The Outsider: When should you remove a rod in your leg?
October 12, 2015
The central Rockies are one of the best places in the world to horribly mangle your bones.
Now, let me explain. Near the end of the 2013-14 ski season, I demolished the right side of my body in a snowboarding accident at Beaver Creek, breaking my tib-fib above the boot and snapping my ulna near the elbow. The leg break was thankfully clean, my dislocated elbow was easily reset and, with the exception of yet another nasty concussion — probably the sixth or seventh of my life — I was pretty damn lucky. Bones heal better when they aren't pulverized into eggshells.
Still, broken legs and mutilated elbows don't heal themselves. And, so, yet again, I was lucky enough to be within limping distance (more like completely unconscious ambulance distance) of Vail Valley Medical Center. It's the on-call home of orthopedic surgeons with Vail-Summit Orthopaedics, which is easily one of the world's most sought-after clinics along with The Steadman Clinic, another group of renowned bone specialists in the Vail area. These docs work with American athletes at every level — MLB, NFL, NHL, U.S. Ski Team, the list goes on — along with dozens of international pros, including players with Spain's La Liga and England's Premier League. In other words, they're the pros for the pros.
So, when I decided to break myself off a few miles from the world's orthopedic epicenter, my surgeon just happened to be William Sterett, team physician for female Olympians like Lindsey Vonn and Julia Mancuso. He also just happens to be an orthopedic trauma specialist — mangled bones are his bread and butter, so to speak. Again, luck was completely on my side, aside from that whole accident thing.
The bionic man
I'm not being dramatic when I say that Dr. Sterett worked miracles. Sure, it took my atrophied chicken leg about four months of physical therapy until I could walk without crutches or a rigid boot, and I still can't throw a baseball as far as I once could. (The unrepaired AC joint I busted earlier that season doesn't help, but that's an entirely different story.) But I was able to snowboard for opening day at Keystone last season, and by the time May rolled around, I'd logged my standard 75 days of riding with very little residual pain. I'm also 27 years old, and Sterett often said that age can make a world of difference with orthopedic recovery.
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But my body wasn't (and still isn't) quite back to normal, even if my outdoor activities are virtually unaffected. I can no longer feel my right kneecap — honestly not a huge deal — and after a long, full day of charging powder, my foot tends to tingle with pins and needles, like it's permanently waking up after falling asleep.
The thing that manages to get in the way is the hardware itself. To repair the tib-fib, Sterett had to remove my kneecap and insert a 5-inch alloy rod through the gap between my bones. He then secured it in place with several screws and pins. He did the same with my ulna, along with a large plate that still runs the length of my forearm.
Sadly, I'm not an "Archer"-style bionic man with robot legs, but these sub-dermal supports are vital to modern orthopedics. Without them — say, with a traditional cast — the recovery would have taken much longer and, most nerve-wracking for a young, active athlete, my bones might not have reset the same way.
But hardware comes with a price. Like many folks who have seen an orthopedic surgeon, I can feel the pins and screws through my skin. The one on my ankle even pokes out far enough to see, which is especially annoying when it's shoved up against a ski or snowboard boot. I'm not sure if that's causing my foot to fall asleep or tingle or whatever it does, but the pin must play some part.
Naturally, I started wondering if hardware removal is in the cards. Along with combating my foot and ankle pain, I've also heard dozens of "what if" horror stories, like, "What if you break your tib-fib again?" It sounds like a reasonable concern, so when I asked Sterett, he said it wouldn't be pretty. After all, a metal rod won't break like my bones — it will just rend through the muscle and skin. Of course, all this gruesomeness depends on another nasty break, which I will try to avoid at all costs.
And that's the rub. It's not like I planned on breaking my bones in the first place — it happened, and I was lucky enough to be near incredible orthopedic surgeons. But I'm also not the sort to avoid cliff drops or terrain parks or luscious, powder-filled glades because I might break my leg again. It's a risk I gladly take, but now, it's a risk that comes at devastating cost, and the last thing I want is to no longer be able to ride, period.
To remove or
not to remove?
What, then, should athletes who have had recent orthopedic work do with their hardware? I was tempted to remove the rod and all pins in my leg this month, just after MTB season ended and a few weeks before ski season began. Sterett had told me that recovering from hardware removal is about 6-8 weeks. In my head, I figured I'd miss the first few weeks of early-season snow and be ready to go by the first big storms of December.
But again, I want to snowboard forever, not cause irreparable harm by indulging my impatience. So I went to the pros. I spoke to one of Sterett's colleagues, Dr. John Paul Elton, a foot and ankle specialist with Vail Summit Orthopedics. He started with the same rationale as Sterett.
"The hardware we put in can stay in," he said. "We don't typically need to take it out except for in specific cases, like the location of the hardware, or if it's served its purpose and has become symptomatic. When it's causing pain, we can look at taking that out."
OK, so the hardware in my arm — the plate and screws on my ulna — can stay in. I hardly notice them, except for when comparing scars with buddies (yep, I'm still a child in some ways). But the rod in my leg and, more importantly, the pin and screw near my ankle can potentially go.
Luckily, both Sterett and Elton told me you can remove hardware in bits and pieces. The rod can remain, even if I want to remove all the pins, which means the doc won't have to move my kneecap again.
"If someone's sport is demanding, they still have the same risks for removal surgery," he said. "I would make the decision based on whether or not the hardware is bothering them. Again, you have a ski boot squeezing on ankle hardware. If we walked around in flip flops, that wouldn't be an issue."
But what about the timeframe? When I was laid up after the accident, I found that most hardware could be removed after about a year (or once the break is fully healed), but that after two years, it's often too ingrained in the body to safely pull out. In other words, orthopedic patients really do become quasi-bionic people.
Elton said that's not entirely true. Like all accidents, it depends on the specific person and their situation, but most hardware can be removed indefinitely — especially once it begins to cause issues. Case in point: He recently removed a 50-year-old femur rod that was beginning to be a burden.
"It was like opening a time capsule," he said. "We found this old piece from 50 years ago that hadn't been seen (in) the light of day for so long."
So, I wasn't under the time crunch I expected. It's been about a year and a half since my surgery, and even though I felt like the clock was ticking, it's not. I have time. But then I started thinking about that miserable ankle pin. Do I really want to go through another year of riding on a tingling nub?
After talking with Elton, I decided that, yes, I do, and it's for the same reason I wanted to get my hardware removed in the first place: Ski season.
"The biggest reason for keeping it in is that it takes surgery to get it out," he said. "Once the bone or the joint has healed, you don't absolutely need it in there. It's just a matter of what someone wants to go through."
After a full 18 months with a rod in my leg, the bone is 100-percent healed and ready to take its typical beating. But, removal still requires a recovery period, and I'm already anxious enough to get back on the snow. I'd likely do something stupid, or just do my normal activity, and that mindset is asking for trouble. I've already been lucky enough once — no need to push things.
Come May, that ankle pin is going away. But until then, there's riding to be done.
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