Management of Lateral Thigh Pain following Cephalomedullary Nail: A Technical Note.
Michael RosenConnor KasikMichael SwordsPublished in: Spartan medical research journal (2020)
Peritrochanteric hip fractures are most commonly treated with proximal femoral fixation devices, such as a cephalomedullary nail or sliding hip screw. As usage rates increase for these fixation devices, complications from their insertion are becoming more prevalent. Lateral hip pain from proximal locking device insertion and prominence continues to be one of the most frequent complaints regarding hardware irritation following this surgical procedure. Conservative treatment options for this complaint include local corticosteroid injection and physical therapy, although once these treatments have been exhausted, surgical intervention may be recommended. This has generally been managed previously with implant removal, although studies have shown associated femoral neck fractures after removal even with the prescribed protected postoperative weight bearing. Additionally, in certain situations (e.g., when the nail is placed for prophylactic treatment), its removal is contraindicated. The purpose of this manuscript is to describe an alternative treatment option that would limit morbidity, and the need for proximal locking device or implant removal by excising the portion of the iliotibial band causing hip irritation at the level of the proximal locking device, while leaving the retained implant in place. This surgical option would allow most patients to return to their pre-operative weight-bearing status immediately following surgery without the need for additional postoperative precautions.
Keyphrases
- minimally invasive
- total hip arthroplasty
- chronic pain
- end stage renal disease
- soft tissue
- body mass index
- patients undergoing
- newly diagnosed
- pain management
- physical activity
- neuropathic pain
- chronic kidney disease
- weight loss
- peritoneal dialysis
- weight gain
- spinal cord injury
- spinal cord
- patient reported outcomes
- combination therapy
- coronary artery bypass
- acute coronary syndrome
- coronary artery disease
- postoperative pain