Hardware Removal & Nonunion Repair
Help for fractures that are not healing, and for plates, screws, or rods that cause problems after a bone has healed, with Dr. Steven Ward in Tucson and Oro Valley.
Call 520-881-1394Typical ranges for general education. Dr. Ward’s plan for you may differ.
What it treats
Most broken bones heal without trouble. A delayed union is a fracture that is healing more slowly than usual. A nonunion is one that has stopped healing.
- Nonunion risk factors include tobacco or nicotine in any form, older age, diabetes, severe anemia, low vitamin D, thyroid problems, poor nutrition, infection, open fractures, and some medications
- Bones with a limited blood supply, like the scaphoid in the wrist or the femoral neck at the hip, and high-energy injuries of the tibia are more likely not to heal
- The main symptom is pain at the break that continues months after the injury, especially with use
Hardware problems are a separate issue. Plates, screws, and rods are usually left in for life, but they can irritate the tendons, muscles, or skin over them once the bone has healed. Hardware may also need to come out if it is loose, broken, or infected, or as part of a nonunion repair.
Is surgery right for you?
A nonunion is diagnosed with X-rays, and sometimes CT or MRI, compared over several months. Blood tests may look for infection, anemia, diabetes, or low vitamin D. Some nonunions can be treated without surgery:
- A splint, cast, or brace to hold the bone still
- A bone stimulator, a small device placed on the skin that uses ultrasound or electromagnetic waves, for 20 minutes to several hours every day
- Quitting all nicotine and correcting nutrition and vitamin D
Surgery is needed when these fail or the fracture is unstable. Hardware removal is considered once the bone has fully healed and the hardware is clearly causing symptoms; hardware that is not causing problems is usually left alone.
How the surgery is done
Nonunion repair gives the bone better stability, better biology, or both:
- Bone graft — your own bone (often from the rim of the pelvis), donor bone, or a graft substitute placed at the nonunion to jump-start healing
- New or stronger fixation — a longer plate, or removing a nail and putting in a larger one (exchange nailing)
- External fixation — a frame outside the limb, especially when there is bone loss or infection
Hardware removal is usually an outpatient procedure, often through the old incision. Dr. Ward will talk with you about the benefits and the limits: the bone is weaker for a period where screws came out, and removing hardware does not always relieve every symptom.
Failed hip fixation
When a broken hip that was fixed with screws or a nail does not heal, or the ball of the hip collapses, the usual solution is to remove the hardware and convert to a hip replacement. That is covered on the revision joint replacement section of Surgical Services and on the hip fracture page.
Recovery overview
General expectations only. OrthoInfo does not give standard timelines for these procedures, and Dr. Ward’s plan for you depends on the bone and the surgery.
After nonunion surgery
- Protection and weight-bearing limits as directed while the graft and fixation take hold
- X-rays or CT scans over the following months to confirm healing
- No nicotine in any form, and a balanced diet with protein, calcium, and vitamins C and D
After hardware removal
- Wound care as instructed until the incision heals
- You may be asked to limit impact or heavy lifting for a period while the screw holes fill in
- Gradual return to normal activity as comfort allows
Long term
- Most nonunions heal once stability and blood supply are improved, though some need more than one procedure
- Keep all follow-up visits until healing is confirmed
When to call the clinic
Call 520-881-1394 if you notice any of the following after surgery or while you are recovering:
- A fever of 101°F or higher, or chills
- Redness spreading around an incision or pin site, or drainage that is cloudy, foul-smelling, or keeps soaking the dressing after the first few days
- Fingers or toes that turn pale, blue, or cold, or numbness or tingling that does not go away once the anesthesia has worn off
- A cast, splint, or dressing that feels too tight: throbbing pain, swelling, or numbness under it that does not ease after you raise the arm or leg above your heart. Do not cut or remove a cast yourself
- Pain that is not controlled by your prescribed medication, elevation, ice, and rest
- Pain, swelling, or tenderness in the calf that is new or getting worse
It is normal to have swelling, bruising, and soreness for a while after surgery, and for the arm or leg to feel numb or weak until a nerve block or spinal anesthetic wears off. Follow your weight-bearing and splint instructions exactly. Call if something feels different from what you were told to expect.
for chest pain, shortness of breath, or trouble breathing. These can be signs of a blood clot in the lungs and need emergency care.
If something does not match the instructions you were given, call the office. Dr. Ward or one of his physician assistants will get back to you.
Related resources
Hip fracture
Dr. Ward’s broken-hip page: fracture types, partial vs. total hip, nails, and the recovery plan.
Open pagePhysical therapy locations
Find a physical therapy clinic near you in Tucson and Oro Valley.
Open pagePost-op packets
Dr. Ward’s post-operative instructions and packets, organized by joint.
Open pageExercise guides
Printable home exercise programs to use with your physical therapist.
Open pageOrthoInfo: Nonunions
Patient education on fractures that do not heal from the AAOS.
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