A Case of Lower Extremity Weakness with Foot Drop Following Intramedullary Nailing of a Pathologic Femoral Fracture

A 62-year-old woman presented with a pathologic femoral fracture. She underwent bilateral femoral intramedullary nailing (IMN) fixation, and her postoperative course was complicated by worsening lower extremity weakness and foot drop. Lumbar imaging identified vertebral compression fractures with foraminal encroachment. The patient was thereafter started on a radiotherapy regimen and discharged home. Pathologic fractures most commonly occur in the proximal femur. In some patients, contralateral weakness suggests an additional fracture, though it may represent spinal involvement. This case explores multiple current treatment options for pathologic fractures of the femur and spine and suggests that prophylactic endoprostheses may have greater selective benefit than IMN fixation.