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In our case, the fracture was a highly unstable one (Kyle V, reverse type, AO 31-A3) with not only a separation of the diaphysis from the trochanteric region but also a fracture of the greater trochanter itself and a separation of the head�Cneck fragment from the greater trochanter, and all of it in osteoporotic bone. Technically, the reduction was not perfect, and the lag screw was placed too high and too anterior in the femoral head, although the TAD [3] was FK228 chemical structure this rare complication, we have followed the steps recommended in the literature: (1) rule out and treat, if present, intra-abdominal visceral and/or vascular injury, (2) rule out infectious process, (3) implant removal, and (4) prosthetic joint replacement, with a good clinical and radiological evolution. Lag screw medial migration is a rare but serious complication. In front of the dramatic increase in the incidence of intertrochanteric fractures, it is extremely likely that this type of complication will increase in number as well. For this reason, it is important to be aware of the potential risk factors related to it, and to avoid those related to the operative technique. All of the authors confirm that they have no conflict of interest whatsoever NVP-BGJ398 manufacturer in relation with the publication of this manuscript. There were no sources of funding GNAT2 involved in the realization of this manuscript, nor did we have any writing assistance. ""In severely comminuted metaphyseal fractures of proximal humerus, the use of conventional single locking plate does not provide stable fixation, leading to complications such as varus collapse of neck-shaft portion and nonunion [1], [2]?and?[3]. Therefore, a more robust and enhanced fixation method, the dual plating technique using locking plates (Proximal Humeral Internal Locking System (PHILOS), Synthes, Switzerland & Variable Angle Locking Compression Plate (VA-LCP) Distal Radius System, Synthes, Switzerland) was developed. A delto-pectoral exposure is used to expose the proximal humerus, as described previously by Badman and Mighell [4]. Delto-pectoral exposure revealing the long head of the biceps brachii, which is released from the supraglenoid tubercle. After delto-pectoral expose, further dissection is made through posterior side of greater tubercle with careful consideration not to injure axillary nerve and posterior circumflex humeral artery which can be identified upon the additional exposure. Both direct and indirect reduction under image amplifiers is performed to minimise soft tissue damage and to conserve maximum blood supply to the fragment.