Medial lag screw migration in an intramedullary nail combination

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 weeks 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.