Painful Hardware After Hand, Wrist, or Elbow Fracture Surgery

Symptomatic hardware tends to announce itself with a specific, reproducible complaint tied to the implant site rather than a vague, diffuse ache.

• Localized pain directly over the plate or screw, often worse with pressure
• Pain specifically when leaning on the elbow, resting the wrist on a desk, or wearing a watch or sleeve near the site
• Tenderness to touch over the old incision
• A palpable or visible bump or ridge under the skin
• Cold intolerance or unusual sensitivity limited to the area over the metal
• Occasionally, painful clicking, snapping, or catching from a tendon rubbing against the hardware

If you notice new weakness, a sudden inability to fully extend a finger or the wrist, or a snapping sensation followed by loss of motion, call our office promptly. Those findings can indicate a tendon has been worn through by the hardware and needs prompt evaluation rather than continued observation.

Diagnosis starts with a focused history: which motion or activity reproduces the pain, how long after the original surgery symptoms began, and whether the discomfort is improving or worsening. On examination, we look for focal tenderness precisely over the implant, a palpable prominence, and pain reproduced by direct pressure on the hardware itself rather than diffusely around the joint.

Radiographs confirm hardware position and integrity, rule out screw backout or breakage, and, importantly, document that the original fracture has fully healed before we discuss removal. In cases where the diagnosis is not entirely clear-cut, an injection of local anesthetic directly over the hardware site can help confirm that the implant, rather than something else, is the source of the pain.

Outcomes after elective hardware removal are generally favorable when the decision is made for the right reasons. In the olecranon cohort referenced above, only 15 percent of patients ultimately needed removal, and those who did had low disability scores at 24 weeks after surgery, reflecting a good functional recovery (De Giacomo et al., Injury, PubMed). A separate study of 119 patients undergoing removal of symptomatic upper- and lower-extremity implants found statistically significant improvement in function, bother, and daily-activity scores after surgery, with 73.5 percent of upper-extremity patients reporting improvement; across the broader literature, reported rates of pain improvement after removal range from 53 to 100 percent (Williams et al., JAAOS Glob Res Rev, PMC).

The most important conversation before removal concerns refracture risk, which is real but not evenly distributed. In a study of 401 patients who had 459 forearm plates removed, no refractures occurred after removal of 76 stainless-steel one-third tubular plates, while 10 of 177 removals of heavier stainless-steel dynamic compression plates were followed by refracture (Beaupre & Csongradi, J Orthop Trauma, PubMed). A 2024 meta-analysis confirmed this pattern broadly, finding that removing a forearm plate carries a significantly higher risk of refracture compared with leaving it in place (Cao et al., Orthop Surg, PMC). This is why removal is reserved for genuinely symptomatic cases and why we build in a period of activity restriction, and sometimes splinting, after the hardware comes out. Complication rates from the removal surgery itself are low, and returning to the operating room for a problem after removal is uncommon (Williams et al., JAAOS Glob Res Rev, PMC).