Arthroscopically assisted replacement of dynamic hip screw for unrecognized joint penetration of lag screw through a new portal.

Abstract

Nails penetrating into the hip joint after fixation of intertrochanteric fractures may account for one third of all treatment failures. Some authors recommend leaving the nail in the penetrated position until union is certain. However, if the lag screw is long enough penetrate the acetabular joint surface and cause severe pain and limited range of motion, a new shorter one should replace it. In this situation, direct visualization of the joint surface may not be possible, and fluoroscopy can be difficult to interpret. To our knowledge, this is the first case report of left intertrochanteric fracture with unrecognized joint penetration of the lag screw that was replaced by a new shorter one with arthroscopic assistance through a new portal of the screw canal. This case constitutes a unique and interesting application of hip arthroscopy.