Continued hip pain

My husband is 32 years old and was injured in an MVA in Sept. 1999.  His right femur broke in half and he had an intramedullary rod nailed in place at Vanderbilt University Medical Center in Nashville.  Of course, there are also screws in the hip and knee.  We were told immediately after the surgery that he could expect pain up to one year post surgery.  Well, it has been over five years and he continues to have excruciating pain at times with this.  He has been to three orthopaedic surgeons and his family physician about the continuation of this severe pain.  The pain is almost unbearable and is almost always in the hip and not at the fracture site.  It flares up approximately once every two weeks and lasts for days at a time.  During the flare ups, he cannot get relief even with Percocet.  Also during every episode his temperature will spike up to around 101 to 102, and then goes back down when the "episode" is over.  During the office visits with the orthopaedic surgeons, they have performed plain films x-rays which do not show any loosening or other abnormality.  He has NOT had a CT scan or MRI (which I'm not sure he could have anyway due to the metal in his leg).  We are getting very frustrated with this, no one is able to give us an answer as to why he continues to have this severe pain which is disabling when it flares up.  The physicians just keep telling us that they don't have an answer and throw medication at him.  He doesn't want medication, he wants to know if there could be a problem that is not showing up on plain film.  He wants his life back.  He has to miss work on the days that his pain flares up and this is very frustrating for both of us.   The physicians that we have consulted don't seem to offer any hope of finding an answer.  The family physician suggested that it takes a tremendous impact to break a femur in half and that the impact almost certainly had to do damage to the hip joint during that process, but still no solution was offered!  Also I'm not sure that the physicians understand just how intense and disabling his pain is (we tell them but I feel that they brush it off).   We are at our wits end with this and need some advice.  Is there anything else that could be going on here that they haven't told us or thought of?  Are there any other tests that he could undergo to check for problems that wouldn't be seen on plain film?  Any other solution that you can think of?  Any doctor in our area that you could recommend? He is at the point that he wants to bring up hip replacement surgery to his doctors (I work in the medical field and I personally don't feel that he should go there yet).  Please help!!

[Kevin Pho, MD]

I can appreciate your husband being in a difficult position.  MRI imaging likely cannot be done given the presence of metal in the body.  A CT scan can be done, however I'm not sure it has the resolution that would be useful.  You can consider a bone scan, which can help if there is an infectious process present and MRI cannot be done.

If surgery is not an option, and after being to 3 orthopedic surgeons there has certainly been many opinions, then a physiatry consult (a rehabilitation specialist) or pain consult can be considered to make the discomfort tolerable.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
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