Intrapelvic migration of the lag screw in intramedullary nailing after intertrochanteric fracture fixation: A case report.

The expected number of hip fractures worldwide will rise from 1.7 million in 1990, to 6.3 million in 2050. In parallel, surgical complications are expected to increase. We describe a rare complication of intrapelvic migration of the lag screw from trochanteric nail in a 90-year-old woman.

CLINICAL CASE

A 90‐year‐old woman sustained an intertrochanteric fracture (AO/OTA 31‐A2) of the right femur after an accidental fall from standing position. She underwent closed reduction and internal fixation with a short gamma nail. Postoperative hospitalization was uncomplicated. The patient was discharged one week after the operation. The plain radiographs, at 6 weeks follow‐up, showed no material complications (Figure 1). Two years later, the patient consulted us for pain in her right hip. On plain radiographs, the lag screw had migrated through the acetabulum (Figure 2A,B). Arteriography was performed and did not reveal any vascular compromise (Figure 2C). The migrated lag screw was carefully removed and a cemented hemiarthroplasty of the hip was performed (Figure 3).

FIGURE 1

Plain radiographs, at 6 weeks follow‐up, showing no material complications

FIGURE 2

Plain radiographs (A, B), at 2 years follow‐up, showing intrapelvic migration of the lag screw through the femoral head and the medial wall of the acetabulum. (C) Arteriography showing no vascular injury

FIGURE 3

Postoperative radiographs showing revision surgery with cemented hemiarthroplasty of the hip

To our knowledge, only 19 similar cases have been reported through literature. Several factors may be associated with lag screw migration such as damage to femoral head while reaming, rotational and/or varus malreduction, misplaced set screw, and additional subsequent trauma. One of the nineteen patients had a fatal outcome, he died of lethal hemorrhage during implant removal. To conclude, technical mistakes should be avoided as much as possible when using gamma nail surgery and, in case of intrapelvic migration of the lag screw, vascular complication is to be feared.

AUTHOR CONTRIBUTIONS

Aymen Ben Fredj contributed to writing and editing of the manuscript. Hedi Rbai contributed to supervision and validation. Fourat Farhat contributed to the conceptualization of the manuscript. Marouen Berriri collected the clinical data.

CONFLICT OF INTEREST

None.

ETHICAL APPROVAL

This clinical image is the authors’ own original work, which has not been previously published elsewhere.

CONSENT

Written informed consent was obtained from the patient to publish this report in accordance with the journal's patient consent policy.