Iliopsoas bursitis-associated femoral neuropathy exacerbated after internal fixation of an intertrochanteric hip fracture in rheumatoid arthritis: a case report

• Published in: Modern rheumatology Vol. 18; no. 4; pp. 394 - 398
• Main Authors: Tokita, Asami, Ikari, Katsunori, Tsukahara, So, Toki, Hiroe, Miyawaki, Motoko, Mochizuki, Takeshi, Kawamura, Koichiro, Tomatsu, Taisuke, Momohara, Shigeki
• Format: Journal Article
• Language: English
• Published: Informa Healthcare 01-08-2008
• ISSN: 1439-7595; 1439-7609
• DOI: 10.3109/s10165-008-0060-1

Abstract
We present the case of a 63-year-old woman with a six-year history of rheumatoid arthritis (RA) and a left iliopsoas bursitis. Radiography had detected destructive changes in her hip joint associated with her bursitis, and she had reported some paresthesia along the left anterior distal thigh. Her pain and numbness remained tolerable, and her disease activity was well controlled until she accidentally fell on the floor, which resulted in an unstable intertrochanteric fracture of left femur with displacement of the proximal portion. The fracture was successfully treated with open reduction and internal fixation, but after the surgery, her femoral nerve palsy worsened. She subsequently underwent bursa excision after the failure of conservative treatment. Accordingly, after bursa excision, the postoperative course was uneventful, and her neurological symptoms gradually disappeared. We would recommend that bursa excision be considered even in cases of iliopsoas bursitis associated with mild femoral neuropathy when destructive changes in the hip joint are also present.