The PFNAII nailing system due to its helical blade has superior rotational stability as well as enhanced sub chondral bone purchase in the treatment of intertrochanteric fractures. However, complications such as screw cut out, loss of reduction, failure of lateralization, medial migration continue to worry treating surgeons. We report an interesting case of post operative medial migration of helical blade perforating the femoral head leading to varus malunion and its management
