Key result
Revision surgery using a long intramedullary nail with cement augmentation and a layered haemostatic agent successfully treated medial lag screw migration in a non-ambulatory patient.
Why the study?
Hardware migration and non-union after intramedullary fixation for intertrochanteric fractures remain challenging to manage, often requiring complex revision procedures.
Case Report (n=1)
No
This case report describes a novel surgical strategy for managing medial lag screw migration in an intramedullary nail combination using a haemostatic agent and cement augmentation.
Alerts clinicians to hardware migration risk after intramedullary fixation in paraplegic patients; leaves open prevention strategies.
Intramedullary fixation is increasingly used for intertrochanteric fractures in the elderly population. The management of hardware migration and non-union remains a challenge for orthopaedic surgeons, often necessitating complex revision procedures. We report a case of medial lag screw migration with propagation of a reverse oblique neck of femur fracture 8 weeks postoperatively in a patient in their mid-70s with pre-existing paraplegia. A revision procedure was performed. Existing hardware was removed without complication. The lag screw tract was packed with layers of a haemostatic agent to prevent intra-articular cement migration followed by fixation with a long intramedullary nail with cement augmentation via the new lag screw. There were no intraoperative complications, and postoperative progress was satisfactory. This report presents a rare case of medial lag screw migration in an intramedullary nail combination and provides a novel surgical strategy for revision.
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Dragan et al. (2025) conducted a case report in Medial lag screw migration and reverse oblique intertrochanteric proximal femur fracture (n=1). Revision surgery with long intramedullary nail and cement augmentation was evaluated on Clinical and radiographic outcome after revision surgery. Revision surgery using a long intramedullary nail with cement augmentation and a layered haemostatic agent successfully treated medial lag screw migration in a non-ambulatory patient.
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