• David J Heineman, Jesse M van Buijtenen, Gijsbert Heuff, Eric J Derksen, and Ruud G Pöll.
• Department of Orthopedics, Slotervaart Hospital, Amsterdam, The Netherlands. David.Heineman@gmail.com
• J Orthop Trauma. 2010 Dec 1;24(12):e119-22.

AbstractAn 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.

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