Challenges in the Removal of Circular Cross-Section Lag Screw Following Compression Hip Screw Fixation: A Report of Two Cases.

The compression hip screw (CHS) is a commonly used implant for the treatment of proximal femoral fractures. Although implant removal is not always required after fracture healing, it is occasionally performed in relatively young patients due to symptoms such as implant-related discomfort or in preparation for future procedures. While removal difficulties have been well documented for locking plates and intramedullary nails, challenges specifically involving lag screw removal from the femoral head in CHS systems are rarely reported. We report two cases of difficult lag screw removal following CHS fixation using a circular cross-section lag screw that necessitated an internal hexagonal interface for insertion and removal. In the first case, removal was unsuccessful due to strong fixation and deformation of the T-handle, resulting in retained hardware. In the second case, removal was achieved only after applying additional torque using Roman forceps. In both cases, the internal hexagonal design of the T-handle connection may have contributed to the difficulty. These cases suggest a potential limitation of CHS systems utilizing circular cross-section lag screws, particularly in younger patients with dense cancellous bone. Awareness of this complication is important when planning implant removal.