Intrapelvic migration of the hip screw of a proximal femoral nail: report of two cases and review of the literature
Keywords:Medial migration of the hip screw, Cephalo-medullary nail, Pertrochanteric fractures
Two cases of medial migration of the hip screw in cases of cephalon-medullary nailing for the treatment of extra-articular proximal femoral fractures are reported. The first case was revised to hemiarthroplasty, that was subsequently complicated with infection and death of the patient, while the second was revised to a similar devise with favorable outcome. A review of the literature is performed in order to identify the contributing factors that result in the medial migration of the hip screw. Emphasis is given in further reporting of similar cases in order to abolish this potentially lethal complication.
Ramkumar U, Saffar N, Thinakarajan TR, Parmar HV. Pelvic migration of lag screw from a nailing device. Injury Extra. 2006;37:53-55.
Mark Tauber, Herbert Resch. Sigmoid perforation after medial migration of lag screw in gamma nailing. Arch Orthop Trauma Surg. 2006;26:118-122.
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(2):e6-e1.
Xinning Li, Heffernan MJ, Kane C and Leclair W. Medial pelvic migration of the lag screw in a short gamma nail after hip fracture fixation: a case report and review of the literature. J Orthop Surg Res. 2010;5:62.
Heineman DJ, van Buijtenen JM, Heuff G, Derksen EJ, Pöll RG. Intra-abdominal migration of a lag screw in gamma nailing: report of a case. J Orthop Trauma. 2010;24(12):e119-e122.
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).
Robinson SJ, Fountain JR, Torella F, Pennie BH. Intrapelvic migration of a lag screw from a cephalomedullary femoral nail: a case report. Injury. 2011; 42(11):1384-6.
Takigami I, Ohnishi K, Ito Y, Nagano A, Sumida H, Tanaka K, Shimizu Acetabular perforation after medial migration of the helical blade through the femoral head after treatment of an unstable trochanteric fracture with proximal femoral nail antirotation (PFNA): a case report. J Orthop Trauma. 2011;25(9):e86-9.
Lal H, Sharma DK, and Mittal D. Intrapelvic migration of hip lag screw of proximal femoral nail-sequele to a paradoxical reverse Z effect and their critical analysis. J Clin Orthop Trauma. 2012;3(1):4853.
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(11):e264-7.
Thein E, De Cannière A, Burn A, Borens O. Medial migration of lag screw after gamma nailing. Injury. 2014;45(8):1275-9.
Takasago T, Goto T, Toki S, Hamada D, Yoshioka S, Tonogai I et al. Migration of the Lag Screw in Intramedullary Nailing. Case Rep Orthop. 2014;2014:519045.
Gomes PL, Castelo LS, Lopes AL, Maio M, Miranda A, Dias AM. Pelvic migration of the helical blade after treatment of transtrochanteric fracture using a proximal femoral nail. Rev Bras Ortop. 2016;51(4):482-5.
Pinheiro AC, Alpoim B, Félix A, Alves C, Sousa C, Rodrigues A. Medial migration of the intramedullary Gamma 3nail- a case report. Rev. bras. ortop. 2016;51(6).
van Hoef S, Fuchs MC1, Ten Broeke RH. Late Occurring Medial Migration of a Lag Screw in Gamma Nailing. Case Rep Orthop. 2016;2016:5201674.
Lee JW, Cho HM, Seo JW. Intrapelvic Penetration of Lag Screw in Proximal Femoral Nailing - A Case Report. Journal of the Korean Fracture Society. 2017;30(4).
Kim YW, Kim PKJ, Lee SW. Intrapelvic Migration of the Lag Screw With Wedge Wing From Dyna Locking Trochanteric Nail: A Case Report and Literature Review. Hip Pelvis. 2019;31(2):110-119.
Nayak M,Yadav R, Ganesh V and Digge V. An unusual case of femoral head perforation following fixation with proximal femoral nail antirotation (PFNA-II) for an unstable intertrochanteric fracture: Case report and literature review. Trauma Case Rep. 2019;20:100178.
Weil YA1, Gardner MJ, Mikhail G, Pierson G, Helfet DL, Lorich DG. Medial migration of intramedullary hip fixation devices: a biomechanical analysis. Arch Orthop Trauma Surg. 2008;128(2):227-34.
Werner-Tutschku W, Lajtai G, Schmiedhuber G, Lang T, Pirkl C, Orthner E. Intra- and perioperative complications in the stabilization of per- and subtrochanteric femoral fractures by means of PFN Unfallchirurg. 2002;105(10):881-5.