![]() ![]() Physical exam may be solely relied upon for identification, or diagnostic injection may also be used. Proper patient selection is key, as additional symptoms (e.g., thigh pain) are not addressed. The technique described in this report was developed by the authors to alleviate lateral hip pain from PLD irritation. 5–7 In specific situations, implant removal may be contraindicated, such as when placed for impending fracture as prophylactic treatment. In addition, after hardware removal, patients must maintain protected weight bearing postoperatively to minimize fracture risk, although no definitive time is agreed upon for return to full activity. However, several reports can also be found in the literature describing associated femoral neck fractures following removal of hardware. Options to address this evolving postoperative problem may include conservative treatment with local steroid injection at the site of maximal tenderness, physical therapy or invasive options including isolated PLD removal or complete hardware explantation. Symptomatic lateral hip pain may develop as the fracture compresses on the proximal locking device (PLD), creating increased hardware prominence. 3,4ĬMN and SHS implants facilitate a dynamic compressive mechanism at the fracture site by allowing shortening (compression) at the fracture with weight bearing. 2 Over 40% of patients report pain after nail placement, 2 one of the most common being lateral hip pain over the greater trochanter. 1 The additional prevalence of these implants leads to an increased incidence of the associated complications, with little attention often paid to persistent pain after successful fracture union. Usage of proximal femoral fixation devices, such as cephalomedullary nails (CMN) and sliding hip screws (SHS), for peritrochanteric femoral fractures continue to rise, increasing from a rate of 3% in 1999 to 67% in 2006. 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. 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. Additionally, in certain situations (e.g., when the nail is placed for prophylactic treatment), its removal is contraindicated. 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. 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. 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. As usage rates increase for these fixation devices, complications from their insertion are becoming more prevalent. Peritrochanteric hip fractures are most commonly treated with proximal femoral fixation devices, such as a cephalomedullary nail or sliding hip screw. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |