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titanium screws or removable pins

by Lena
(Virginia)

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 ?

Thank you

Hi Lena,
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

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Feb 01, 2012
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Better think twice!!
by: Anonymous

I personally would NOT recommend them. I had surgery on my left ankle in 2/11. 6 weeks later had to have surgery again to remove original pin and place a "smaller" one, not to mention the fact that it had migrated had become slightly displaced. I felt like I was walking around with a bruised ankle all the time. In 4/11, had pin placed in right ankle. Again I kept complaining of having pain on the top of my foot and my ankle would "roll" very easily especially on uneven ground. Surgeon took 5 x-rays over several months and said everything was ok. Obviously I would not be taking 7 pain pills a day if it were ok! I am a nurse and HATE narcotics and pain meds. Anyway, I finally convinced the surgeon to remove the pin in the right foot, nearly a year later! He said this pin also migrated and it had become displaced and it was not detected on the 5 previous x-rays. Oh.. by the way, I failed to mention that I have NOT been able to work in 1 year due to all of the complications from these surgeries. My original complaint to see him was for a painful bunion that I had on the left foot! Needless to say this has been a complete nightmare for me!!

Mar 26, 2010
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My foot is ruined
by: Anonymous

I have had two bunion surgeries. The first one the surgeon used bio-degradeable screws. THe screws dissolved before my foot healed. I had the same problem again that I went in for. My mistake was letting the Dr. do the second surgery. This time he used titanium secrews, put a pin in which had to be removed. My foot did o.k. until about one year later and agin my big toe started lapping over the next one. I went to a new foot Dr. and from there
he sent me to a vascular surgeon who told me he would not touch my toe. The two surgeries had cut off most of the blood supply to my toe.
The new foot Dr. said there isn't anything he can do to fix my toe because of the limited blood supply. So now I can hardly wear any shoes.My toe turns purple and bruises under the nail.
What a mess. I hope you have better luck. Be sure you knoiw the Dr. who is going to do the surgery.

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