Slipped hip acetabular cortical screw: Laparoscopy to the rescue

Displacement of screw following acetabular fracture is rare and causes significant complications resulting in pain, functional impairment, neurovascular compromise, infection and intrapelvic migration requiring additional surgical intervention. This case describes the successful laparoscopic retrieval of a displaced 40 mm × 4.5 mm cortical screw from the psoas muscle who underwent open reduction and internal fixation for a complex acetabular fracture. A 54-year-old male patient was referred from the orthopaedic department with persistent left lower abdominal pain radiating to the lower limb after open reduction and internal fixation. Computed tomography revealed screw migration into retroperitoneum abutting external iliac artery (EIA). Laparoscopy confirmed the screw's retroperitoneal position and was abutting EIA posterior to it, embedded in psoas muscle and was removed through 10 mm port without any visceral or vascular injury. The patient had uneventful recovery. Intrapelvic migration of screw after hip screw fixation has been reported at 4.8%, rising to 6.2%. It poses dangerous complications if vascular structures are involved like in our case as abutting EIA. Open surgical approaches were used for screw retrieval. Few cases have been reported where diagnostic laparoscopy was used, and successful laparoscopic removal of a migrated screw was performed from pelvis. This case highlights the efficacy of laparoscopy over open approaches for retrieving displaced screw in anatomically challenging locations. Laparoscopy can be considered in cases of implant migration for safe and effective retrieval while avoiding the risks of extensive dissection. With expertise and adequate equipment, it reduces operative morbidity, shorter recovery and provides better visualisation of retroperitoneal structures.