Intrapelvic Neck Screw Migration after Trochanteric Fixation Nail Advanced Fixation of a Trochanteric Femoral Fracture: A Case Report and Proposed Treatment Algorithm.

Abstract

Introduction: Although rare, mechanical failure of fixation in trochanteric fractures can lead to significant morbidity, particularly when medial migration of the cephalic screw occurs, posing a serious risk of life-threatening injury to intrapelvic vascular and visceral structures.

Case report: We report a case of severe intrapelvic migration of a cephalic screw in a 79-year-old patient following short trochanteric fixation nail advanced fixation for an unstable trochanteric fracture (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association 31-A2). The patient presented with acute mechanical failure, pain, and severe agitation. Urgent surgical intervention was performed, consisting of hardware removal and single-stage conversion to total hip arthroplasty (THA) using a dual-mobility construct. This multidisciplinary strategy successfully resolved the intrapelvic risk, provided stable joint reconstruction, and allowed for immediate full weight-bearing and early mobilization.

Conclusion: Intrapelvic screw migration requires prompt recognition and urgent surgical intervention with multidisciplinary preparation. Single-stage conversion to dual-mobility THA may provide a salvage procedure that mitigates visceral/vascular risks and enables early functional recovery in frail elderly patients.