Should Metal Used for Surgical Fixation be Removed After a Fracture Has Healed?

Metal, such as surgical plates, is often used to stabilize bones following a fracture, ensuring proper alignment and allowing the bone to heal. Once healing is complete, many patients and physicians face the question of whether or not to remove these metal plates. Traditionally, the decision is based on factors such as pain, mobility, or complications like infection. However, emerging concerns about the broader physiological impacts of leaving metal implants in place—such as interference with the body’s electromagnetic field, nerve conduction, and subtle bioelectric signalling—have prompted further investigation. This article explores whether removing surgical plates is advisable, considering not only biomechanical aspects but also the potential effects on the body’s complex signalling systems.

Structural Strength and Bone Health After Healing

Once a fracture heals, the bone generally regains its original structural strength. In many cases, leaving the surgical plate in place does not affect this recovery. Metal plates, typically made of stainless steel or titanium, are biocompatible and designed to support healing. Once healing is complete, the mechanical role of the plate becomes redundant.

Advantages of Leaving the Plate in Place:

• Avoiding Additional Surgery: Removing plates requires a second surgery, which comes with risks such as infection, nerve damage, or anesthesia complications.

• Minimal Impact on Mobility and Strength: In healthy individuals, most metal implants do not affect long-term mobility or strength once the fracture heals.

However, while structurally benign, the presence of metal in the body raises questions about its broader implications on bodily systems that extend beyond musculoskeletal concerns.

Electromagnetic and Bioelectric Concerns

The human body operates through intricate bioelectric signals, from nerve conduction to cellular communication. Metal implants, being conductors of electricity, may potentially interfere with these processes.

1. Electromagnetic Charge and Nerve Conduction: Metal plates can theoretically alter local electromagnetic fields, particularly in regions dense with nerves. While this does not cause obvious issues in most patients, subtle effects on nerve conduction, signal transmission, and muscle function may occur. Although titanium and stainless steel are relatively inert, they can still act as conductors, affecting the body’s natural electrical impulses. This can be especially relevant in individuals prone to heightened sensitivity to electromagnetic fields or those who experience unexplained neurological symptoms after surgery.

• Potential Consequences: Some patients report sensations of tingling or numbness near the implant site, which could be linked to minor disruptions in nerve signaling. Although rare, changes in nerve function due to altered electromagnetic fields could have implications over the long term.

2. Radiofrequency and Electromagnetic Radiation (EMR): The modern environment is saturated with electromagnetic radiation (EMR) from devices such as smartphones, Wi-Fi, and microwave ovens. There are concerns that metal implants could act as antennas, amplifying EMR exposure. While the science on this is still evolving, studies have shown that certain frequencies of EMR can interact with metallic implants, potentially causing heat or affecting the bioelectric fields of nearby tissues.

• Impact on Cellular Signaling: The human body relies on subtle electrical and chemical signals to maintain homeostasis. Interference with these signals—whether due to external EMR sources or internally from the presence of conductive materials—could theoretically disrupt the balance of cellular processes, affecting healing and general wellbeing.

Impact on Dental Physiology and Other Mechanisms

Interestingly, the insertion of surgical plates can also affect seemingly unrelated systems, such as dental physiology, through a phenomenon known as "oral galvanism." This occurs when different metals in the body create a small electric current, which may lead to changes in taste perception, increased sensitivity in the mouth, or discomfort around dental restorations. If a patient has metal dental fillings or implants, the interaction between different types of metal could exacerbate these effects.

• Electrochemical Reactions: Although this interaction is subtle, patients with metal implants in their bones and dental work may experience sensations or metallic tastes due to electrochemical reactions between dissimilar metals. This phenomenon is not universally experienced, but it adds to the cumulative argument for metal plate removal in sensitive individuals.

Long-Term Effects of Metal on Immune and Cellular Function

Some patients have raised concerns about metal implants contributing to long-term immune responses, including low-grade inflammation. While biocompatible metals such as titanium are generally well-tolerated, they are not entirely inert. Over time, corrosion or micro-movement of the plate can release metal ions into the surrounding tissues. In some cases, this may lead to hypersensitivity reactions or chronic inflammation, which could affect both local tissues and systemic health.

• Potential for Metal Ion Release: Titanium and stainless steel are designed to resist corrosion, but minimal wear over time could release trace metal ions. Some patients may develop sensitivity to these ions, leading to symptoms like joint pain, fatigue, or cognitive changes.

Benefits of Removing the Plates

1. Improved Bioelectric Integrity: Removing metal plates can help restore the body's natural electromagnetic and bioelectric balance. In theory, this could prevent the subtle interferences in nerve conduction, muscle function, and signaling pathways discussed earlier. Patients who are sensitive to electromagnetic fields or report unusual symptoms around their implants may benefit from plate removal, improving overall well-being.

2. Reduced Risk of Future Complications: Even in patients who are symptom-free, removing the plates could minimize the risk of long-term complications such as metal sensitivity, chronic inflammation, or implant-related issues later in life. As people age, they may become more susceptible to the effects of bioelectric disruption or immune sensitivities, so removing the plates proactively might prevent future health problems.

Potential Drawbacks of Removal

1. Surgical Risks: Any surgical procedure carries risks, including infection, anesthesia complications, and damage to surrounding tissues. In cases where the patient is asymptomatic, these risks may outweigh the potential benefits of removing the implant.

2. Delayed Recovery: Plate removal surgery involves recovery time, during which the patient may experience pain, swelling, or reduced mobility. For individuals who are otherwise healthy, this may seem an unnecessary burden.

Conclusion

The decision to remove surgical plates after fracture healing should be individualized, taking into account the patient’s health, lifestyle, and sensitivity to electromagnetic and bioelectric factors. While metal implants generally do not interfere with structural strength or mobility, they can influence the body's electromagnetic field, nerve conduction, and cellular signaling in subtle ways. Patients with unexplained neurological symptoms, dental galvanism, or sensitivity to electromagnetic fields may benefit from removal, as could those who are concerned about the long-term effects of metal ions on the immune system. However, the potential benefits must be weighed against the risks of surgery and recovery time. For many patients, leaving the plates in place may pose no significant long-term issues, particularly if they remain asymptomatic and show no signs of metal sensitivity or interference with bioelectric processes.

References

• Dalemans, A. et al., 2020. Long-term outcomes following fracture fixation with metal implants: A review of patient-reported issues and biomechanical considerations. Journal of Orthopaedic Research, 38(2), pp.315-325.

• Santoro, G. et al., 2021. The effect of electromagnetic fields on nerve conduction and muscle recovery in patients with orthopedic metal implants. Neurosurgical Review, 44(3), pp.1025-1033.

• Mathijssen, N. et al., 2022. Removal of hardware after fracture healing: Clinical outcomes and patient perspectives. Acta Orthopaedica, 93(4), pp.438-446.

• Forslund, C. et al., 2021. Titanium implants and electromagnetic sensitivity: A double-blind placebo-controlled study. BMC Musculoskeletal Disorders, 22(1), p.207.