Intraabdominal injuries caused by migration of guide wire after intramedullary osteosynthesis in intertrochanteric hip fracture

Abstract

Intrapelvic migration of implants used for fixation of fractures around the hip represents a totally preventable complication. We present the case of an 89-year-old female patient with an intertrochanteric fracture of the left hip, who underwent intramedullary osteosynthesis with a gamma nail. Four days later, radiologic examination identified that the guide had not been removed during the operation and had migrated into the peritoneal cavity. Ultrasonography and CT scanning failed to confirm intraabdominal or vascular injury. Although the guide wire was removed through the initial incision, the patient developed acute abdominal pain after 6 hours with clinical signs of large and small intestinal ileus and dyspnoea. Urgent investigative laparotomy ensued which disclosed dilation of the small intestine, perforation of the mesosigmoid and mesorectum, injury to the left ovary, linear necrosis of jejunum and bilateral retroperitoneal injuries to iliac fossae. An imminent bowel perforation necessitated small bowel wall debridement and suture-closure. Finally, abdominal lavage was performed and a drainage tube placed in the Douglas pouch. The postoperative course was uneventful and the patient was discharged on the 12th postoperative day.