pfn

Somewhat bike related, somewhat not.

In 99 or so, I got into a bad accident and broke my femur and had to have a titanium pin inserted to aid in healing. It's been there since. The orthopedic surgeon specified that I should have it removed if I had any risk factors (motorcycles, etc.) I'm reluctant to undergo surgery again.

I've been wondering if road biking and possibly racing bikes would present a risk factor and whether I should get the rod removed.

An anecdotal experience: a friend of mine got into a bike vs. van car accident down Mt Diablo a few years back and had to have his femur pinned (it was crushed badly).

I wouldn't like my femur to do the same thing again. Unhappy days, but is there enough of a risk factor that it [the pin] should be removed?

ripperj 

I'm not a Doctor so pardon the stupid question, but why would the pin come out? ssems like you would want it in for strength?

RideCO

If it were me I would not have it removed. I am no doctor but I don't believe in unnecessary surgery, you have to weigh one risk vs the other.

If you decide on the surgery you might want to see if they can replace it with a carbon fiber pin, carbon fiber stuff is all the rage lately.

Szczuldo

I'm with ripperj on this one, unless the rod can somehow cause a significant amount of extra carnage within your leg I don't see a reason for it to be removed but then again I'm also not a doctor but there are a few here...

I would assume you asked the doctor why would you get it removed, and if not maybe you should go back to him and ask him.

pfn

The titanium is stronger than bone. Now, imagine that the bone breaks. Very unhappy days.

pfn

Oh, and my femur was fully healed within about 2 years of the accident, so the rod is no longer necessary.

sestivers

I am not a doctor. But I would ask myself what the odds are of breaking my femur (again).

Your femur is one of (if not the) largest and strongest bones in your body. I personally have never met someone who broke his femur. I'm not saying it never happens since it obviously happened to you and others I've heard about. You would have to have a significant accident and a lot of bad luck to break it again, even with riding a bicycle regularly. With surgery, you are guaranteed to have some kind of complication along the way, at least the healing process itself.

So I'd leave it alone, unless your doctor has more convincing evidence that you have some likelihood of breaking your femur again.

pfn

Indeed, and this is why I am asking: does bike riding and racing pose a significant risk factor? The doctors will heartily recommend removing it if I am riding a motorcycle (I know of several people with the same injury from motorcycles). I know of one person, personally, with the same injury from a bicycling accident. This is all anecdotal, and again, that is why I asked for "advice" here; is the risk factor significant?

Wanderer

I am not a doctor, but speak from experience.

I suffered a tibial plateau fracture, where one side sheared off, and the other side crushed.

My leg was screwed, pinned, and plated, back together.

The final surgery, (#6) was to remove the pins, plates, and screws. Primarily, to relieve discomfort, and to help avoid catastrophic (the doctor's words) fracture at a later date.

Believe it or not, most of your bones flex when stressed, and when they are prevented from doing that by pins and plates, it is very uncomfortable. And, when prevented from flexing, they can snap like a branch over a rock.

I sure hope I never break that one again!

My advice - follow the doctor's advice.....

pfn

Ow, sorry to hear. In my case, there is no pain nor discomfort, and as far as the surgeon/doctors were concerned I should only remove the rod if I wanted to, or if I had risk factors. There's some amount of grating in my hip but not discomfort.

celerystalksme

I'd have it removed...but that's just me...

Scorer75

I've got screws and a plate in my leg. It's not a rod through my femur, but metal parts nonetheless.

My doctor gave me the option to remove them, but the decisive factor for me was that it would take 6 months for the holes after the plate and pins were removed to fully heal. 6 months of no hockey or other vigorous activity.

With very little additional risk, certainly less than getting cut open again, I decided to keep them in.

It's been 17 years and I've had no problems due to leaving the pins and plate in place.

Good luck.

tanguy frame

I met a guy who's metal hardware was causing him pain and when he had it removed, the pain went away. My daughter has pins in her talus that will be there forever - she has no pain or risk in having the Ti in her bones. so we are not qualified to answer your question.

melissam

Hi pfn,

In 1990 I had a spiral fracture of my left femur that was surgically repaired with a rod and two pins down by my knee. My orthopedic surgeon originally thought that the rod would stay forever, but the pins would be removed in a couple of years. He also said I could ride my bike again 6 months after the accident. Playing softball (which I made into a contact sport) would have to wait a whole year. Ironic, because I broke my femur during a crash on my bike.

My orthopedic surgeon never mentioned that having the rod or pins in place could be catastrophic if I broke my leg again. Not sure why he didn't say anything; I never even considered the consequences, so I never asked about that scenario.

Anyway, I had issues with the rod in my leg, so the rod & pins were removed about a year after the original break. I had to wait 6 weeks after the second surgery before resuming sports activities.

I can tell you that the second surgery was MUCH easier than the first. It was out-patient surgery, and they re-opened the area by my knee to remove the pins, and re-opened the area on my hip to pull the rod out. I was back on my feet within an hour after waking up -- the nurses even suggested not using crutches. I think I used one crutch for the day after surgery, because I felt a little whoozy coming out of general anesthesia. Pain during recovery was mostly due to the incisions, and I think that went away within the first week.

If I still had the rod in today and had to decide whether to remove it, I'd probably opt to remove it. I know -- there's risks with any surgery. However, in my case, I think the risk of surgical complications is less than the risk of damaging my leg again. (I can be a bit accident prone.)

I wonder if you could have the surgery performed under a local anesthetic? That would probably lessen the risks. (Of course, you might want to bring an iPod and some noise cancellation headphones....)

Best of luck in making the right decision for you,
Melissa

oilman_15106

They told me I was too old to bother removing the plate, eight screws, and 2 pins in my leg. And yes when you get even older it you will know you have all that hardware when the weather is changing.

trad

had a plate put into my clavical. was told that titanium is the only metal the body does not reject over time and is safe to keep in. in my case, it restricted mobility and I had some pain, so I'm glad I took it out.

Siu Blue Wind

Because of the bone flexibility issue, I'd remove it. Plus, with the ability to for the bone to flex you will be able to have the normal teeny stresses that make bone stronger when it rebuilds itself after hard activity.

merlin55

Ask your doctor, not us bicycle geeks. Do you ask your Doctor how to true a wheel?

My neighbor who is a doctor, broke his leg (tib/fib compound fracture) and had a 1 cm diameter rod inserted down the center of the bone, and then all the bone pieces screwed to the rod (internal fixation). He said that his otho advised no more sking, until and unless the rod (over 25 cm in length) was pulled out of his leg. Apparently the risk is that another fall, and the rod would spit the bone open, and he could lose his leg. But you didn't hear this from me. Ouch.

pfn

I ask bike geeks for any experience with bone breaks that occur coinciding with riding. I would certainly ask my doctor if I had any pain related to riding, so it'd be perfectly ok for me to ask you folks if you or those among you have incurred any such "hardware" installations and the experiences of such. The femur is an extremely strong bone and only breaks in catastrophic circumstances, the question is whether bicycle riding can be catastrophic enough and there is a large enough chance. A doctor is unlikely to know unless he is also well versed in cycling.

Everyone else, thanks for the insights, I will have to find a new ortho/doctor (I'm young, I don't get sick, I don't have a regular doctor) and ask for his opinion on how much downtime any surgery would involve. Local anesthesia would be awesome, but I somehow doubt they'd let me watch; general anesthesia is some rough stuff.

TRaffic Jammer

From what I've heard from doctors is that generally, if the hardware has done it's job in the realm of helping stuff align while healing then once the healing is done it is really preferable to have said hardware removed as soon as it's possible. I have a friend that will be off her feet for 6 weeks after the junkyard is removed from her ankle after a nasty fracture last winter.

Shabubu

Hi there, new member to the forums and an orthopaedic surgeon so just though I'd throw my opinion in there.

Just to get the terminology straight, the long pin or rod along the bone is a nail, the small pins at each end are screws that go through the nail (called locking screws).

The concern your surgeon has is that in the event of another accident you could break at either end of the nail, meaning a very low or high fracture which is difficult to fix. Worst case scenario is that you could break mid shaft of the femur and the nail would bend, making it difficult to remove (which is required to fix the new break).

I tend to avoid removing metal work, any aching or soreness is not garunteed to improve, you weaken the bone slightly when you remove the screws (empty screw holes in bone take about 6 weeks to get to the same strength as screw holes with screws in them), and there is the risk of anaesthetic etc., remember that in the States removal of metal work is financially renumerated so it is performed a lot more commonly than in Europe. That being said if you are in high risk activities fixing a break is a lot easier if the nail isn't there. If you do a lot of cycling on busy roads, or any of roading then you would probably be safer removing the nail.

I should mention that I have not personally nailed a femur or tibia in a cyclist during the past 5 years, and i'm on call every 5th day.

Camilo

OK, this will be harsh: but why the "f" would you think that advice you get from yahoos on the internet would have more credibility than your "f'ing" doctor who not only studied medicine for umpteen years, but is TOTALLY familiar with your case including the actual injury, the success of the procedure, and typical future consequenses? Yeah we bike riders know a lot about all that.

I mean this is just bizarre!!

I don't disagree at all with your reluctance to avoid surgery if possible, but FOR GOD'S SAKE IF YOU WANT A SECOND OPINION, GET ONE FROM SOMEONE WHO'S QUALIFIED TO GIVE YOU ONE!!! Find an orthopedist who is familiar your type of case, who is familiar with road bike racing so he/she will have a good idea of practical considerations. Your current doctor should be happy to refer you for a second opinion - it's very common to feel nervous about repeat surgery and it shouldn't be offensive to your doctor for you to ask for this.

Geeze.

pfn

I never asked for advice on whether or not I should have it removed. What I asked is whether bicycling a risk factor; are there any experiences here, anecdotal or otherwise, that would indicate such a thing. Back in '99, my surgeon only indicated riding a motorcycle as a risk factor--probably because he saw a relatively large number of cases with a similar injury. Now, I agree with you, I should find a surgeon who is familiar with cycling, but I'm certain they would be quite rare; so, I ask here for experiences.

curiouskid55

Broken femur's are not a commom cycling injury. Most common are collar bones and thumbs. I think a broken femur would fall into the range of freak accident and highly unlikely.

pfn

I don't have any aching or soreness related to the nail in my leg, except maybe imaginary sometimes when I feel a dull/light ache in the thigh (lifting heavy weights). All I feel is a grating in my hip, probably because of the exposed screw-head.

Thanks for the insight. What I need to do is find some statistics on bicycling injuries to find the number of injuries involving bone breaks (particularly of the femur) and then compare the risk.

6 weeks of "slightly" weakened bone doesn't sound bad at all, but I would need a consult to tell for certain in my case.

Thanks.