Intrapelvic Migration of Cephalic Screw: Report of two Cases and Review of the Literature
Keywords:
macular hole, microinvasive vitrectomy, platelet-rich plasma, internal limiting membrane, Artery of Percheron, thalamic infarct, bilateral stroke, young adult, vertical gaze palsy, altered consciousness, education, mothers, newborn care, ANC., cephalic screw, intrapelvic migration, hip fracture, Gamma 3 nail, PFNA nail, surgery complications.Abstract
Intramedullary nails are widely used to treat extracapsular femoral neck fractures, providing a minimally invasive approach that allows early weight-bearing. However, in about 5% of cases, proper fixation is not achieved. One rare complication is the intrapelvic migration of the cephalic screw, which occurs in less than 0.5% of cases. This study reports two cases of intrapelvic screw migration and reviews the literature on this complication.
A retrospective descriptive study was conducted at our hospital between 2015 and 2022, analyzing two cases of cephalic screw migration following hip fracture treatment. Case 1 involved an 85-year-old male who underwent treatment for a right pertrochanteric fracture with a Gamma 3 nail. Three months post-surgery, the cephalic screw migrated into the pelvic cavity, requiring removal via laparotomy. A partial hip prosthesis was implanted in a subsequent surgery, and the patient recovered successfully. Case 2 involved an 83-year-old female with multiple comorbidities. After a right pertrochanteric fracture was treated with a PFNA nail, the cephalic screw migrated intrapelvically 20 months post-surgery. Due to her comorbidities, the screw was removed through the hip approach, and the patient passed away six months later from pre-existing health issues.
A literature review of 17 reported cases revealed that screw migration often occurs due to improper screw placement, repeated axial loading, and unstable fixation. Prevention strategies emphasize achieving an anatomical reduction, selecting an appropriately sized screw, and proper follow-up to detect complications early. Treatment options include screw removal via open surgery, laparotomy, laparoscopy, or endovascular approaches.
In conclusion, medial migration of the lag screw is rare but significant. Preventing this complication requires optimal fracture reduction, precise screw placement, and proper follow-up to avoid severe consequences for the patient.
References
B. Gullberg, O. Johnell, J.A. Kanis (1997) Worldwide projections for hip fracture. 7(5), 407–413.
M.R. Karagas, G.L. Lu-Yao, J.A. Barrett, M.L. Beach, J.A. Baron (1996) Heterogeneity of hip fracture: age, race, sex, and geographic patterns of femoral neck and trochanteric fractures among the US elderly. 143(7), 677-82. https://doi.org/10.1093/oxfordjournals.aje.a008800
J.M. Broderick, R. Bruce-Brand, E. Stanley, K.J. Mulhall (2013) Osteoporotic hip fractures: the burden of fixation failure. 515197.
E. Rebuzzi, A. Pannone, S. Schiavetti, P. Santoriello, U. de Nicola, G. Fancellu (2002) IMHS clinical experience in the treatment of peritrochanteric fractures. The results of a multicentric Italian study of 981 cases. 33(5), 407–412.
Z. Mousati, M. Van Den Broek, J. Callaert, J. Gielis, K. Govaers (2023) Endovascular assisted removal of intrapelvic lag screw after intramedullary proximal femoral nail: a case report and literature review. 100873. https://doi.org/10.1016/j.tcr.2023.100873
K. Kuroshima, K. Kasahara, S. Kihara, Y. Harada, M. Sumi (2021) Medial pelvic migration of the lag screw after intramedullary nailing for trochanteric femoral fracture. 5553835.
Y.W. Kim, W.Y. Kim, K.J. Kim, S.W. Lee (2019) Intrapelvic migration of the lag screw with wedge wing from dyna locking trochanteric nail: a case report and literature review. 110-9.
J.W. Lee, H.M. Cho, J.W. Seo (2017) Intrapelvic penetration of lag screw in proximal femoral nailing: a case report. 203-8.
S. Akçay, İ.S. Satoğlu, H. Çabuk, K. Turan (2013) Pelvic migration of lag screw following fixation of an intertrochanteric femur fracture with proximal femoral nail. 44-6. https://doi.org/10.5152/jarem.2013.13
A. Georgiannos (2016) A case report of a rare complication of an intrapelvic migration of the lag screw of a gamma nail: review of the literature. https://doi.org/10.23937/2469-5777.1510031
I. Nagura, T. Kanatani, A. Inui, Y. Mifune, T. Kokubu, M. Kurosaka (2015) Medial migration of the lag screw in Gamma nailing system: a case report. https://doi.org/10.4172/2167-1222.S2-011
C Lozano-Alvarez, A Alier, X Pelfort, S Martínez-Díaz, L Puig (2013) Cervicocephalic medial screw migration after intertrochanteric fracture fixation, OTA/AO 31-A2, using intramedullary nail Gamma3: report of 2 cases and literature review. 27(11), e264-7. https://doi.org/10.1097/BOT.ob013e31829203ca
J. H. Flint, C. F. Sanchez-Navarro, J. A. Buckwalter, J. L. Marsh (2010) Intrapelvic migration of a gamma nail lag screw: review of the possible mechanisms. 33(4), p. 4. https://doi.org/10.3928/01477447-20100225-19
H Lal, D. K. Sharma, D Mittal (2012) Intrapelvic migration of hip lag screw of proximal femoral nail-sequele to a paradoxical reverse Z effect and their critical analysis. 3, 48–53. https://doi.org/10.1016/j.jcot.2012.02.002
D. J. Heineman, J. M. van Buijtenen, G Heuff, et al (2010) Intra-abdominal migration of a lag screw in gamma nailing: report of a case. 24, e119–22. https://doi.org/10.1097/BOT.obo13e3181db7f25
A. C. Pinheiro, B Alpoim, A Félix, et al (2016) Medial migration of the intramedullary Gamma 3 nail - a case report. 51, 720–4. https://doi.org/10.1016/j.rboe.2016.10.004
Z Dragan, R. J. Campbell, T. R. Moopanar (2025) Medial lag screw migration in an intramedullary nail combination. 18(3), e262436. https://doi.org/10.1136/bcr-2024-262436
E Thein, A De Canniere, A Burn, O Borens (2014) Medial migration of lag screw after Gamma nailing. 45(8), 1275-9.
S. J. Robinson, J. R. Fountain, F Torella, B. H. Pennie (2011) Intrapelvic migration of a lag screw from a cephalomedullary femoral nail: a case report. 42(11), 1384-6.
Y. A. Weil, M. J. Gardner, G Mikhail, G Pierson, D. L. Helfet, D. G. Lorich (2008) Medial migration of intramedullary hip fixation devices: a biomechanical analysis. 128(2), 227–234.
N. W. Lang, R Breuer, H Beiglboeck, A Munteanu, S Hajdu, R Windhager, et al (2019) Migration of the lag screw after intramedullary treatment of AO/OTA 31.A2.1-3 pertrochanteric fractures does not result in higher incidence of cut-outs, regardless of which implant was used: a comparison of Gamma nail with and without U-Blade (RC) lag screw and proximal femur nail antirotation (PFNA). 8(5), 615. https://doi.org/10.3390/jcm8050615
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Authors and Global Journals Private Limited
This work is licensed under a Creative Commons Attribution 4.0 International License.
