{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:06:31Z","timestamp":1756339591742,"version":"3.44.0"},"reference-count":34,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2025,3,3]],"date-time":"2025-03-03T00:00:00Z","timestamp":1740960000000},"content-version":"unspecified","delay-in-days":2,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,1,2]]},"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:p>Intramedullary fixation is increasingly used for intertrochanteric fractures in the elderly population. The management of hardware migration and non-union remains a challenge for orthopaedic surgeons, often necessitating complex revision procedures. We report a case of medial lag screw migration with propagation of a reverse oblique neck of femur fracture 8\u2009weeks postoperatively in a patient in their mid-70s with pre-existing paraplegia. A revision procedure was performed. Existing hardware was removed without complication. The lag screw tract was packed with layers of a haemostatic agent to prevent intra-articular cement migration followed by fixation with a long intramedullary nail with cement augmentation via the new lag screw. There were no intraoperative complications, and postoperative progress was satisfactory. This report presents a rare case of medial lag screw migration in an intramedullary nail combination and provides a novel surgical strategy for revision.<\/jats:p>","DOI":"10.1136\/bcr-2024-262436","type":"journal-article","created":{"date-parts":[[2025,3,3]],"date-time":"2025-03-03T16:40:44Z","timestamp":1741020044000},"page":"e262436","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Medial lag screw migration in an intramedullary nail combination"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-9874-6357","authenticated-orcid":false,"given":"Zac","family":"Dragan","sequence":"first","affiliation":[{"name":"Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryan J","family":"Campbell","sequence":"additional","affiliation":[{"name":"Orthopaedics and Trauma Surgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Terence R","family":"Moopanar","sequence":"additional","affiliation":[{"name":"Orthopaedics and Trauma Surgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,3,3]]},"reference":[{"key":"2025082711533342000_18.3.e262436.1","doi-asserted-by":"crossref","first-page":"178","DOI":"10.11622\/smedj.2016071","article-title":"Hip fractures in the elderly: operative versus nonoperative management","volume":"57","author":"Tay","year":"2016","journal-title":"Singapore Med J"},{"key":"2025082711533342000_18.3.e262436.2","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1302\/0301-620X.106B1.BJJ-2023-0740.R1","article-title":"The impact of an ageing population on future increases in hip fracture burden","volume":"106-B","author":"Harris","year":"2024","journal-title":"Bone Joint J"},{"key":"2025082711533342000_18.3.e262436.3","doi-asserted-by":"crossref","DOI":"10.1186\/s13018-019-1431-3","article-title":"Outcome of intramedullary nailing treatment for intertrochanteric femoral fractures","volume":"14","author":"Hoffmann","year":"2019","journal-title":"J Orthop Surg Res"},{"key":"2025082711533342000_18.3.e262436.4","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1097\/CORR.0000000000002792","article-title":"Intramedullary Nailing of Intertrochanteric Femoral Fractures in a Level I Trauma Center in Finland: What Complications Can be Expected?","volume":"482","author":"L\u00e4hdesm\u00e4ki","year":"2024","journal-title":"Clin Orthop Relat Res"},{"key":"2025082711533342000_18.3.e262436.5","doi-asserted-by":"crossref","first-page":"373","DOI":"10.4055\/cios22149","article-title":"Midterm Outcomes of Intramedullary Fixation of Intertrochanteric Femoral Fractures Using Compression Hip Nails: Radiologic and Clinical Results","volume":"15","author":"Suh","year":"2023","journal-title":"Clin Orthop Surg"},{"key":"2025082711533342000_18.3.e262436.6","doi-asserted-by":"crossref","first-page":"2319","DOI":"10.1007\/s00264-023-05865-z","article-title":"Clinical observation and finite element analysis of femoral stable interlocking intramedullary nail in intertrochanteric fractures","volume":"47","author":"Wu","year":"2023","journal-title":"Int Orthop"},{"key":"2025082711533342000_18.3.e262436.7","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1186\/s12891-023-06725-y","article-title":"Intravenous application of tranexamic acid in intramedullary nailing for the treatment of geriatric intertrochanteric fractures: a systematic review and meta-analysis","volume":"24","author":"Zhang","year":"2023","journal-title":"BMC Musculoskelet Disord"},{"key":"2025082711533342000_18.3.e262436.8","doi-asserted-by":"crossref","first-page":"3397","DOI":"10.1016\/j.injury.2021.07.025","article-title":"Risk factors for implant failure of intertrochanteric fractures with lateral femoral wall fracture after intramedullary nail fixation","volume":"52","author":"Fan","year":"2021","journal-title":"Injury"},{"key":"2025082711533342000_18.3.e262436.9","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.98B7.36061"},{"key":"2025082711533342000_18.3.e262436.10","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1111\/os.12736","article-title":"Internal Fixation versus Hemiarthroplasty in the Treatment of Unstable Intertrochanteric Fractures in the Elderly: A Systematic Review and Meta-Analysis","volume":"12","author":"Tu","year":"2020","journal-title":"Orthop Surg"},{"key":"2025082711533342000_18.3.e262436.11","first-page":"1","article-title":"Is internal fixation of the intertrochanteric fractures reliable option in patients with cognitive dysfunction?","volume":"82","author":"Avc\u0131","year":"2016","journal-title":"Acta Orthop Belg"},{"key":"2025082711533342000_18.3.e262436.12","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.1097\/JS9.0000000000000373","article-title":"The SCARE 2023 guideline: updating consensus Surgical CAse REport (SCARE) guidelines","volume":"109","author":"Sohrabi","year":"2023","journal-title":"Int J Surg"},{"key":"2025082711533342000_18.3.e262436.13","doi-asserted-by":"crossref","first-page":"e119","DOI":"10.1097\/BOT.0b013e3181db7f25","article-title":"Intra-abdominal migration of a lag screw in gamma nailing: report of a case","volume":"24","author":"Heineman","year":"2010","journal-title":"J Orthop Trauma"},{"key":"2025082711533342000_18.3.e262436.14","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1016\/j.rbo.2015.12.006","article-title":"Medial migration of the intramedullary Gamma 3 nail - a case report","volume":"51","author":"Pinheiro","year":"2016","journal-title":"Rev Bras Ortop"},{"key":"2025082711533342000_18.3.e262436.15","article-title":"Late Occurring Medial Migration of a Lag Screw in Gamma Nailing","volume":"2016","author":"van Hoef","year":"2016","journal-title":"Case Rep Orthop"},{"key":"2025082711533342000_18.3.e262436.16","doi-asserted-by":"crossref","first-page":"110","DOI":"10.5371\/hp.2019.31.2.110","article-title":"Intrapelvic Migration of the Lag Screw with Wedge Wing from Dyna Locking Trochanteric Nail: A Case Report and Literature Review","volume":"31","author":"Kim","year":"2019","journal-title":"Hip Pelvis"},{"key":"2025082711533342000_18.3.e262436.17","doi-asserted-by":"crossref","DOI":"10.1186\/1749-799X-5-62","article-title":"Medial pelvic migration of the lag screw in a short gamma nail after hip fracture fixation: a case report and review of the literature","volume":"5","author":"Li","year":"2010","journal-title":"J Orthop Surg Res"},{"key":"2025082711533342000_18.3.e262436.18","doi-asserted-by":"crossref","first-page":"1275","DOI":"10.1016\/j.injury.2014.04.016","article-title":"Medial migration of lag screw after gamma nailing","volume":"45","author":"Thein","year":"2014","journal-title":"Injury"},{"key":"2025082711533342000_18.3.e262436.19","article-title":"Medial Pelvic Migration of the Lag Screw after Intramedullary Nailing for Trochanteric Femoral Fracture","volume":"2021","author":"Kuroshima","year":"2021","journal-title":"Case Rep Orthop"},{"key":"2025082711533342000_18.3.e262436.20","doi-asserted-by":"crossref","first-page":"e264","DOI":"10.1097\/BOT.0b013e31829203ca","article-title":"Cervicocephalic medial screw migration after intertrochanteric fracture fixation, OTA\/AO 31-A2, using intramedullary nail Gamma3: report of 2 cases and literature review","volume":"27","author":"Lozano-Alvarez","year":"2013","journal-title":"J Orthop Trauma"},{"key":"2025082711533342000_18.3.e262436.21","doi-asserted-by":"crossref","first-page":"e6","DOI":"10.1097\/BOT.0b013e3181a4eeb2","article-title":"Medial migration of lag screw with intrapelvic dislocation in gamma nailing--a unique problem? A report of 2 cases","volume":"24","author":"Lucke","year":"2010","journal-title":"J Orthop Trauma"},{"key":"2025082711533342000_18.3.e262436.22","doi-asserted-by":"crossref","DOI":"10.11604\/pamj.2014.18.188.4877","article-title":"Rare complication of gamma nail: cervical screw migration in contact with iliac vessels","volume":"18","author":"Ouchrif","year":"2014","journal-title":"Pan Afr Med J"},{"key":"2025082711533342000_18.3.e262436.23","doi-asserted-by":"crossref","DOI":"10.2106\/JBJS.CC.19.00623","article-title":"Late Medial Migration of Lag Screw After Gamma3 Nailing Threatening the Internal Iliac Vessels: A Case Report","volume":"10","author":"Pawar","year":"2020","journal-title":"JBJS Case Connect"},{"key":"2025082711533342000_18.3.e262436.24","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1007\/s00402-005-0085-2","article-title":"Sigmoid perforation after medial migration of lag screw in gamma nailing","volume":"126","author":"Tauber","year":"2006","journal-title":"Arch Orthop Trauma Surg"},{"key":"2025082711533342000_18.3.e262436.25","doi-asserted-by":"crossref","first-page":"203","DOI":"10.12671\/jkfs.2017.30.4.203","article-title":"Intrapelvic Penetration of Lag Screw in Proximal Femoral Nailing: A Case Report","volume":"30","author":"Lee","year":"2017","journal-title":"J Korean Fract Soc"},{"key":"2025082711533342000_18.3.e262436.26","article-title":"Intrapelvic migration of the lag screw in intramedullary nailing","volume":"2014","author":"Takasago","year":"2014","journal-title":"Case Rep Orthop"},{"key":"2025082711533342000_18.3.e262436.27","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.jcot.2012.02.002","article-title":"Intrapelvic migration of hip lag screw of proximal femoral nail-sequele to a paradoxical reverse Z effect and their critical analysis","volume":"3","author":"Lal","year":"2012","journal-title":"J Clin Orthop Trauma"},{"key":"2025082711533342000_18.3.e262436.28","doi-asserted-by":"crossref","first-page":"1384","DOI":"10.1016\/j.injury.2011.01.019","article-title":"Intrapelvic migration of a lag screw from a cephalomedullary femoral nail: A case report","volume":"42","author":"Robinson","year":"2011","journal-title":"Injury"},{"key":"2025082711533342000_18.3.e262436.29","doi-asserted-by":"crossref","unstructured":"Flint JH , Sanchez-Navarro CF , Buckwalter JA , et al . Intrapelvic migration of a gamma nail lag screw: review of the possible mechanisms. Orthopedics 2010;33. doi:10.3928\/01477447-20100225-19","DOI":"10.3928\/01477447-20100225-19"},{"key":"2025082711533342000_18.3.e262436.30","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.injury.2005.07.021","article-title":"Pelvic migration of lag screw from a nailing device","volume":"37","author":"Ramkumar","year":"2006","journal-title":"Injury Extra"},{"key":"2025082711533342000_18.3.e262436.31","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1097\/BOT.0b013e31819211b2","article-title":"The treatment of intertrochanteric fractures: results using an intramedullary nail with integrated cephalocervical screws and linear compression","volume":"23","author":"Ruecker","year":"2009","journal-title":"J Orthop Trauma"},{"key":"2025082711533342000_18.3.e262436.32","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1302\/0301-620X.95B6.31018","article-title":"Inadequate \u201cthree-point\u201d proximal fixation predicts failure of the Gamma nail","volume":"95-B","author":"Abram","year":"2013","journal-title":"Bone Joint J"},{"key":"2025082711533342000_18.3.e262436.33","doi-asserted-by":"crossref","DOI":"10.1097\/OI9.0000000000000191","article-title":"Tips and tricks to avoid implant failure in proximal femur fractures treated with cephalomedullary nails: a review of the literature","volume":"5","author":"Petfield","year":"2022","journal-title":"OTA Int"},{"key":"2025082711533342000_18.3.e262436.34","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1007\/s00402-007-0497-2","article-title":"Medial migration of intramedullary hip fixation devices: a biomechanical analysis","volume":"128","author":"Weil","year":"2008","journal-title":"Arch Orthop Trauma Surg"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2024-262436","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T18:53:41Z","timestamp":1756320821000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2024-262436"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3]]},"references-count":34,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,3,3]]},"published-print":{"date-parts":[[2025,3]]}},"alternative-id":["10.1136\/bcr-2024-262436"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2024-262436","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2025,3]]}}}