J Korean Fract Soc.  2017 Oct;30(4):203-208. 10.12671/jkfs.2017.30.4.203.

Intrapelvic Penetration of Lag Screw in Proximal Femoral Nailing: A Case Report

• Lee JW
• Cho HM
• Seo JW

• KMID: 2424133
• DOI: http://doi.org/10.12671/jkfs.2017.30.4.203

Abstract

Hip fractures are common among elderly individuals. Internal fixation with the intramedullary system has been widely used to treat intertrochanteric femur fractures. The Gamma 3 nail is a useful device for fixating trochanteric fractures of the proximal femur. We report a rare complication of medial pelvic penetration of the lag screw of a Gamma 3 nail two months after surgery. There was a complete separation between the nail body and lag screw, and the lag screw penetrated through the acetabulum into the pelvis. We report a case of unstable intertrochanteric fracture with intrapelvic penetration after surgical treatment with proximal femoral nailing and a case followed by fatal results.

Keyword

Intrapelvic penetration; Intertrochanteric fractures; Lag screw migration; Gamma 3

MeSH Terms

Acetabulum
Aged
Femur
Hip Fractures
Humans
Pelvis

Figure

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  Fig. 1 Radiographs in 2 planes show pertrochanteric fracture of the right femur (31-A2.3 OTA/AO).

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  Fig. 2 (A) This photo is an intraoperative C-arm image. (B, C) Postoperative radiographs in 2 planes after internal fixation with a Gamma 3 nail. The reduction in C-arm image and postoperative radiographs was unsatisfactory anatomically, and a lag screw was mid-anterior to the femoral head with a tip apex distance above 25 mm.

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  Fig. 3 Radiographs in 2 planes 2 weeks after the surgery shows a lag screw being in a more superior position, suggesting an impending cut-out of the lag screw.

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  Fig. 4 Radiograph in anteroposterior view two months after the surgery of the right hip, showing complete disengagement of the implant with a medially dislocated lag screw into the pelvis.

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  Fig. 5 Computed tomography scan 2 months after surgery depicting the tip of the lag screw inside the pelvis with respect to the iiliopsoas muscle.

Reference

1. Radford PJ, Needoff M, Webb JK. A prospective randomised comparison of the dynamic hip screw and the gamma locking nail. J Bone Joint Surg Br. 1993; 75:789–793.

2. Ahrengart L, Törnkvist H, Fornander P, et al. A randomized study of the compression hip screw and Gamma nail in 426 fractures. Clin Orthop Relat Res. 2002; (401):209–222.

3. Hesse B, Gächter A. Complications following the treatment of trochanteric fractures with the gamma nail. Arch Orthop Trauma Surg. 2004; 124:692–698.

4. Cleveland M, Bosworth DM, Thompson FR, Wilson HJ Jr, Ishizuka T. A ten-year analysis of intertrochanteric fractures of the femur. J Bone Joint Surg Am. 1959; 41-A:1399–1408.

5. Flint JH, Sanchez-Navarro CF, Buckwalter JA, Marsh JL. Intrapelvic migration of a gamma nail lag screw: review of the possible mechanisms. Orthopedics. 2010; 33(4):

6. Werner-Tutschku W, Lajtai G, Schmiedhuber G, Lang G, Pirkl C, Orthner E. Intra- und perioperative Komplikationen bei der Stabilisierung von per- und subtrochantären Femurfrakturen mittels PFN. Unfallchirurg. 2002; 105:881–885.

7. Lucke M, Burghardt RD, Siebenlist S, Ganslmeier A, Stöckle U. Medial migration of lag screw with intrapelvic dislocation in gamma nailing: a unique problem? A report of 2 cases. J Orthop Trauma. 2010; 24:e6–e11.

8. Lozano-Alvarez C, Alier A, Pelfort X, Martínez-Díaz S, Puig L. Cervicocephalic medial screw migration after intertrochanteric fracture fixation, OTA/AO 31-A2, using intramedullary nail Gamma3: report of 2 cases and literature review. J Orthop Trauma. 2013; 27:e264–e267.

9. Horas U, Ernst S. Medial dislocation of hip screw following internal fixation of a pertrochateric metastasis in the femur with gamma nails. Unfallchirurg. 2008; 111:746–748.

10. Rebuzzi E, Pannone A, Schiavetti S, et al. IMHS clinical experience in the treatment of peritrochanteric fractures. The results of a multicentric Italian study of 981 cases. Injury. 2002; 33:407–412.