Intraoperative Guidewire Breakage During Proximal Femoral Nailing Managed Through Direct Anterior Approach: A Case Report and Review of Literature.

CASE: We report a rare intraoperative complication during proximal femoral nailing for an intertrochanteric femur fracture in a 54-year-old male. During helical blade preparation, the guidewire migrated intra-articularly and fractured during withdrawal. Retention risked cartilage damage, while retrieval through the blade tract was unsuitable and threatened implant stability. With the nail in situ, safe surgical dislocation was not feasible. The fragment was successfully removed through an direct anterior approach. At 14 months follow-up the patient had returned to his pre injury activity level indicating excellent functional outcome.

CONCLUSION: Anterior approach offers a safe, joint-preserving option for retrieval of intra-articular guidewire fragments while maintaining implant stability and femoral head vascularity.