Open reduction and internal fixation (ORIF) is a common surgical procedure used to treat unstable or complex ankle fractures. The “open reduction” involves the surgeon making an incision to realign broken bone fragments. Once aligned, “internal fixation” secures them, typically using metal plates and screws made of stainless steel or titanium. These devices hold the bone fragments together securely while natural healing occurs. Post-operative sensations related to this implanted hardware are common among patients recovering from ankle surgery.
The Reality of Feeling Ankle Hardware
The presence of plates and screws in the ankle is a common experience for many patients after the initial swelling subsides. This sensation is distinct from the deeper pain associated with the original injury or the healing fracture. Patients often report feeling a distinct bump or prominence directly beneath the skin, especially over the outer ankle bone (lateral malleolus) where plates are frequently placed.
A common complaint is a heightened sensitivity to direct pressure, such as when the hardware rubs against the inside of a shoe or boot. Patients also report increased sensitivity to temperature changes, often feeling cold or achy during colder weather. This occurs because metal conducts temperature more readily than surrounding soft tissues. For the majority of people, the hardware does not cause pain and is left in place permanently.
Anatomical Reasons for Hardware Sensation
The primary reason hardware is often noticeable relates directly to the ankle’s unique anatomy. Over bony prominences like the malleoli, the ankle has very little soft tissue padding. A minimal layer of subcutaneous fat and skin covers the bone, meaning plates and screw heads are placed superficially.
When post-operative swelling resolves, the hardware lies close to the surface, making it easily palpable and sometimes visible. The sensation can also be triggered by irritation when tendons or ligaments glide and rub across the fixed metal edges during ankle movement, causing inflammation and discomfort. Occasionally, a small cutaneous nerve near the surgical site may become irritated by the hardware, leading to a localized sharp or burning sensation.
When Surgical Removal Becomes Necessary
Hardware removal, known as explantation, is an elective surgery and is not routinely performed unless the hardware causes specific problems. Doctors primarily recommend removal for persistent, debilitating pain or discomfort that significantly impacts daily life, or for irritation that limits joint function. Less common criteria include complications like infection, metal allergy, or if the hardware breaks or becomes loose.
Hardware is typically not considered for removal until the bone is completely healed, generally 12 to 18 months following the initial ORIF surgery. While the explantation procedure is usually less complex than the original fracture repair, it still carries surgical risks. If the hardware is not causing symptoms or complications, it is often left in place indefinitely.