Spontaneous proximal migration of Kuntscher nail: an uncommon complication.

Abstract

The Kuntscher nail (K-nail) was initially designed with an axial section in the letter 'V' shape. Still, it was later reintroduced in a cloverleaf shape to achieve additional strength and easier use. Migration of the K-nail proximally or distally in the femur is a well-documented complication, with distal migration reported as one of the complications in the 1940s. However, spontaneous extrusion of the K-nail proximally is a rare complication. The common causes of the extrusion include disuse/senile osteoporosis, infection, inappropriate K-nail size, delayed union with shortening and premature weight bearing.A woman in her early 80s presented with a history of a fall 3 months ago. She had pain in the left hip and was unable to bear weight. She was diagnosed with a left neck of femur fracture. On the right side, she had a femur shaft fracture for which K-nailing was done 11 years ago. She started feeling the implant in her right buttock for 3 years but did not seek medical advice and was able to do her routine activities. She underwent implant removal on the right side with left hip hemiarthroplasty.Spontaneous migration of the K-nail proximally is an uncommon presentation. It is suggested that K-nails be routinely removed as soon as union and consolidation of the fracture are achieved radiologically.