Pain from Exposed Screws After Hip Fracture Surgery: What to Do?

Sleeping on the area where a steel implant is located can cause pain?

In early July, I fell and sustained a fracture of the left femoral neck.
The doctor performed surgery and implanted four screws for fixation.
After the surgery, the femoral head shifted from a slight displacement to a significant displacement, which the doctor said could not be helped.
Since the surgery, I have been unable to lay my left leg flat while sleeping; whenever I try to do so, my upper body naturally arches, putting pressure on my lumbar spine.
Currently, I can only sleep with my feet elevated on a pillow.
It has been nearly two months post-surgery, and although the doctor said sleeping on my side is fine, I experience significant pain whenever I press on the area where the screws are located (not the surgical incision).
An X-ray shows that one of the screw heads is almost completely exposed outside the bone.
Now, I can only sleep on my back with my legs bent or on my right side, constantly adjusting the position of my pillow while trying to sleep, resulting in very poor sleep quality.
I would like to inquire whether the pain from pressure on the area with the screws is likely due to the exposed screw head and if this will persist unless the screws are removed in the future.
Is it possible to reopen the surgery for a revision and realignment?

Lán, 30~39 year old female. Ask Date: 2015/08/24

Dr. Shi Guozheng reply Orthopedics

Exposed metal pins can irritate the skin and subcutaneous tissue, leading to pain.
You may consult the surgeon to see if it is possible to remove the protruding pin.
Additionally, if the bone is misaligned and does not heal properly, reoperation should also be considered.

Reply Date: 2015/08/24

More Info

Experiencing pain from exposed screws after hip fracture surgery can be a challenging situation, especially when it affects your quality of life and sleep. Based on your description, it seems that you have undergone surgery for a left femoral neck fracture, where screws were implanted for stabilization. The fact that one of the screw heads is nearly exposed can indeed lead to discomfort and pain, particularly when pressure is applied to that area, such as when lying down or sleeping.

Understanding the Pain and Its Causes
1. Exposed Screws: When screws are placed during surgery, they are intended to stabilize the fracture and allow for healing. However, if a screw head is exposed, it can irritate the surrounding soft tissues, including muscles and nerves. This irritation can lead to localized pain, especially when pressure is applied, such as during sleep or movement.

2. Positioning and Pain: The inability to sleep flat or comfortably on your side due to pain indicates that the exposed screw is likely causing significant discomfort. The body’s natural response to pain often leads to compensatory postures, which can further exacerbate discomfort in other areas, such as the lower back due to increased pressure from awkward sleeping positions.

3. Healing Process: After a hip fracture surgery, the healing process can take time. While some patients may experience a relatively quick recovery, others may have prolonged discomfort due to various factors, including the extent of the injury, the surgical technique used, and individual healing responses.

Recommendations for Management
1. Consult Your Surgeon: It is crucial to communicate your concerns with your orthopedic surgeon. They can assess the situation through physical examination and imaging studies, such as X-rays, to determine the position of the screws and the overall healing of the fracture. If a screw is indeed exposed, your surgeon may discuss options for managing the pain or the possibility of surgical intervention to remove or reposition the screw.

2. Pain Management: In the interim, managing pain with over-the-counter pain relievers, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), may help alleviate discomfort. However, always consult your physician before starting any medication to ensure it is safe for your specific situation.

3. Physical Therapy: Engaging in physical therapy can be beneficial. A physical therapist can provide exercises to strengthen the surrounding muscles, improve mobility, and help you find comfortable sleeping positions. They can also guide you on how to gradually increase your activity level without exacerbating the pain.

4. Sleep Positioning: Since you are currently using pillows to support your leg while sleeping, consider experimenting with different pillow arrangements to find a position that minimizes pressure on the affected area. A body pillow or a wedge pillow may provide additional support and comfort.

5. Follow-Up Care: Regular follow-up appointments with your orthopedic surgeon are essential to monitor your recovery. If the pain persists or worsens, further evaluation may be necessary to determine if surgical intervention is required.

Conclusion
In summary, the pain you are experiencing from the exposed screws after your hip fracture surgery is likely due to irritation of the surrounding tissues. It is essential to maintain open communication with your healthcare provider to address these concerns effectively. They can provide tailored advice and treatment options based on your specific situation. Remember, recovery from such surgeries can vary widely among individuals, and it is crucial to be patient and proactive in seeking the care you need.

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