An unusual case of femoral head perforation following fixation with proximal femoral nail antirotation (PFNA-II) for an unstable intertrochanteric fracture: Case report and literature review

The proximal femoral nail antirotation (PFNA-II) is designed for fixation of unstable proximal femoral fractures in Asian patients due to its superior biomechanical properties. The helical blade achieves purchase through bone compaction and requires less removal of bone than a screw. Medial migration of the helical blade with perforation into the hip joint without loss of reduction is a rare problem noted with PFNA. Past literature reporting the migration of the helical blade medially, perforating the femoral head has been addressed as a characteristic complication of the PFNA. A review of literature suggests various reasons for the same such as fresh trauma, fracture settlement and failure of lateralization of the blade. We report a case of postoperative medial migration of the helical blade perforating the femoral head due to loosening of the locking bolt of the helical blade without any signs of rotational or varus displacement of the fracture.