Evaluation and Management of Persistent Pain After Trochanteric Nailing

Initial Diagnostic Workup

• The American College of Surgeons recommends evaluating gait pattern and weight-bearing tolerance, as pain with weight-bearing suggests hardware failure or nonunion 1

Management Based on Findings

• Initial conservative management for greater trochanteric pain syndrome includes physical therapy focusing on hip abductor strengthening, regular acetaminophen, and avoiding NSAIDs in elderly patients due to acute kidney injury and gastrointestinal complications 1, 2
• The World Journal of Emergency Surgery suggests cautious opioid use, as elderly patients are vulnerable to accumulation, over-sedation, and respiratory depression, and avoiding codeine due to constipation, emesis, and postoperative cognitive dysfunction 1, 2

Osteoporosis Evaluation and Treatment

• The Annals of the Rheumatic Diseases recommends that every patient over 50 with a fragility fracture requires systematic evaluation for subsequent fracture risk, including outpatient DEXA scan and referral to bone health clinic or endocrinology for osteoporosis management 1, 3, 4
• Adequate calcium and vitamin D supplementation is essential for osteoporosis management, according to the Annals of the Rheumatic Diseases 3