Dear Dr. Roach: I am anxious to know your opinion regarding removal of surgical hardware. Fourteen months ago, I broke and dislocated my wrist. It was a serious injury and required surgery. They put in a cadaver bone, a plate and eight screws. My recovery has gone quite well, and I have pretty good mobility and strength considering how bad the injury was. However, at times I have sudden jabbing pain about where the hardware is. If I do any heavy lifting or strenuous work, that spot in particular hurts for days after. I’ve had an MRI and X-ray that show the hardware is good and there’s no tendon damage.
My surgeon won’t say definitively if I should or should not have the hardware removed, and I vacillate. I can tell, though, that he leans toward removal because current research indicates hardware sometimes ruptures tendons. He did also mention that the hardware might be contributing to my pain because bone “gives” a bit, but metal doesn’t.
I know there’s no guarantee that removal would help. I may just continue to have pain. I do worry whether it might make things worse. Would an additional surgery make more scar tissue and perhaps cause more problems for me? — Anon.
Answer: My personal experience with removal of surgical hardware for symptoms is limited to only a few patients, but the results have been favorable. In one study, among over 300 patients surveyed after removal of hardware (most commonly in the wrist or ankle), 96% noted decreased pain and 72% had increased function. Ten percent suffered a complication — poor wound healing, nerve damage and infection were the most common. Of all patients surveyed, 96% said they would do the procedure again, even 66% of those who suffered a complication said the same.
The percentages look good, but if a complication happens to you, it’s 100%. If the symptoms are bothersome, the results from removal are generally good, but there is a chance of developing a problem.
Dear Dr. Roach: Your recent column discussed smoking or vaping for insomnia and/or pain. A 70-ish friend uses three drops of CBD oil under her tongue each night and finds it really helps her sleep and quiets arthritis pain. I’m thinking of trying it. Any pros or cons to be aware of? — N.C.
Answer: Cannabidiol is one of the principal pharmacologically active components of cannabis. Unlike tetrahydrocannabinol, it does not have psychoactive effects. The data showing effectiveness are more robust than they were a few years ago, but it is still approved only for uncommon seizure disorders. Some people certainly find it effective for pain. It seems to be safe even in high doses.
The main issue is that the amount of CBD in a given preparation has been found to vary considerably, with over half of CBD sold online found to be incorrectly labeled, and over 20% containing THC. Independent (third party) verification of quality and strength is best for being able to trust a product, since they are not regulated by the Food and Drug Administration.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected] or send mail to 628 Virginia Dr., Orlando, FL 32803.
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