Intra-abdominal migration of a lag screw in gamma nailing: report of a case.
An 83-year-old female patient was referred to the emergency room with progressive pain on mobilization. Three weeks before presentation, she had been treated with a gamma nail for an unstable right intertrochanteric fracture. Pelvic x-ray showed an intra-abdominally migrated lag screw. No evidence of intra-abdominal lesions was visible on computed tomographic scan. The lag screw as well as the intramedullary nail was extracted and in a second operation, a total hip arthroplasty was implanted. Unfortunately, the total hip implant dislocated and needed reduction. The three consecutive operations seriously weakened the soft tissue envelope. A plaster cast and brace, immobilizing the right hip and pelvis, were provided to prevent recurrences of dislocation. After 6 weeks of immobilization, the patient did well. No late complication occurred. A review of the literature with an emphasis on pathophysiology of intra-abdominal or retroperitoneal migration of lag screws in gamma nailing is presented.
Department of Orthopedics, Slotervaart Hospital, Amsterdam, The Netherlands. David.Heineman@gmail.com
David J
DJ
Heineman
Jesse M
JM
van Buijtenen
Gijsbert
G
Heuff
Eric J
EJ
Derksen
Ruud G
RG
Pöll
D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D001858:Bone Nails; D001863:Bone Screws; D004868:Equipment Failure; D005260:Female; D005548:Foreign-Body Migration / Q000000981:diagnostic imaging*; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D011860:Radiography, Abdominal; D016896:Treatment Outcome