titanium screws or removable pins
Am 65 yr old, very healthy female with upcoming severe type bunion surgery. am not comfortable with suggested titanium screws (permanent) with concern as to long term effects of metal in my body (arthritis, coldness,stiffness), so choice is removable pins?
What are the pro and cons of this ?
From a surgical standpoint it is usually just the preference of the surgeon. Over the years I have probably used more removable pins than implanted hardware.
In general terms implanted screws tend to result in a better bone to bone contact via better compression then does removable pins. This may be a concern in your particular situation because at your age there should be a concern about osteoporosis. The more demineralized your bones are the greater the liklihood of a non-union, where the surgically broken bone does not heal.
The problem with screws is that they can loosen up and at some point in time may have to be removed resulting in a second surgery.
Your complaints, mentioned above, about the screws, although possible, generally are not an issue in bunion surgery because the screws are so small.
Removable pins (k-wires) are generally put in through a separate hole in the skin which means there is a potential for infection. This is so that they can be removed at a later date. One variation to this is to use absorbing k-wires (orthosorb) which are implanted underneath the skin and are absorbed by the body in the same way that deep sutures are aborbed. Keep in mind that this type of fixation does not give good compression across the fracture line like screws so there would be a greater chance of a non-union.
Marc Mitnick DPM