Intrapelvic Migration of the Lag Screw with Wedge Wing from Dyna Locking Trochanteric Nail: A Case Report and Literature Review

Abstract

The intrapelvic migration of cervicocephalic lag screws is a rare complication after intertrochanteric fracture synthesis with an intramedullary nail. Only 15 cases of intrapelvic penetration by three different instrument systems have been described in the literature. However, to our knowledge, there is no report of intrapelvic migration of the lag screw with wedge wing designed to increase fixation power using the Dyna locking trochanteric (DLT) nail. We present a case of intrapelvic migration of the lag screw with wedge wing from DLT nail. The patient described herein underwent a two-staged operation of implant removal without intrapelvic approach followed by bipolar hemiarthroplasty. With intrapelvic migration conditions, although it is not uncommon to require an additional intrapelvic approach, this modification can lead to lethal consequences. For this reason, it is recommended to coordinate with the vascular surgery department due to the close proximity of the major vessels.

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

“…To our knowledge, only 19 similar cases have been reported through literature 1 . 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 1 . One of the nineteen patients had a fatal outcome, he died of lethal hemorrhage during implant removal 2 .…”

“… 1 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. 1 One of the nineteen patients had a fatal outcome, he died of lethal hemorrhage during implant removal. 2 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.…”

Intrapelvic migration of the hip screw of a proximal femoral nail: report of two cases and review of the literature

“…One of the most uncommon is intrapelvic migration of the hip screw. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] Apart from the two presented cases in this article, twenty cases have been documented in the international literature in English language. Weil, Gardner et al attempted in 2008 to give a hypothesis in order to understand the biomechanical contributors to this phenomenon.…”