The Gamma nail, an implant specifically designed for intertrochanteric and subtrochanteric femoral fractures, has been criticized for its high risk of secondary shaft fractures. A modified design, the intramedullary hip screw has recently been introduced to correct this complication. We present a case of mechanical failure of this new implant that occurred in a pathological subtrochanteric fracture. The centering sleeve of the implant became loose and migrated while the head screw penetrated the acetabulum. Refixation was successful.