A 56-year-old female presented to our hospital complaining of acute right hip pain after a motorcycle accident. A plain pelvic radiograph revealed a stable intertrochanteric fracture (Fig. 1A). The patient was scheduled for surgical fracture fixation. Fixation of the fracture was performed using a ZNN (Cephalomedullary Asia) with the closed method under image intensifier guidance on an orthopaedic traction table. Intraoperative problems associated with the implant including lag screw insertion were not detected during the operation. Postoperatively, an anteroposterior pelvic radiograph was taken (Fig. 1B). Neither surgical wounds nor neurovascular complications were observed in this patient postoperatively. Complete bone union was obtained within 3 months after the operation. At 14 months postoperatively, the patient came to our hospital and desired removal of the implant. Physical examination revealed no abnormal findings with normal joint range of motion. A plain anteroposterior pelvic radiograph showed complete bone union with no sign of implant failure (Fig. 1C). Then, the operation for removal of the implant was scheduled. Implant removal was planned through the previous incision with the patient in lateral position. Intraoperatively, a problem was detected during removal of the lag screw. According to the manufacturer's protocol, after insertion of the original Zimmer lag screw inserter and retaining shaft (Fig. 2A, B), it was attempted to remove the lag screw by maneuvering it in the counter-clockwise direction. However, an unpredicted breakage of the tail portion of the lag screw occurred. Two pieces of the broken part of the tail portion of the lag screw were removed (Fig. 3A). A wider skin incision was made to obtain a good exposure of the tail of lag screw associated with clearing the bone and soft tissue around it. The use of clamping device was not possible, then removal of the lag screw was successfully performed by making new matched slots for reinserting the original Zimmer lag screw inserter and retaining shaft into the lag screw with use of a high speed burr with a 2 mm size of burr tip (Fig. 3B). Selection of the tip burr size and the burring site was important in order to make new matched slots (Fig. 3C). No significant problem was detected during nail removal after removing the lag screw. A bone allograft was inserted to fill the bone space after removing all implant parts. No complications occurred after the removal operation, and an anteroposterior pelvic radiograph was also taken postoperatively (Fig. 1D).

A 56-year-old female presented to our hospital complaining of left hip pain since 1 month ago. She had history of left intertrochanteric fracture and received surgical fixation at our hospital 1 year before. Previously, fixation of the fracture was also done using a similiar implant and procedure described in the previous case. No history of intraoperative problems detected during the operation. A recent anteroposterior hip radiograph showed a bone union with no sign of hardware failure (Fig. 4A). A lateral protruded tail portion of the lag screw was also noted and maybe causes a soft tissue irritation which induced pain. An operation for removal was planned. During operation, we tried to turn out the lag screw carefully using a Zimmer lag screw inserter and retaining shaft. An incomplete breakage of lag screw tail portion was noted at the similiar site with the previous described case (Fig. 4C). Fortunately the tail portion of the lag screw was more protruded in this case, later removal of the lag screw was successfully done using a clamping device (vise grip).