50 Years Later: Delayed Presentation of Foot Drop Due to Sciatic Nerve Neuropathy on a Background of Ipsilateral Femur Intramedullary Nailing - A Case Report.

INTRODUCTION: Causes of foot drop are varied, one of which is sciatic nerve neuropathy. This report demonstrates a delayed presentation of foot drop due to sciatic nerve neuropathy on a background of ipsilateral femur intramedullary nailing 50 years ago. CASE REPORT: A 77-year-old female with a background of previous left femur intramedullary nail presented with a sudden onset of left foot drop for 1-day duration following minimal trauma. Magnetic resonance imaging and electrodiagnostic studies were conducted, with overall findings suggestive of a left sciatic neuropathy. The femur nail was eventually removed in the operating theater. Intraoperatively, the nail was found to be proud and extending past the bony surface of the femoral greater trochanter, with the left sciatic nerve noted to have significant scarring. Sciatic nerve neurolysis was done in the same setting, but the foot drop did not recover. DISCUSSION: Ipsilateral foot drop after intramedullary nailing of the femur is a rare but known complication, usually due to sciatic nerve palsy. In this case, the delayed sciatic neuropathy was likely due to the chronic mechanical irritation from the retained femoral nail causing scarring and fibrosis. CONCLUSION: While it is rare, it remains possible that retained metal implants may contribute to chronic nerve irritation or compression decades after the index surgery. Careful clinical evaluation, electrodiagnostic studies, and relevant imaging are important for accurate diagnosis and management of the foot drop.