PROXIMAL THIGH PAIN AFTER FEMORAL NAILING - CAUSES AND TREATMENT

We have reviewed retrospectively 80 patients who were treated for trau matic fractures of the femur with a Grosse-Kempf nail to assess the in cidence and causes of persisting pain in the proximal thigh. At a mean of 21 months after operation 33 patients had residual pain severe eno ugh to interfere with their lifestyle or mobility. This was in the reg ion of the scar on the greater trochanter in three-quarters of the pat ients. Only four showed no radiological abnormality. There was nonunio n of the fracture in two, Paget's disease in one, breakage of the nail in two and prominence of the proximal locking screw in five, although we found no correlation between prominence of the nail and pain. Ther e was a strong relationship between pain and heterotopic ossification at the proximal end of the implant; this was present in 64% of the pat ients with pain as compared with those without pain (p < 0.001, Mann-W hitney U test). Of the 80 patients, 27 had the implant removed after 1 8 months, 17 of them because of pain. In six of these 17, the pain was not relieved. prominence of the nail proximally was not associated wi th pain, but protuberance of laterally-based proximal locking screws c aused problems. We found a strong association between heterotopic bone formation and pain, but it is uncertain whether this is the true caus e or merely an indication of some other factor such as traumatic damag e to the glutei during insertion of the nail. Removal of the implant d oes not always core such pain.