Screw Migration After Intramedullary Nail Surgery

Screw displacement

Hello Dr.
Lee, I would like to ask about a situation following a car accident where I fractured my tibia and fibula.
I underwent surgery and had an intramedullary nail implanted.
However, after more than two months, an X-ray showed that one of the screws near the knee has protruded slightly.
Why did this happen? Shouldn't the screws be securely tightened?

Mr. Lin, 30~39 year old female. Ask Date: 2019/08/27

Dr. Li Yongheng reply Orthopedics

Hello, as long as there is not much displacement of the bone screws due to activities like walking, there should be no major issues, so please don't worry too much.

Reply Date: 2019/08/27

More Info

Screw migration after intramedullary nail surgery can be a concerning issue, especially following a traumatic injury such as a fracture from a car accident. When a screw is inserted to stabilize a fracture, it is expected to remain securely in place. However, several factors can contribute to screw migration, which may lead to complications.

Firstly, it is essential to understand the mechanics of intramedullary nailing. Intramedullary nails are designed to provide internal fixation by being inserted into the medullary cavity of the bone. Screws are then used to secure the nail to the bone, providing stability during the healing process. However, if the screw is not adequately secured or if there is excessive movement at the fracture site, it can lead to screw migration.

One common reason for screw migration is inadequate fixation. If the screw is not tightened sufficiently or if the bone quality is poor (for example, in cases of osteoporosis), the screw may not hold as well as expected. Additionally, if the fracture has not healed properly, there may be movement at the fracture site, which can cause the screw to loosen and migrate.

Another factor to consider is the mechanical load placed on the bone during the healing process. If a patient begins to bear weight too soon or engages in activities that place excessive stress on the healing bone, this can lead to screw migration. It is crucial to follow the surgeon's recommendations regarding weight-bearing and rehabilitation to ensure proper healing.

Moreover, the design of the screw and nail system can also play a role. Some screws are designed to be locking screws, which provide a more secure fixation by locking into the nail. If a non-locking screw is used, it may be more prone to migration, especially if there is any movement at the fracture site.

In your case, the observation of a screw migrating after two months post-surgery is concerning and should be addressed promptly. It is essential to follow up with your orthopedic surgeon for further evaluation. They may recommend additional imaging studies, such as X-rays or CT scans, to assess the extent of the migration and determine if any intervention is necessary.

Treatment options may vary depending on the degree of migration and the stability of the fracture. In some cases, the screw may need to be repositioned or replaced to ensure proper fixation. If the fracture has not healed adequately, further surgical intervention may be required to promote healing.

In summary, screw migration after intramedullary nail surgery can occur due to inadequate fixation, excessive mechanical load, or the design of the fixation system. It is crucial to communicate any concerns with your orthopedic surgeon, who can provide guidance on the best course of action to address the issue and ensure proper healing of your fracture.

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