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Dr. David
Dr. David, Board Certified Physician
Category: Medical
Satisfied Customers: 51429
Experience:  Experienced Physician trained in New York City. I'm ready to help.
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I have a titanium plate in my foot with 8 screws. If I need

Customer Question

Hello, I have a titanium plate in my foot with 8 screws. If I need a biopsy, mri or surgery on other parts of my foot, I have not found where the plate is a risk. Should I be able to have surgery without removing the plate? My dr seemed to imply I need to remove it for any type of biopsy. I do not hear about people with rods in their back being removed for any of the above. She is very smart. Thanks
JA: Are you keeping a personal medical record while dealing with this?
Customer: No.
JA: Anything else in your medical history you think the doctor should know?
Customer: Like what?
Submitted: 11 months ago.
Category: Medical
Customer: replied 11 months ago.
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Customer: replied 11 months ago.
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Expert:  Dr. Muneeb Ali replied 11 months ago.

Hi,
Welcome to JA and thanks for this question. I'm sorry to hear about your past medical conditions. Actually, a titanium plate in your foot should not be a contraindication of MRI as most titanium plates are MRI compatible. The newer titanium plates are made in such a way that they would be stable when an MRI is done, this is because of them being formed as an alloy and they are nonmagnetic. Secondly, you can still have surgery done with the plate in place, the presence of the plate does not mean that surgery cannot be done. Most surgical procedures can be done around it.

Now if a biopsy has to be done under the guidance of a CT scan or an MRI THEN the plate may need to be removed, the reason being that most titanium plates would cause an artifact to appear when an MRI or CT scan is done, this would cause the area to be obscured and the biopsy could not be done in that case. Because of the artifact appearing in the scans, we would not be able to see where the biopsy needle has to be inserted. So this is a situation where the plate may have to be removed. A way around it could be to do a biopsy under the guidance of an ultrasound where the plate would not cause interference in the image.

So apart from the CT guided biopsies, the other things can be done even with the plate being in place.

Do you have any more questions?

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Customer: replied 11 months ago.
I am not really understating your answer. If they cut open/ surgery where the tumor is, they do not need guidance of a MRI?
Customer: replied 11 months ago.
The growth is on the side of foot on top. Plate is under.
Expert:  Dr. Muneeb Ali replied 11 months ago.

They need an initial MRI to locate the tumor but not during the surgery itself. DO you have a tumor in your foot? because you did not indicate that in your initial question

Expert:  Dr. Muneeb Ali replied 11 months ago.

Ok so you have a growth on your foot, then she is right, in order to do a MRI to locate the tumor and its extensions into the foot they would have to remove the plate because the plate would cause interference in the image which is created by the MRI. The MRI would be safe but it would cause a blindspot to appear in teh region of the foot.

Customer: replied 11 months ago.
Above you said surgery doesn't affect it. She was talking about an infection. MRI to see if we can tell what kind of tumor, not location. We know the location..you can see and feel on top. There would not be doing a guided mri during surgery.
Customer: replied 11 months ago.
I can request surgery and take chances leaving plate in place? No where have I found you take it out. They would cut right on top and this would not interfere with the plate.
Customer: replied 11 months ago.
It seems extreme to take out a plate and pins just to remove a growth on top.
Customer: replied 11 months ago.
You mentioned surgeries can be done around the plate. The growth if it grew would of grown around it and then they just cut around it, right?
Expert:  Dr. Muneeb Ali replied 11 months ago.

When i said location, that means the exact location and its EXTENSION into the tissues around it. When a tumor has to eb removed the surgeon has to know where the tumor is extending into. for example we need to know if the tumor is going into any vessels or into any tendons, so a proper surgical plan can be formulated. This depends on the tumor and its aggressive nature. The MRI would determine the type of the tumor BUT at the same time it would also tell us whether it is going into an artery or into a nerve or into a tendon, so that the surgeon can know what structures have to repaired when the tuor is removed. And if we cannot see that before the surgery with the help of a MRI, then we would not know what kind of problems we might face during the surgery.

I think your doctor is worried about the same thing, she wants to know if the tumor is extending downwards into the foot encroaching on the structures that i described.

Customer: replied 11 months ago.
the MRI shows where the tumor is. When she does surgery she has her eyes to actually see where it went. Therefore, you cut the tumor out, whether around a bone or plate, it should be the same. When they open you up they have a better idea of where it is but the MRI should show it also.So, as you first stated, most surgeries should be able to work around the plate. She is not using a self guided procedure/MRI/CT scan to look at it.
Expert:  Dr. Muneeb Ali replied 11 months ago.

Yes surgeries can be done around it but again the problem here is not whether the surgery can be done around the plate, the problem would be to understand the extension of trhe tumor into the foot below. Secondly, the infection risk is certainly a little higher post surgery if you have a plate in place BUT that can be controlled with broad spectrum antibiotics and adopting a completely sterile approach during surgery. Infection risk alone should not warrant plate removal in MOST cases unless your doctor has seen something which makes her uncomfoirtable to do the surgery with the plate in place. For example in patients with diabtes and plates, the infection risk is MUCH higher than patients without diabetes. It is possible that your doctor knows something in your clinical history which made her think that in your particular case the infection risk would be much higher.

Also when she does not know BEFORE hand where the tumor went, she has to do everything on teh fly when she removes the tumor. This way the risk of complications is high. many a time without knowing the extension of tumor, surgeons open up a patient and when they get in, they find out that the tumor is so entrenched into the vessels etc that they cannot take it out. That is why a MRI beforehand gives them time to figure out a SAFE plan to take out such tumors WITHOUT causing complications to the patients.

Expert:  Dr. Muneeb Ali replied 11 months ago.

That is why surgical plans are made before a surgery, a surgeon knows where he or she can face problems in a surgery and be prepared for it. If she does not know what she will find when she gets in there, she would be unprepared thus increasing the risk of major complications including bleeding and nerve damage (if the vessels and nerves are involved).

Expert:  Dr. Muneeb Ali replied 11 months ago.

The other way is also possible, not to remove the plate and go straight for the surgery. the plate does not preclude the removal of the tumor as you said, but it is a more risky procedure. If your doctor and you are willing to take the risk in this situation then it can certainly be done, the plate wont cause problems during the surgery itself and teh risk of infection can be controlled with broad spectrum antibiotics. But you should be aware of the risk in that situation.

Customer: replied 11 months ago.
If infection is higher with a patient, taking out a plate is more risk because it is a major surgery. I do not have any other diagnoses to suggest diabetes or risk.I appreciate your help. I am still a little confused because I hear you saying you can leave the plate in..cut around it. She has not done a MRI yet so we do not know if it is a tumor where it has spread. But taking it out is more serious and can lead to complications just to take out a tumor.To cut on top and do a biopsy I would think would be the first step. That is what most doctors do. To do this you are saying you should have major surgery and remove the plates or not?Why is it more risky to cut around the plate?
Customer: replied 11 months ago.
why it is a higher risk since you can cut around it as you mentioned?
Expert:  Dr. Muneeb Ali replied 11 months ago.

Lets simplify this, is the tumor directly ON TOP of the plate or is the plate located to one side of the tumor?

Customer: replied 11 months ago.
The plate is on my heel. The tumor is on the side of my foot, possibly on top of the plate. Either way, people have titanium in their backs and body all the time. They don't undo the back surgery if they need to do a biopsy and remove a tumor. They cut around it.
Customer: replied 11 months ago.
Simply my question...Someone needs a biopsy and they have titanium in their body, they can do biopsy while halving plate in body?
They can have surgery to do the biopsy and the plate should not interfere since the tumor is right on top of skin?
Expert:  Dr. Muneeb Ali replied 11 months ago.

You are right they dont in most cases, but i myself have managed cases where removal of a plate was advised , this was a case where removing a spinal tumor was complicated. The reason was essentially the same that i mentioned above. Without a MRI removing the tumor was difficult, so they first removed the plate in a minimally invasive manner without disturbing the tumor, the tumor in this case was slightly below the plate and then did a MRI.

In your case, they may remove the plate without going from the side of the tumor so as to prevent any issues with the tumor, it is possible that their plan is to remove the plate by entering from the other side of the heel.

Yes a biopsy can be done initially, that would be done under ultrasound guidance or even blind if need be, that will tell us about the type of the tumor but NOT its extension. If it is a benign tumor then yes it is less likely that it would have invaded into the surrounding tissue and may be removed without a MRI but if it is a malignant tumor or aggressive tumor then a MRI would be needed.

To answer your last question, YES they can do a biopsy on a tumor which is present ON THE SURFACE but not deeper biopsies which need MRI guidance. Surface biopsies can be done blindly without MRI guidance and would not need plate removal. DEEPER biopsies would need MRI guidance and warrant plate removal.

In your case IF the tumor is ON the surface, then a biopsy would not need plate removal, the surgery on teh other hand may need it.

Customer: replied 11 months ago.
If you open up and do surgery, why would you need an mri guidance? I am really confused.
MRI shows extent of tumor and location and possibly what kind of tumor. You can do a biopsy with needle or surgery. Do not need to take out plate for that. You are using your eyes to see, not a guided MRI.As you oriiginally said you can do surgery without taking a plate out. She has not even done the MRI yet. She just talked about surgery which I found strange because MRI shows much more than an XRAy and you normally need mri before surgery of a tumor in question.
Customer: replied 11 months ago.
I am getting more confused. I am not understanding for some reason. I hear you say one thing and then something else. Thank you for your help.
Expert:  Dr. Muneeb Ali replied 11 months ago.

I think i am not getting my point across. ill opt out and let someone else jump in.

Customer: replied 11 months ago.
IT should be pretty simple.
MRI shows where tumor is and possibly what kind. Titanium plates are compatible with MRIs.
If biopsy performed, should not affect the plate.
If need to remove tumor, cut around the plate to get most or all out.
Taking plate out seems extreme. You would not take out a rod in someones back to cut out tumors.
A guided MRI is when it is inside the body and you can not see it. When you do surgery and you open up your foot/ankle and the tumor is right there, you use your eyes, not MRI. Therefore, no reason to take out plate. Plate is not blocking anything. Cut around it. This is what I have found and normally procedures. Mentioned diabetes or other issues. Any infection needs to be controlled. DOIng a major surgery, removing a plate when not necessary is more risk. Why would you need to remove the plate? You are saying guided MRI. We would do surgery to see tumor so we don't need guided MRI.
Expert:  Dr. David replied 11 months ago.

This is Dr. David

I see the other expert has opted out.

do you have any other questions?