Removal of osteosynthesis material from healed hip fractures. Indications and prognosis

Many patients complain of pain after their hip fractures have healed. We tried to determine if it is possible, on the basis of radiographic findings and pain localization, to select the patients who will improve if the osteosynthesis material is removed. In 39 instances (34 patients) hardware was removed because of pain. These patients were interviewed and their radiographs reviewed. In 23 instances the pain was lateral, in 4 in the groin and in 12 in both locations. Complete or very considerable alleviation of pain was seen in respectively 16, 2, and 7 of the patients in these groups after osteosynthesis material removal, in 22 within three months. Seventeen patients had pathological radiographic findings before removal. No consistent association was detected between these findings and pain localization. Four out of nine with segmental collapse of the head of the femur were improved by removal. A number of these had had only lateral pain. Of the ten patients where the hardware protruded laterally into the soft tissues, eight improved. Three of these had only groin pains. Pain localization is a poor indicator of the value of osteosynthesis material removal. Perhaps more patients should be offered removal. This may also apply to those with some segmental collapse of the femoral head.