Ankle Plates and Screws: Do They Need to Come Out After Fracture Surgery?

As of November 9, 2026, San Francisco 49ers rookie defensive tackle Gracen Halton is out for the season with a broken left ankle. ESPN reported that a teammate rolled into his foot and ankle late in Sunday’s 38-17 win over the Las Vegas Raiders, and coach Kyle Shanahan confirmed his season is over.^[3] No surgery had been reported. We have no connection with this athlete or his team and have not examined him. The studies below describe other patients, not a forecast for anyone in the news.

Why do surgeons put plates and screws in a broken ankle?

When an ankle fracture is displaced or unstable, the surgeon lines the bones back up and holds them with plates, screws, rods or wires while they heal. This approach often lets people regain function sooner and may lower the risk of a bone that heals crooked or not at all.^[1] The outer ankle bone is often fixed with a plate and screws, the inner ankle bone with one or two screws, and an injured syndesmosis (the ligaments that bind the two shin bones) with screws or a suture button.^[4] For how that first operation works, see fracture surgery.

Plates and screws may be left in or removed after the bone heals.^[1]

How often are ankle plates and screws removed?

It is common. In Finland, 27% of 68,865 adults who had ankle fracture surgery over 20 years later had a hardware removal operation.^[5] In a study of 997 patients, 17% had their implants removed, 144 of them because of complaints and 26 because of infection.^[6]

Pain over the hardware is the usual reason. In 126 patients after ankle fracture surgery, 31% had pain over the plate or screws on the outer ankle.^[7] In 211 patients treated for outer ankle fractures, the most common reason for removal was pain around the implant.^[8]

When is ankle plate and screws removal worth it?

Removal helps most when there is a clear, specific problem.

• Pain right over the hardware. In 167 people who had implants removed around the knee, ankle or foot after healed fractures, those who had removal for pain had about six times the odds of being satisfied.^[9]
• Complaints after an ankle fracture. In 66 patients who had hardware removed after an ankle fracture, about 75% of those with complaints such as soreness over the implant or scar reported improvement.^[10] In 43 patients with symptomatic ankle implants, function scores improved significantly 6 months after removal.^[11]
• A problem inside the joint, too. When a loose fragment or pinching of tissue inside the joint was also causing pain, combining removal with ankle arthroscopy (a camera look inside the joint) improved scores more than removal alone.^[12]

Vague discomfort is less predictable. In the same study, only 27.5% of people who had removal for nonspecific discomfort felt relief.^[9]

Should a syndesmotic screw come out?

A syndesmotic screw crosses from the fibula into the tibia. Surgeons once removed it routinely. In the RODEO randomized trial of 152 patients, leaving the screw in unless it caused complaints gave ankle function as good as routinely removing it 8 to 12 weeks after surgery, with fewer complications (1 of 79 compared with 12 of 73).^[13] At about four years, function still did not differ.^[14] Two reviews also found no support for routine removal of an intact screw.^[15,16]

So the screw usually comes out only for a reason, such as pain. When it is removed, one group advises waiting at least 8 to 12 weeks, because the joint widened again more often after earlier removal.^[17] For flexible suture-button fixation, see TightRope surgery for high ankle sprain.

When can ankle hardware be removed?

Plates and screws that come out are removed after the bone has healed.^[1] In a Dutch trial of 477 patients having implants removed below the knee, the median time since the implants were placed was 11 months.^[18] Your surgeon times it from your X-rays, your bone healing and the type of hardware.

Removing plates and screws from the ankle: recovery time

The operation can be done under general anesthesia or, in selected patients, wide awake with local numbing. In a randomized trial of 56 patients, the wide-awake approach caused less pain at 2 and 6 hours and less nausea, with a shorter stay in the recovery room.^[19] Your surgeon sets when you can return to normal shoes, work and sport.

Relief builds over months. In the 60-patient study, pain scores improved 76% by one year and 53% of patients had no pain at all.^[2]

Sources: four cohort studies.^[2,10,11,9]

What are the limits and risks?

Hardware removal is still surgery. In the Dutch trial, 14% of patients developed a wound infection within 30 days, and a single dose of antibiotics before surgery did not lower that rate.^[18] In 1,990 planned removals after limb fractures, 4.1% had complications and 1.56% had major ones; the ankle was a higher-risk site, and smoking raised the risk of deep infection.^[20] In a prospective study of 179 patients, function improved after removal, but on average not by enough to count as a clinically meaningful change.^[21] In one older ankle study, only 11 of 22 patients with hardware pain had less pain after removal.^[7] Removing a syndesmotic screw routinely can let the joint widen again or reveal a broken screw.^[17] Most studies are small and retrospective.

Common questions

What is the recovery time after removing plates and screws from the ankle?

Your surgeon sets the plan for shoes and activity. Relief builds over months, and in one study more than half of patients were pain-free at a year.^[2]

Should you remove a plate and screws from your ankle?

Not routinely. Removal makes the most sense for pain over the hardware or another clear problem, and it is less predictable for vague discomfort.^[9]

Can ankle plates and screws cause pain?

Yes. In one study, 31% of patients had pain over the outer ankle hardware, and pain around the implant is the most common reason for removal.^[7,8]

When can ankle hardware be removed?

After the fracture has healed, typically months later. In one large trial, the median was 11 months after placement.^[18]

The bottom line

Plates and screws let a broken ankle heal in the right position, and most can stay. When they hurt, removal is a small operation that helps many people. Dr. Ozturk is a double board certified Foot and Ankle Surgeon and podiatrist who sees patients in Lyndhurst, Paramus and Millburn. X-ray and ultrasound are available on site; see foot and ankle imaging. Our parent practice explains when a broken ankle needs surgery (external site), and you can read about walking after broken ankle surgery or request an appointment.