CASE REPORT   

Minerva Ortopedica e Traumatologica 2019 September;70(3):169-73

DOI: 10.23736/S0394-3410.19.03931-6

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Lateral migration of the femoral head lag screw in Locking Nail Hip Fracture System and transient osteoporosis of the hip

Marco DE MONTI ✉, Florian LUDWIG, Luca REGUSCI, Giuseppe PELONI, Fabrizio FASOLINI

Department of Surgery, Beata Vergine Regional Hospital, Ente Ospedaliero Cantonale, Mendrisio, Switzerland

A common treatment of the proximal femur fracture is a cephalocondylic intramedullary nail osteosynthesis. Failure of the osteosynthesis is described in about 3% of patients; rupture and medial migration occupies the majority of these cases whereas lateral migration is very rare and currently described only in one case in English literature. An 84-year-old man with subtrochanteric fracture was treated with intramedullary osteosyntesis with long Nail System without short-term complications. At 87 postoperative day we diagnosed a nearly complete lateral displacement of the cephalic lag screw, that was first removed, but for clinical instability of the fracture quickly replaced. Later he developed a painful post-traumatic transient osteoporosis in the femoral head and neck. A secondary dislocation of the head screw in patients treated with gamma nail is a rare complication. In case of radiological signs of initial cephalic lag screw displacement it is necessary a surgical revision, either a complete removal or a replacement of the cephalic lag screw to prevent further complications.

KEY WORDS: Femoral fractures; Fracture fixation, internal; Treatment failure; Hip injuries; Osteoporosis