Medical Hardware (Screws, wires, pins)

[Guest jriggoMOANG]

I have in the past had surgury to repair a broken right elbow. I now have 4 titanium screws

in that elbow. They are not needed now and I could get them taken out if need be. Is this something that could disqualify me from UPT. Should I have them removed before my FC1. Any advice would be helpful. Thanks

[Guest acj7464]

I had my plates and screws removed before applying. During my FC1 the flight doc did multiple range of motion tests, strength tests, and a complete review of the ortho medical records.

Because my ankle was 100% human there was no need for a waiver, and the doc just noted his extra testing of the previous surgery.

I can't say 100% but I am fairly sure you would need a waiver to complete your FC1 with hardware still installed.

Good Luck

[Guest F16PilotMD]

Will require waiver but they are not too tough to get depending on the details of what was actually done. If they could come out easily that may be your best bet but if not I would go through the process and work for the waiver.

[Guest jriggoMOANG]

I found this information on the brooks.af.mil waiver site. Just want to make sure that I understand it. Is it saying that as long as the hardware does not serve any structural purpose, then I am most likely to get a waiver? If the AF wants me to get the hardware out after I have been given a UPT slot, will they pay for it or will I have to cover the cost. Thanks and sorry for the long post but I thought I would include the waiver article that pertains to my situation.

I. Overview. Fractures requiring open reduction and internal fixation (ORIF) are fairly common among our active aircrew member population. Less common are degenerative joint diseases requiring prosthetic joint implants due to the relatively young population served. Retained hardware, except in the case of joint replacement consists primarily of screws, plates and wires. These components are placed to stabilize the fracture and allow for adequate healing. Once the bone has healed, in most cases the materials may be removed without detriment to the patient, whereas prosthetic joint replacement devices are life long. Occasionally the orthopedic specialist will defer removal of ORIF hardware due to the complexity of the procedure and the risk of surgery outweighing the benefit of removing an unoffending foreign body. If the retained fixation device is intact, not subject to trauma, and does not cause the patient pain or a reduction in function, it can usually remain and the patient may be considered for waiver. Fixation devices in the spine are not waiverable.

II. Aeromedical Concerns. The chief aeromedical concerns of aircrew members with retained hardware are the actual underlying orthopedic diagnoses. If the ORIF hardware has to remain in place due to a bony defect then the condition can not be waived whereas a prosthetic joint may be waived. Other concerns are discomfort due to the hardware, risk of re-fracture, adequacy of function, soft tissue inflammation, increased risk of infection leading to osteomyelitis, stress shielding and fatigue failure of the devices which all may lead to flight safety issues and failure to complete mission requirements. Finally in the case of prosthetic joint replacements is the concern that they generally wear out in 10 to 15 years.

III. Information Required for Waiver Submission. A request for waiver for a retained fixation device or prosthetic joint should be accompanied by appropriate x-rays, orthopedic consultations, operative reports, physical therapy reports regarding muscle strength and functionality and a written opinion from an orthopedist that the hardware should not be removed and that it is unlikely to cause problems during the patient’s lifetime.

IV. Waiver Considerations. Patient is grounded until evidence of bone healing and return of full function can be documented. Waiver is not required on recovery from fractures where full function has been restored without retained fixation devices or when fixation devices have been removed. Waiver should be applied for when function is compromised or where fixation devices are retained. Waiver is generally not granted for long bone intramedullary rods, femoral and tibial plates, hip screws or pins, spinal fixation devices or where location could lead to trauma. In the realm of joint prosthetics, a Class IIB (non-ejection seat) waiver may be considered for hip or shoulder replacement and unrestricted waivers may be applied for in other joint replacements. The Air Force experience is fairly low with both retained ORIF hardware and joint prosthetics, but of those applying, over 80% have obtained a waiver in the past.

Thanks for any advice,

Jason

[Guest F16PilotMD]

The following sentence from your post says it all:

"If the retained fixation device is intact, not subject to trauma, and does not cause the patient pain or a reduction in function, it can usually remain and the patient may be considered for waiver."

Most people in your shoes want to avoid ANY waiver they can...if that's you, the screws need to come out. If you can handle the stress of waiting for a waiver (which you should get easily if you're well healed and have normal function, etc), than go for it.

The USAF won't select you for a UPT slot and then ask you to get the screws out. If they don't like the screws, they will medically DQ you and the rest is up to you...walk away, apply for waiver, get them out and re-submit to a physical, etc.

My advice is press ahead and get the waiver. If they refuse your waiver, get the screws out and reapply.

NOTE: I would start ASAP getting all the documentation from your injury and from your surgeon that outlines EXACTLY what, why, when, etc. Also...VERY IMPORTANT...a letter from the orthopaedic surgeon CLEARLY stating how well you've healed and that you are under no restrictions and that you are at NO risk for joint instability, etc, etc. A lack of these kind of documents will bring your waiver application to an immediate halt and will cost you lots'o'time and aggravation.

[Guest priorE]

Get the waiver, I did.

I have plates and 9 screws from when I fractured my right humerus. I was able to go to the same surgeon that fixed my arm and get a letter. (The AF will set that up for you and pay for it)

He checked it out and wrote that he did not recommend taking them out and that I have full range of motion, etc. Why would ya want to go under the knife if you don't have to?

The AF also sent me to the nearest base for an x-ray so a flight surgeon could make his/her recommendation.

That is it, though. No hassle, no pain. That's all I had to do for the waiver. I have my FC1 in my possession right now with the stamp of approval with a waiver for retained hardware. I commissioned the other day and am UPT bound!!!!

Just make sure that your surgeon recommends leaving them in.

[Odium]

I had jaw surgery to correct an overbite. The surgery resulted in screws being put in to secure the bone as it grew back together. Would having those screws still in my jaw require any sort of wavier process?

[Guest F16PilotMD]

Retained hardware will likely require waiver. Not too difficult to get as long as it doesn't interfere with function, wearing a facemask, helmet, etc.

[Guest jriggoMOANG]

Have a quick question to follow up on this thread. I am scheduled to take my MEPS physical for an OTS/UPT application and was told that I need a waiver )which I already knew). Will the waive I get now be the same that I need for my FC1, or will I need to get another waiver when I go for my flight physical? Thanks for the help!

[Guest P27:17]

The new AFI 48-123 reads a little different than the previous edition...below are the current standards for retained hardware. A3 is for Commission and A4 is for Flying...I don't think you need a waiver unless you have "symptoms", it is easily subject to trauma, or you can't wear military, protective, and/or aviator gear.

A3.25.4.2. Current retained hardware that is symptomatic, interferes with proper wearing of protective

equipment or military uniform, and/or is subject to easy trauma, is disqualifying (V53.7).

Retained hardware (including plates, pins, rods, wires, or screws used for fixation) is not disqualifying

if fractures are healed, ligaments are stable, there is no pain, and it is not subject to easy

trauma.

A4.26.1.11. Any retained orthopedic fixation device that interferes with function or easily subject to trauma.

Anybody have a different read?

[Guest jriggoMOANG]

I had not seen that as of yet. Thanks for the information. One question, why does the MEPS say I will need a waiver before I ahve had my physical? They have all pre and post-op records stating that I have 100% functoin and no loss of strength or range of motion. I also have no "symptoms". I played college football and never had any trouble with my elbow. I assume that after they see that I am not symptomatic that they could change their opinion? Just wanting to know what I should expect to hear is all. Thanks for any advice!

[PropWash]

To touch on this same type subject, I just had some knee surgery and am scheduled to go to Brooks this Nov. While I don't have any hardware in my knee except a small metal... loop for lack of a better word, holding my new ACL in place (very common) I am going to be fresh off recovery come Nov. Should I probably get a letter from the surgeon before going?

[Guest doctidy]

JR - We see all kinds of records, letters from doc after doc that says someone will have no problem serving their country.

First off, most of them have never spent a minute in uniform. They have no idea what it takes to be active duty.

Second, a lot of times the applicant has brought the doc the standard saying this is what your letter has to say. So, that's what the doc writes. We had one guy recently without a thumb...but his doc said he was perfect!

In God We Trust...all others we inspect and verify!

Gary - if you aren't fully recovered it is going to be very difficult to get a waiver. Say you are 80%. What guarantee do we have that you will get to 100%? And don't tell me that you just know. Unfortunately, we see all comers...and believe me, not everyone recovers from knee surgery to the 100% level.

[Guest jriggoMOANG]

Rage

I never thought of it that way. Whit that in mind, it is conceviable that the docs at MEPS could deem it UNnecessary for me to get a waiver as well after seeing me, correct? Just wanted to know what to expect. Thanks.

[Guest doctidy]

I think P27 gave u the answer. Re-read A.2.25.4.2. That ain't you.

Even if you did need one...full range of motion, no screws sticking out of the skin, you're g2g.

[Guest jriggoMOANG]

Thanks for the advice. Just got scheduled for my MEPS physical. Next Wednesday 9 AUG I am going to MEPS, I am wondering if anyone has a copy of the updated AFI 48-123 that could be forwarded to me so that I can read it prior to going to my physical and fully know what to expect. Thanks again for all of your help.

[Guest P27:17]

Look 6 posts up...those are VFR direct out of the new AFI 48-123.

http://www.e-publishing.af.mil/pubfiles/af...afi48-123v2.pdf - VOL 2-ACCESSION, RETENTION, AND ADMINISTRATION

http://www.e-publishing.af.mil/pubfiles/af...afi48-123v3.pdf ** VOLUME 3-FLYING AND SPECIAL OPERATIONAL DUTY

Here are the 2 volumes applicable.

Good luck

[Guest doctidy]

LOL!

I love that you guys like copies of those things to bring with you. You don't have a clue what it really means, but dang if you won't read it and quote it like you're an Aviation Medicine expert!

[Guest F16PilotMD]

My advice is know the regs about everything you do in the USAF before the meeting, etc. That goes for everything. Including the docs. One thing you will find in the USAF...and everywhere else...not everyone that should know their job does. Or, in Fighter Pilot terms, people are stupid. GoodOnYaGuys.

[Guest jriggoMOANG]

Rage,

Just wanted copies for myself. Did not take it with me to the MEPS for the physical. I agree it is funny though when people (myself included) try to be experts at something they have no real clue about. Just an update, I did get DQ'd for the hardware, but the DOCs said that both wrote in my chart that they strongly recommended a waiver. Hopefully my recruiter will get the paper work submitted quickly and the SG will approve it. Good luck to me!

Thanks alot for your help and advice guys, it means alot.

[Guest salokin]

Alright, I recently asked about retained femural hardware being a problem and the new AFI said it really wasn't unless it interfered with function or was subject to trauma. Mine is niether, BUT the "waiver guide" on the brooks website says that femural and tibial plates are not generally waiverable. WTF does that mean? Am I going to get DQ'd or not? I have a plate with 8 screws in my femur - is this going to be a problem? I'm not sure which publication to believe. Someone (with insight) please help!

EDIT: Sorry for being a dumbass and posting the same question twice. Anyway - no waiver required for hardware. FC1 approved.

Edited April 19, 2007 by salokin

[Guest doctidy]

Someone (with insight) has helped. We told you we don't think it will be a problem.

Someone (without insight...that would be YOU) is reading a waiver guide and hanging their hat on it. The waiver guides aren't as up to date as the people who are giving you advice. Even the AFI isn't as up to date. They started writing that AFI over 1 yr ago...it was only published in June 2006...and already has many required changes.

salokin - I'm not trying to be mean. I think its great that you are looking into things yourself...reading stuff. But we really don't expect you to have a problem. Looking thru historical waivers, nearly ever femur fracture (with retained hardware) has been granted a waiver. That's not a guarantee...no way can you tell us on a forum everything about your injury.

I know you don't know who we really are, but I know the people behind these pseudonyms. You have some big people here who know what is happening today in the ANG, Reserves, HQ/AF, and AETC / Brooks realm. You have the best inside information available.

[Guest FutrShepStud]

Quick question. Somebody just slammed one of my index fingers in a door and broke it. I may need to have a pin put in.. I am scheduled to commission in ~2 months and start ENJJPT in ~3 months.

If, even with a pin, I regain full flexibility and strength in it, should I have any issues?

As far as being able to commission on time goes, I can still do pushups with that finger off the floor (commissioning PFA is in about a month).

Thanks!

Edited February 26, 2007 by FutrShepStud

[Guest Rage_:P]

LOL - you guys continue to amaze me at your concern about the least little thing.

I've only seen one guy ever DQ for a finger problem...he had his thumb amputated.

Relax...follow the orthopedists advice...and we'll see you in UPT.

[Toro]

Former instructor in my squadron who is now the vice OG/CC at another base had half of his pinky cut off. Absolutely no problem other than looking kind of bizarre.