PMC8177983_01
Anteroposterior (a) and lateral (b) radiographs taken on initial presentation showing a trochanteric fracture with a greater trochanteric fragment in the right femur, which are classified as AO type 31A2.2 and Jensen type 3.
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Radiography revealed an AO type 31A2.2 and Jensen type 3 trochanteric fracture in the right femur (Figure 1).
Radiographs after the osteosynthesis of the right trochanteric fracture. Anteroposterior (a) and lateral (b) views of the right femur showing insufficient reduction and poor placement of the lag screw after implantation of a gamma 3 long nail.
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However, the lag screw was inserted anteriorly and a varus malalignment remained (Evans classification was type 1 group 3) in AP view (Figure 2).
Radiographs showing redisplacement of the fracture and intrapelvic migration of the lag screw through the femoral head and the medial wall of the acetabulum.
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The lag screw penetrated into the pelvis through the femoral head and acetabulum (Figure 3).
A contrast-enhanced computed tomography scan showing the lag screw located deep in the pelvis, between the internal and external iliac vessels, and tangent to the intestine. (a) Axial view (arrow, lag screw) and (b) reconstructed 3D image.
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The lag screw was located between the internal and external iliac vessels, and tangent to the small intestine; however, no signs of pneumoperitoneum or hematuria were present (Figure 4).
Laparoscopic views showing the lag screw, intestine, and peritoneum: (a) damage to the intestine was not observed; (b) the peritoneum around the lag screw was peeled; (c) the lag screw was pulled out with forceps.
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Intestinal damage was not observed, and after peeling the peritoneum around the lag screw, the screw was pulled out with forceps (Figure 5).
A radiograph at 1 year after implant removal showing nonunion of the right trochanter of the femur.
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A follow-up radiograph revealed nonunion of the right trochanter of the femur (Figure 6).