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

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.