Abstract
Hip fractures are a common injury among the elderly. Internal fixation with an intramedullary (IM) system has gained popularity for the treatment of intertrochanteric femur fractures. Multiple complications associated with IM fracture fixation have been described, however, we report a rare complication of medial pelvic migration of the lag screw of a short IM nail in a stable construct ten weeks post surgery. The patient was subsequently treated with Lag Screw removal and revision surgery with a shorter Lag Screw and an accessory cannulated screw acting as a de-rotational device. The patient did well with the revision surgery and was able to return to full activities.
Highlights
Hip fractures are a common injury among adults ages 65 and older, occurring in approximately 300,000 individuals yearly [1,2]
The patient was subsequently treated with Lag Screw removal and revision surgery with a shorter Lag Screw and an accessory cannulated screw acting as a de-rotational device
Conclusion the apparent mechanisms of the femoral neck element medial pelvic migration are undefined, incidents occur in part due to poor device placement during surgery leading to varus collapse post operatively, unstable fracture patterns especially with comminution of the medial calcar or lateral cortex, and post-operative weight-bearing on osteoporotic bone have been reported as contributing factors in literature
Summary
Hip fractures are a common injury among adults ages 65 and older, occurring in approximately 300,000 individuals yearly [1,2]. At the ten week follow up visit, right hip radiographs revealed that the lag screw along with the short IM nail construct had migrated medially through her femoral head and through the medial wall of her acetabulum (Fig. 5), the patient have been ambulating on her right lower extremity and did not complaint of hip pain or have any neurovascular deficits.
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