leg after op; gym 4 times a week: yoga, endurance training and total body conditioning. Also been to an osteopath to get my alignment right as between all the excercise, i had developed severe back and shoulder aches. I was told by my osteopath that my right leg is 1 cm shorter than my left leg!
    To cut the story short, i had just had the nail removed 14 June 2017 after 14 months. It was done at Royal Berkshire Hospital, Reading, day surgery but ended up staying 1 night as I was bleeding from the wounds. No doctor came to see me after the op till the next morning. I was left hanging, not knowing until much later that I was going to stay the night. I had to ask for the nurse to get the Dr to prescribe pain killers and antihistamine for me(My body gets itchy from the anesthesia from previous experience). I was given 1000mg of panadol and 60mg of codeine. I must say it was good to stay the night as i was able to adjust the bed to have my leg propped up and to have some peace and quite from my children.When the pain got unbearable, I had asked for ice pack to put on my knee. That really helped. Wheeled on potty chair to the toilet with the help of the nurse on the day of the op.The next morning, a physiotherapist came to visit my neighbour but none was scheduled for me. I asked and I was told that my notes said full weight bearing therefore, no physio , just get up and walk! I tried to walk to the toilet but it was too painful to be totally weight bearing. Had to ask for a walking frame for support. It would have been nice for the physio to refresh my memory on how to take my first steps and some leg exercise that I could do on my own. No empathy at all. On crutches (luckily I still had my crutches from before)for first 4 days about 80% weight bearing . Was discharged with codeine and stapler remover. Nurse only changed one dressing that was soaked in blood. Was told to see get dressing checked in 2 weeks time!
    To me 2 weeks was too long so I made appointment at my gp to have it checked and changed after 1 week as I could see blood stains in my dressing and was afraid of infection.
    Stopped the codeine on day 3 as it was giving me a headache and I was feeling very groggy and spaced out. Still had my crutches with me until day 6 as my knee would sometimes buckle up !

    Day 1 to 3 Shin and ankle was numb, Leg swollen. Legs up and ice on the sofa. Shower in bath, Leg wrapped in cling film as plaster was not waterproof ones. My husband had to help.

    Day 4 Swelling gone down, slight sensation on ankle and part of shin. Carpet burn pain sensation around and below knee in shin area.Swelling returned when on feet too long. Itchy around one of the plaster, red bumpy patches. Cut part of plaster off ,took antihistamine.

    Day 5 to Day 12 Bruises start to appear. More feeling in the ankle and shin. Weird numb sensation around the knee and below the knees in the shin. Carpet burning pain sensation around knee and shin. Legs up, icing.

    Day 8 Had my dressing removed and changed at the clinic. Waterproof dressing! Can shower on my own!! The screw scars on the side of my leg was 4 to 5 times longer than my original scar.: staples. The scar on the knee was stitched in dissolvable stitches, held together by steri strips.

    Day 11 started alternating heated bean bags with ice pack on leg.

    Today is Day 13. Leg still aching and bruises. Still limping, knees still buckling. Back ache and shoulder ache. No problems with flexing and moving ankle. Knees bend only to 45 °. Stairs mobility: 2 feet on each steps. Shin and ankle and knee still numb.

    Having the staples out in 3 days time! Not looking forward to the pain! Surgeon said I can exercise once the wound is closed up. I have read somewhere that no weight exercise until after 6 weeks. I think I’m going to take it easy and see how well the wound is healing first. Fingers crossed.

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