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Tibia IM rod removal?


Original Post
RandyLee · · Homer, AK · Joined May 2016 · Points: 5

I broke my leg last September. Tib fib, with a distal spiral on the tib. Good times. I've got a rod and 4 screws in, and now my knee hurts at the top of the rod from activities like running or the approaches at Red Rock last weekend.

Has anyone else had an IM rod and gotten it removed? How long between insertion and removal? How bad was recovery?

I imagine 6 months is too soon, but how much longer before it's worthwhile to go talk to the doctor about taking it out?

Andrew Yasso · · Las Vegas, NV · Joined Sep 2012 · Points: 215

Randy,

When I was 18 I had effectively the same injury as yours, including a femur fracture. I had the rod and 12 screws in my tibia, and it stayed in for 1.5 years.

Recovery wasn't too bad, I was just told not to kick anything or jump for at least 6 months. I heard horror stories of people kicking a soccer ball and watching their leg break. I definitely stayed off it for that time, but came back to climbing with way less pain.

I'm guessing you can talk to a doctor at anypoint about taking it out and they'll take some x-rays and let you know.

JSH · · Unknown Hometown · Joined Apr 2007 · Points: 1,028

I had screws and plate removed (calcaneus) at 5 months from injury, and it made a big difference in mobility.

I have an old friend who had a rod removed from femur, years later.

I doubt 6 months is too soon - if it's interfering with normal motion and/or causing pain, you don't want that to get ingrained. Go talk to your doc.

Found this ... Overall, 77.8% (14/18) of patients were satisfied with their IMN removal and would undergo the procedure again if given the opportunity. The average pain score after removal was 4 out of 10. We had no preremoval pain score with which to compare these values. Overall, 72.2% (13/18) of the patients felt that their symptoms had improved since the removal. Patients who had their entire IMN removed had increased symptom resolution as compared with patients who had only a portion of their IMN removed (88.0% v. 71.4%)

RandyLee · · Homer, AK · Joined May 2016 · Points: 5

Thanks for the advice and stories. My schedule rarely has time for me to see a doctor in it, so I'm hoping to not waste days and goodwill of my boss (working in reality TV, if you're "that guy" who takes days off, some people won't hire you for the next job) by going extra times for "is this ok". But it sounds like it's far enough along that it's probably worth trying to find a day to go talk to the doc and hopefully line up the removal.

Thanks!

George Perkins · · The Dungeon, NM · Joined Apr 2006 · Points: 3,019

Thanks for posting, and thanks Andrew for your reply. Don't know if my story helps, but I'm interested to hear responses and opinions, for my own sake. I've had a tibial IM rod for 19 years (broken tib/fib at 17, now 36) and it's still in and I climb 100+ days/year, including a decent number at a fairly hard level ( up to 12-) on non-sport climbs, some of which are at my limit and have a greater risk of non-consequential falls. I hiked the Appalachian Trail with it in, 20 months after injury, and didn't notice problems specific to that injury. Seemed okay when I went through a trail-running phase (1/2 marathons) for a couple years, ~13 years after injury.

I notice (a) the annoying pressure on the screws on the inside of my leg in ski boots, (b) numbness on the outside of my knee, (c) I walk slightly pigeon-toed on that foot, and (d) became a little slower in my top sprinting speed. Nothing intolerable. No pain in my knee. But maybe I don't know how much better it could be?

After I started climbing regularly, my biggest concern is what would happen if I were to fall really hard on it, a ground fall or missing the pads bouldering.

Look forward to opinions on if I should pursue surgical removal, and what to expect for recovery if I were to have it removed at this point.

simplyput . · · Unknown Hometown · Joined Nov 2013 · Points: 60

Can the alien overlords communicate with your canine companion using the rod as a sort of antenna?
Asking for a friend.

RandyLee · · Homer, AK · Joined May 2016 · Points: 5

I spoke with my doctor, they recommend not removing rods unless there are serious issues, and had nothing good to say about removal. He also tried to scare me off with "removing the rod might not fix anything, and is a very invasive procedure that could cause further damage". Then he concluded with saying that they won't do it until it has been a year. I'm left counting down the 7 more months until I can get get this thing taken out. 

RandyLee · · Homer, AK · Joined May 2016 · Points: 5

Update, in case anyone else is thinking of Tibia IM rod removal:  

I had the rod removed May 30th, approximately 7 months after surgery, because an infection wouldn't go away for several months. I had to take 2 weeks off of work, but I spent most of that getting my WFR, starting 5 days after surgery. Those 5 days I wasn't moving very fast, and was back on crutches. 2 crutches for a couple of days, then 1 for a few more. By 2 weeks after surgery I could jog again, now just over a month later I've been hiking long distances, carrying packs, running 6+ miles at a pop, and generally feeling great. For around a month there was slight anterior knee pain if I moved too fast without stretching my knee first, now that has gone away. I was fairly certain that removing the rod would help get me back to where I want to be, now I know - I would never have been able to live my life the way I want to if I had left it in. The final month before removal my right knee hurt all day, every day, with every step, now I'm pain free.  

JSH · · Unknown Hometown · Joined Apr 2007 · Points: 1,028

Very glad to hear that, Randy!

Andrew Yasso · · Las Vegas, NV · Joined Sep 2012 · Points: 215

Awesome to hear Randy. Surprised the doc went back on his/her 1 year waiting period, but glad it is working out for you. Take care.

Anna Lindström · · Los Gatos, CA · Joined Nov 2017 · Points: 0

Thanks. I got my hip, fibia and tibula broken badly 2013. Few screws (4/6) were removed 7 months later. Now most pain still remains especially around the ankle and wonderig if rod removal would be worth negotiating through.  

RandyLee · · Homer, AK · Joined May 2016 · Points: 5

I'm climbing harder than ever and just did the Thunderbolt to Sill traverse, among other mountains. My pain was clearly the rod rubbing on the inside of my kneee and removal fixed it. I'm not in a position to speak to someone else's pain.

I do occasionally get some pain where the break was if I sprint or take a harder landing on it which has me a little worried, but maybe I'm just imagining something. I'll update in the future if it turns into a problem. 

Its worth talking to your doctor about if it's still causing pain. 

Paul Amarante · · Unknown Hometown · Joined Nov 2017 · Points: 0

I had 3 rods in my tibia, after an MC accident in '89, in which I shattered my tibia, and split my fibula.  I had them removed 2 years later due to the irritation of my knee, could not bend my leg without pain, felt the ends of the rods rubbing the soft tissue, my knee was in so much pain due to the rods that I would wrap my leg, it immediately felt better when I had the rods removed, but now I have minor arthritis developing in that knee, always hurt to some degree.  I also had an EBI bone healer, 9 MONTHS in a cast, would have been bone grafts, and possible amputation without, thank God I went to a good ortho, Dr. Richard Ravitch.  Amputation was stated by some idiot in that dog house, Coney Island Hospital, in Brooklyn NY.  Also, the accident and fractures kicked off Multiple Sclerosis, 24 years now, but I still ski, some minor issues, but the stress of the injury caused it, albeit minor, just pain for the most part.  I remember being in my ortho's office, and told him "everytime I bend my head forward, I feel shocks down my legs (lhermitte's sign), and his face dropped, and said I should see a neurologist, it went away, and 2 years later slurring, which lead to my dx.

Read Januskiewiecz · · New England · Joined Oct 2010 · Points: 241

Broke my leg a few years back tib fib rod with four screws. My knee was sore initially after bigger days with lots of hiking or impact. Or even the occasional bump was sensitive. My doctor had brought up the idea of removal but let me know it was no guarantee to eliminate the pain. So I opted to just let it be and see what happened. I've noticed that it has all but gone away at this point it just took some time. The only thing I really notice these days are if I bump a screw just right. 

Stu Ritchie · · Denver · Joined Dec 2007 · Points: 1,735

I had a mid-shaft Tibia fracture 19 years ago. Still living with the rod in place. I have not experienced any issues all these years. 

SMarsh · · NY, NY · Joined Sep 2013 · Points: 0

I have a rod and seven screws after a tib/fib fracture (skiing).  The equipment has been in me for over 10 years, and I really don't experience much discomfort, except in climbing mode for backcountry skiing.

It hasn't changed my performance.  I was never particularly fast.  I am still flexible.

I've left it all alone, since my orthopedist told me that I could explore that option if I was really uncomfortable, and it's not.

Bridgette Hecht · · Unknown Hometown · Joined Mar 2018 · Points: 0

Randy-thanks for posting about this. I'm glad to hear others have had the same experience I'm having and that you're pain free after removal! I've had my tibial rod for 2.5 years and still have pain with activity. I have an appt tomorrow to talk about getting the rod out. Great to hear you've had a good experience with removing it!

Jim Corbett · · Keene, NY · Joined Sep 2008 · Points: 10

I broke my tib/fib pretty badly in an ice climbing fall, then developed a staph infection in the bone. After a couple of months of intensive antibiotics through a pic line they finally managed to fix that by removing the original rod (a nightmare in itself, as it got stuck and they had to send to Boston for special piece of equipment to extract it--two more surgeries) and replacing it with another coated in antibiotic impregnated cement. (thank god, because the surgeon said 'if this doesn't work, the next step is a lot more drastic'). 8 surgeries, three weeks total in the hospital, all because I fell trying to retrieve a $10 knifeblade (Moral of the story: just leave the f***ing gear). 

Anyway, after all that I never had any issues with the rod, but a couple of years later I had it removed anyway. Figured I'd eventually do something stupid again and I heard that if you break it again with the rod in it's a lot worse, and besides, I'd just about had it with rods. Don't remember having any issues or even doing anything special to recover and rehabilitate. I was hiking in a few days and climbing soon after. It's been great ever since, but it's pretty ugly--I'm not going to win any short shorts contests.

Anna Lindström · · Los Gatos, CA · Joined Nov 2017 · Points: 0
Anna Lindström wrote:

 Now most pain still remains especially around the ankle and wonderig if rod removal would be worth negotiating through.  

Just an update. I followed through w/ this. In March started talking with my sports ortho @Stanford to collaborate w/ the trauma ortho taking up 3 surgeries in one next fall. Surgery was last week. They took out the rod, cleaned up scar, that was down to my bone in my shin, causing a lot of pain and fixed my knee a bit. 


Rod had really been hard to get out. My knee looks like a football and feels pretty beaten up. I was told to bear weight on it as tolerated. Few days took it easy with crutches to lean on a bit and just got reading/writing done in my pjs. Incicion was still dripping blood. :( Third day was up driving/walking for bit over 6 hours. Been ok, yet still after a week the whole tibia is pretty sore. I’m still optimistic, and rod gone feels great. But dann I feel much more hammered, than I expected. 
Hiro Protagonist · · Colorado · Joined Apr 2012 · Points: 290

I also broke my tib/fib 10 years ago snowboarding and have a rod and four screws.   After being cleared for activity plus a bunch of extra time, I started trialthon.  The running made my knee area (top of tibia?) sore, but not badly.  After more training, it does not bother me anymore at all (up to marathon distance, 20 day treks, etc).
So completely happy having left it in; only worried about re-injuring that leg (in a developing country especially).
Hint: if you decide to break bones, do it near big skiing regions, they get a lot of practice.

Jim Coleman III · · Port Orchard, WA · Joined 7 days ago · Points: 0

I had a tib rod put in back in 1993. It will be surgically removed today as it has been irritating the knee and I will need a knee replacement before too long, so the rod has to come out first. It's been in there for 26 years! I also have a rod in the femur but they are leaving it in. I am very active and am hoping this will help with the knee pain and maybe buy a little more time before replacement is necessary. I am not all that old and am a borderline case on the replacement right now. 

Guideline #1: Don't be a jerk.

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