Intra-abdominal migration of a lag screw in gamma nailing: report of a case

J Orthop Trauma. 2010 Dec;24(12):e119-22. doi: 10.1097/BOT.0b013e3181db7f25.


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.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Aged, 80 and over
  • Arthroplasty, Replacement, Hip
  • Bone Nails*
  • Bone Screws*
  • Equipment Failure*
  • Female
  • Foreign-Body Migration / diagnostic imaging*
  • Fracture Fixation, Internal / instrumentation*
  • Hip Fractures / surgery*
  • Humans
  • Radiography, Abdominal
  • Treatment Outcome