Slipped hip acetabular cortical screw: Laparoscopy to the rescue

Area of Science:

• Orthopedic Surgery
• Minimally Invasive Surgery
• Surgical Complications

Background:

• Screw displacement after acetabular fracture fixation can lead to severe complications, including pain, functional loss, and neurovascular compromise.
• Intrapelvic screw migration rates range from 4.8% to 6.2%, posing risks, especially when adjacent to vital structures like the external iliac artery (EIA).

Purpose of the Study:

• To describe the successful laparoscopic retrieval of a displaced acetabular fixation screw from the psoas muscle.
• To highlight the efficacy of laparoscopy as a minimally invasive alternative for managing screw migration in challenging anatomical locations.

Main Methods:

• A 54-year-old male patient with persistent abdominal pain post-acetabular fracture fixation underwent computed tomography (CT) scan.
• CT revealed a migrated screw in the retroperitoneum, abutting the EIA.
• Laparoscopic surgery was performed for screw retrieval through a 10 mm port.

Main Results:

• The displaced 40 mm × 4.5 mm cortical screw was successfully retrieved laparoscopically from the psoas muscle.
• The procedure avoided injury to visceral and vascular structures, including the EIA.
• The patient experienced an uneventful recovery.

Conclusions:

• Laparoscopic screw retrieval is an effective and safe method for managing displaced implants in anatomically challenging retroperitoneal locations.
• This minimally invasive technique reduces operative morbidity, shortens recovery time, and offers better visualization compared to open surgery.
• Laparoscopy should be considered for implant migration cases, especially when vascular structures are at risk.