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  • Removal of femoral rod and screw

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    Old 07-09-2020, 09:56 AM   #1
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    Removal of femoral rod and screw

    My wife (age 64) and I need help understanding conflicting opinions we have received from orthopedic specialists regarding the rod/screw placed in her left leg and hip to reduce and heal fractured femur.

    Wife suffered a comminuted intertrochanteric fracture in a low impact fall late June 2017. Sixty-hours after the fall our orthopedic surgeon placed a titanium intermedullary rod in her left femur. Here are some notes from that surgery:

    A guidepin was then advanced under AP fluoroscopic imaging. Once positioned, a starting reamer was used. We then advanced a short Stryker TFN nail. However, after placing the nail despite relatively little impacted into place and now there was an irregularity distal to the nail. It was seen in both AP and lateral views that was concerning for a possible fracture. I therefore removed the short nail and converted to a long nail. … 400mm x 1 mm nail was selected and tamped into position.
    We placed a triple sleeve for the lag screw…and a 95mm lag screw was positioned into place in the femoral neck…final fluoroscopic image obtained and showed acceptable reduction of the fracture and excellent alignment of hardware and screws.

    Her recovery was rapid while receiving PT three times a week for a month. Three months post surgery she was walking without pain and at six months was able to gently run.

    Wife has been a serious and very fast long distance runner and bicyclist for over 40-years. She is fastidious about her diet and exercises daily. However, she is very lean with almost no body fat at 5’ 6” and 95-pounds.

    Nine-months post surgery she began experiencing sudden, severe pain that caused her left leg to buckle. At that time we were walking several miles a day with no problems and she was doing light weight bearing leg exercises on a daily basis.

    X-Rays and multiple physical exams led the orthopedic surgeon to believe that the fracture healing process had caused bone compression and the head of the 95mm lag screw was pressing against the underside of her muscle/skin leading to extreme localized pain.

    In late September 2018 the surgeon removed the 95mm lag screw, which secures the top of the femoral rod to the femoral neck, and replaced it with a 66 mm screw.

    Recovery from that day-surgery was uneventful and the wife was back to walking and easy running within a few months.

    15-months after the 2nd surgery the intense, sudden and extreme localized pain returned. During some walks she could cover several miles with absolutely no discomfort and other times the pain was suddenly so severe she could walk no further. The pain also occurs while sitting, e.g. she sits and crosses her left leg over her right knee and then cannot uncross the leg due to the pain and having no control over the left leg muscles.

    X-Rays and multiple physical exams done by the “hip specialist” in the same practice as the original surgeon led to a “painful hardware” diagnosis. The “hip guy” was very specific, telling us that the top of the intermedullary rod was irritating the muscle around it and muscle fibers were being trapped by the rod during leg movements and thus the extreme and sudden pain. He was quite positive and upbeat, telling us that removal of the rod and lag screw would alleviate all the symptoms and the femur (now 36-months post surgery) would be as strong as without the rod. He referred us to another surgeon in his orthopedic practice who specializes in removing problematic hardware.

    The “hardware removal” specialist reviewed the X-rays and did a physical exam. He agreed with the “painful hardware” diagnosis but said removal of the hardware would not alleviate the pain and loss of leg control.

    His opinion was that a bursa has formed around the top of the intermedullary rod and at the point where the head of the lag screw enters that rod. He said wife has no subcutaneous fat and little muscle to pad the bone impinging on the underside of the epidermis and the same problem with the bursa irritating the epidermal nerves.

    He refuses to consider hardware removal and clearly stated that there was nothing that could be done to alleviate the pain and loss of leg control unless wife can gain 20 or 30 pounds and grow some fat and muscle in the area currently being irritated.

    That was a devasting diagnosis because wife is in severe pain about six-hours a day and finds walking to be frightening because she never knows when her left leg is going to quit working. And, she occasionally gets stuck in sitting position and has to lift her left leg by hand to stand or move.

    So, at this point the original surgeon and the revision specialist tell us there is no further medical assistance to be offered. The hip replacement specialist says that removing the hardware will be a cure all.

    All three agree that the pain and irritation are caused by the femur or hardware rubbing on nerves/tissue that should be padded with fat/muscle but is not due to wife’s thinness.

    Has anyone else had this problem?
    DOB: July 1947
    RALP 8/23/18 pT3a, G7 (3+4), 20% involvement, SM+ (Focal 2mm G6), EPE(Focal G6)+, PNI+, LNI-, SVI-, LVI-
    7g Tumor 20x size in MRI & biopsy report & in BOTH lobes not just L as biopsy reported
    Decipher RP = 0.47, which is .01 above a LOW risk

    Post-RP PSA
    10/3/18 0.021 01/4/19 0.018 04/03/19 0.022 06/26/19 0.028 10/1/19 0.035 3/14/20 0.050 4/16/20 0.055 7/8/20 0.060

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    Old 08-13-2020, 08:50 PM   #2
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    Re: Removal of femoral rod and screw

    I would consult a orthopedic dr in another town. One with zero connections to the drs in your hometown.

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