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Georges O, De Dominicis F, Rahal MB, Le Pessot J, Berna P, Arab OA, Beyls C. Successful removal of an intra-pericardic Kirschner wire via fluoroscopy-guided minimal invasive approach: a case report. Surg Case Rep 2024; 10:57. [PMID: 38466481 DOI: 10.1186/s40792-023-01803-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/26/2023] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Kirschner wires are widely used in trauma surgery. Their migration into the pericardium is a rare but often fatal phenomenon, requiring urgent management. CASE PRESENTATION We describe the case of a 65-year-old patient who underwent Kirschner wire placement to treat a humeral head fracture. Three months after the operation, pleural and pericardial effusions with cardiac tamponade were observed, leading to the diagnosis of wire migration within the pericardium. A minimally invasive approach guided by fluoroscopy allowed emergency wire extraction without needing a median sternotomy. The postoperative clinical course was uncomplicated. CONCLUSIONS The use of pre- and per-operative multimodal imaging allowed for the safe extraction of an intra-pericardial Kirschner wire through a minimally invasive approach.
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Affiliation(s)
- Olivier Georges
- Department of Thoracic Surgery, Anesthesiology and Critical Care Medicine, Amiens University Hospital, 1, Rond Point du Pr Cabrol, 80054, Amiens Cedex 1, France.
| | - Florence De Dominicis
- Department of Thoracic Surgery, Anesthesiology and Critical Care Medicine, Amiens University Hospital, 1, Rond Point du Pr Cabrol, 80054, Amiens Cedex 1, France
| | - Malek Ben Rahal
- Department of Thoracic Surgery, Anesthesiology and Critical Care Medicine, Amiens University Hospital, 1, Rond Point du Pr Cabrol, 80054, Amiens Cedex 1, France
| | - Jules Le Pessot
- Department of Thoracic Surgery, Anesthesiology and Critical Care Medicine, Amiens University Hospital, 1, Rond Point du Pr Cabrol, 80054, Amiens Cedex 1, France
| | - Pascal Berna
- Department of Thoracic Surgery, Clinique Victor Pauchet, Amiens, France
| | - Osama Abou Arab
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, 80054, Amiens, France
| | - Christophe Beyls
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, 80054, Amiens, France
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Wang P, Chen C, Liu B, Wang X, Jiang W, Chu X. Intracardic migration of Kirschner wire from the right sternoclavicular joint: a case report. BMC Surg 2021; 21:294. [PMID: 34134678 PMCID: PMC8207770 DOI: 10.1186/s12893-021-01292-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/10/2021] [Indexed: 11/10/2022] Open
Abstract
Background Migration of wires and pins within the heart is an uncommon complication. Intracardic migration of Kirschner wire can cause several complications. Case presentation A 55-year-old male patient was admitted to the emergency service with dyspnea, stabbing chest pain. The patient’s medical history showed that he had undergone a fixation operation using Kirschner wire and plate for treatment of the right sternoclavicular joint dislocation about 5 months prior. Chest computerized tomography revealed a metallic foreign body locating in the pericardium between the aorta and the right ventricle. There were not any serious complications occurred before operation due to the timely detection of potential risks. Removal of the wire was performed via median sternotomy under general anesthesia without cardiopulmonary bypass. The symptoms of dyspnea and chest pain were relieved after surgery, and the patient recovered without any complications. Conclusion The Kirschner wire should be used judiciously in amphiarthrosis in orthopedic surgery for the risk of breakage and migration. The possibility of intracardiac migration of wire should be considered when chest symptoms presenting after surgery with the Kirschner wire. Migrated wires must be removed immediately to prevent serious complications. Regular follow-up and early removal of fixation wires are recommended to prevent migration of wires.
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Affiliation(s)
- Peng Wang
- Department of Spine Surgery, Weihai Municipal Hospital, Shandong University, Weihai, Shandong, China
| | - Cong Chen
- Department of Spine Surgery, Weihai Municipal Hospital, Shandong University, Weihai, Shandong, China
| | - Bo Liu
- Department of Spine Surgery, Weihai Municipal Hospital, Shandong University, Weihai, Shandong, China
| | - Xiaokang Wang
- Department of Cardiac Surgery, Weihai Municipal Hospital, Shandong University, Weihai, Shandong, China
| | - Wei Jiang
- Department of Medical Imaging, Weihaiwei People's Hospital, Weihai, Shandong, China
| | - Xiangquan Chu
- Department of Orthopedic Surgery, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, China.
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3
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Unexplained pellets in heart after shotgun wound through the hip: A case report. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.641944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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4
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Palauro FR, Stirma GA, Secundino AR, Riffel GB, Baracho F, Dau L. Kirschner Wire Migration after the Treatment of Acromioclavicular Luxation for the Contralateral Shoulder - Case Report. Rev Bras Ortop 2019; 54:202-205. [PMID: 31363268 PMCID: PMC6510575 DOI: 10.1016/j.rbo.2017.09.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 09/13/2017] [Indexed: 11/24/2022] Open
Abstract
The use of metal wires, called Kirschner wires, is a simple and effective fixation method for the correction of shoulder fractures and of dislocations in orthopedic surgery. Wire migration during the postoperative follow-up is a possible complication of the procedure. The authors present the case of a 48-year-old male patient, a business administrator, who suffered a fall from his own height during a soccer match resulting in right shoulder trauma. The patient was treated at a specialized orthopedics and trauma hospital and was diagnosed with a grade V acromioclavicular dislocation. Four days after the trauma, the acromioclavicular dislocation was surgically treated using ligatures with anchor wires, coracoacromial ligament transfer, and fixation with Kirshner wires from the acromion to the clavicle. At the follow-up, 12 days after the surgical procedure, migration of the Kirschner wire to the acromion edge was identified. The patient was oriented to undergo another surgery to remove the Kirshner wire, due to the possibility of further migration; nonetheless, he refused the surgery. Nine months after the surgical treatment, the patient complained of pain on the left shoulder (contralateral side), difficulty to mobilize the shoulder, ecchymosis, and protrusion. Bilateral radiographs demonstrated that the Kirschner wire, originally from the right shoulder, was on the left side. The patient then underwent a successful surgery to remove the implant.
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Affiliation(s)
- Fabiano Rogerio Palauro
- Departamento de Ortopedia e Traumatologia, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brasil
| | - Guilherme Augusto Stirma
- Departamento de Ortopedia e Traumatologia, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brasil
| | - Armando Romani Secundino
- Departamento de Ortopedia e Traumatologia, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brasil
| | - Gabriel Bonato Riffel
- Departamento de Ortopedia e Traumatologia, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brasil
| | - Filipe Baracho
- Departamento de Ortopedia e Traumatologia, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brasil
| | - Leonardo Dau
- Departamento de Ortopedia e Traumatologia, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brasil
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5
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Hwang JH, Lee DG, Kim KS, Lee SY. Proximal migration of retained pencil lead along a flexor tendon in the hand: A case report. Medicine (Baltimore) 2019; 98:e13876. [PMID: 30608408 PMCID: PMC6344185 DOI: 10.1097/md.0000000000013876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE The hand is the most common site for foreign body injuries. Pencil lead penetration mainly occurs in school-age children.We report a case of proximal migration of a retained pencil lead in the hand, emphasizing the importance of adequate imaging and prompt removal of the foreign body. PATIENT CONCERNS We report the case of an 8-year-old boy who visited our outpatient clinic for a retained foreign body in the right palm. Removal was planned under general anesthesia. Black staining from the pencil lead was observed around the tendon sheath in the operative field, but the foreign body itself was not apparent. DIAGNOSIS Intraoperative radiography located the foreign body at the wrist, 5 cm away from the original site. Proximal migration of the retained foreign body was suspected. INTERVENTION Incision was extended toward the wrist and the foreign body was discovered in the flexor sheath at the wrist. CONCLUSION Foreign bodies may migrate to adjacent tissues, but rarely wander far. Computed tomography is the most useful tool in diagnosing a pencil lead foreign body. LESSONS Adequate imaging and prompt removal of the foreign body is important. When a retained foreign body is removed after a delay, the physician must always consider the possibility of foreign body migration.
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6
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Pientka WF, Bates CM, Webb BG. Asymptomatic Migration of a Kirschner Wire from the Proximal Aspect of the Humerus to the Thoracic Cavity: A Case Report. JBJS Case Connect 2018; 6:e77. [PMID: 29252654 DOI: 10.2106/jbjs.cc.16.00032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
CASE A 78-year-old man presented with an open fracture of the proximal aspect of the humerus and an axillary artery laceration; the fracture was treated provisionally with Kirschner wires (K-wires). Forty-five days postoperatively, he presented with pin prominence at the lateral aspect of the arm, and was incidentally noted to have migration of a separate K-wire to the left lung. He underwent successful thoracotomy and lung wedge resection for wire removal. CONCLUSION K-wires used in the fixation of fractures of the proximal aspect of the humerus may migrate into the thoracic cavity. No modification of this technique, including the use of threaded, terminally bent, or external pins that are visibly secured, eliminates the potential for devastating complications.
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Affiliation(s)
- William F Pientka
- Department of Orthopaedic Surgery, John Peter Smith Hospital, Fort Worth, Texas
| | - Christopher M Bates
- Department of Orthopaedic Surgery, John Peter Smith Hospital, Fort Worth, Texas
| | - Brian G Webb
- Department of Orthopaedic Surgery, John Peter Smith Hospital, Fort Worth, Texas.,Department of Orthopaedic Surgery, University of North Texas Health Science Center, Fort Worth, Texas
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Nguyen TD, Sandhaus T, Doenst T. Chronic Perforation of the Aortic Arch by Kirschner Wires. Thorac Cardiovasc Surg Rep 2016; 5:65-67. [PMID: 28018830 PMCID: PMC5177428 DOI: 10.1055/s-0036-1584268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 04/27/2016] [Indexed: 10/26/2022] Open
Abstract
Perforation of the heart or great vessels by orthopedic wires is a rare complication that mostly results in severe or even lethal organ injury. Therefore, such conditions mostly require immediate surgical removal of the wires. However, in some individual cases, a conservative approach may be preferable. We describe a case of a 70-year-old woman whose aortic arch has been penetrated by two Kirschner wires used for fixation of a right clavicle fracture 13 years ago. Notably, the complication was an incidental finding during computed tomography angiography for clarification of transient nonspecific neurological symptoms.
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Affiliation(s)
- T Dung Nguyen
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | - Tim Sandhaus
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
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8
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Abstract
Migration of wires or pins around the shoulder is a known complication, though their migration within the chest is uncommon. We report an unusual case of hydropneumothorax due to migration of a bent Kirschner wire from the right proximal humerus in a 63 year-old man. We reviewed his clinical history, physical examination, imaging findings, surgical method and outcome. We also reviewed the literature on orthopaedic wire migration and latest technique in removal of the wires. Chest radiographs and chest computerized tomography are useful in detection and diagnosis of this disorder. Regular radiographic follow-up is needed for patients with internal fixation devices; any fractured or migrated pins or wires must be removed immediately to prevent dangerous complications. It is always important to remove the wires at the end of the treatment. Early removal of fixation wires and regular follow-up if wires are retained are essential to prevent serious complications.
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9
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Tesson P, Ammi M, Ghomri D, Daligault M, Péret M, Picquet J. Intra-aortic migration of a Kirschner pin: hybrid surgical repair. J Shoulder Elbow Surg 2016; 25:e281-3. [PMID: 27475454 DOI: 10.1016/j.jse.2016.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 05/26/2016] [Indexed: 02/01/2023]
Affiliation(s)
- Pierre Tesson
- Vascular and Thoracic Department, University hospital of Angers, Angers, France.
| | - Myriam Ammi
- Vascular and Thoracic Department, University hospital of Angers, Angers, France
| | - Djamel Ghomri
- Orthopaedic Department, Centre Hospitalier de Laval, Laval, France
| | - Mickaël Daligault
- Vascular and Thoracic Department, University hospital of Angers, Angers, France
| | - Matthieu Péret
- Vascular and Thoracic Department, University hospital of Angers, Angers, France
| | - Jean Picquet
- Vascular and Thoracic Department, University hospital of Angers, Angers, France
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Tan L, Sun DH, Yu T, Wang L, Zhu D, Li YH. Death Due to Intra-aortic Migration of Kirschner Wire From the Clavicle: A Case Report and Review of the Literature. Medicine (Baltimore) 2016; 95:e3741. [PMID: 27227938 PMCID: PMC4902362 DOI: 10.1097/md.0000000000003741] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 04/26/2016] [Accepted: 04/26/2016] [Indexed: 12/01/2022] Open
Abstract
Migration of orthopedic fixation wires into the ascending aorta though a rare occurrence can have devastating consequences. Therefore, prompt recognition, with immediate and cautious retrieval of the implant is paramount in averting these complications.We present a case of a 5-year-old boy with the intra-aortic migration of a K-wire used for the treatment of a right clavicle fracture. He was transferred to us with a history of syncope, chest pain, and shortness of breath 7 days after K-wire placement, which was performed at another hospital. On CT scan, the wire was found to be partially inside the ascending aorta, which was associated with massive hemopericardium and cardiac tamponade. The patient was taken up for emergency surgery for the removal K-wire and for the management of cardiac temponade. However, the patient developed cardiac arrest during the induction of intravenous anesthesia and endotracheal intubation. The K-wire was retrieved from the thorax via thoracotomy. However, the patient died 10 days after the surgery.As the migration of wires and pins during orthopedic surgery can cause potentially fatal complications, these should be used very cautiously, especially for percutaneous treatment of shoulder girdle fractures. The patients with such implants should be followed frequently, both clinically and radiographically. If migration occurs, the patient should be closely monitored for emergent complications and the K-wire should be extracted immediately.
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Affiliation(s)
- Lei Tan
- From the Departments of Orthopedic Trauma (LT, DH-S, TC-Y, LX-W, DZ); and Cardiology and Echocardiography (YH-L), The First Hospital of Jilin University, Changchun, China
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11
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Cerruti P, Mangano T, Giovale M, Repetto I. Early asymptomatic intrathoracic migration of a threaded pin after proximal humeral osteosynthesis. INTERNATIONAL JOURNAL OF SHOULDER SURGERY 2016; 10:41-3. [PMID: 26980989 PMCID: PMC4772416 DOI: 10.4103/0973-6042.174520] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Pinning with metallic wires is a suitable therapeutic option for proximal humeral fractures. Loosening and migration of such devices from this site is uncommon. Despite infrequently occurring, however, the literature reports dramatic and potentially lethal complications related to wires dislocation. A 69-year-old woman underwent closed reduction and fixation of a proximal 3-part humeral fracture by mean of two retrograde Kirschner wires and one anterograde threaded pin. One month after surgery, during a routine follow-up control, it was diagnosed the migration of the threaded pin in the left lung parenchyma. In the meantime, the only symptom the patient complained was an episodic intercostal pain of mild intensity, with referred onset 1 week after surgery. The migrated pin was removed through thoracoscopic approach in the emergency setting, without intra- or post-operative complications. Only a few authors reported similar complications after fixation of proximal humeral fractures. Immediate surgical removal of the device is always mandatory. When considering pinning fixation for shoulder girdle's fractures, orthopedic surgeons should take into account the risk for wire dislocation, and take up adequate precautions during surgery and follow-up control visits.
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Affiliation(s)
- Paola Cerruti
- Department of Orthopaedics and Traumatology, University of Genova, School of Medicine, Padiglione 40, Largo Rosanna Benzi 10, Genova, Italy
| | - Tony Mangano
- GSL, Albenga Orthopedic Center, Santa Maria di Misericordia Hospital, Viale Martiri Della Foce, Albenga, Italy
| | - Marcello Giovale
- GSL, Albenga Orthopedic Center, Santa Maria di Misericordia Hospital, Viale Martiri Della Foce, Albenga, Italy
| | - Ilaria Repetto
- Department of Orthopaedics and Traumatology, University of Genova, School of Medicine, Padiglione 40, Largo Rosanna Benzi 10, Genova, Italy
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Aydın E, Dülgeroğlu TC, Metineren H. Migration of a Kirschner wire to the dorsolateral side of the foot following osteosynthesis of a patella fracture with tension band wiring: a case report. J Med Case Rep 2016; 10:41. [PMID: 26911242 PMCID: PMC4765234 DOI: 10.1186/s13256-016-0819-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 02/01/2016] [Indexed: 11/10/2022] Open
Abstract
Background Patella fractures represent 1 % of all musculoskeletal system fractures. Fixation of patellar fractures using open reduction and tension band wiring is a commonly used and successful surgical fixation method. Case presentation A 28-year-old male patient from Turkey presented to our clinic with complaints of palpable foreign bodies under the skin on the dorsolateral side of his right foot. Except for the palpable and moving body of about 6 cm length under the skin in his foot, he had no functional complaints. On X-ray, a Kirschner wire was visible in front of the lateral malleolus on the dorsolateral side of his right foot. In addition, there was a cerclage wire from the tension band fixation of his patella in the ipsilateral knee. The Kirschner wire was removed surgically. Conclusion Despite the use of different fixation materials for the surgical treatment of patellar fractures, tension band wiring is still a commonly used technique. We recommend that after fixation of a patellar fracture using the tension band wiring technique, the ends of the Kirschner wires be bent and the wires then removed in the early phase after patellar union to prevent Kirschner wire migration.
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Affiliation(s)
- Ekrem Aydın
- Department of Orthopaedics and Traumatology, Dumlupinar University School of Medicine, 43270, Kutahya, Turkey
| | - Turan Cihan Dülgeroğlu
- Department of Orthopaedics and Traumatology, Dumlupinar University School of Medicine, 43270, Kutahya, Turkey.
| | - Hasan Metineren
- Department of Orthopaedics and Traumatology, Dumlupinar University School of Medicine, 43270, Kutahya, Turkey
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External Iliac Artery-Appendicular Fistula due to Antegrade Unusual Migration of K-Wire from Hip to Pelvis: An Unreported Complication. Case Rep Orthop 2015; 2015:207078. [PMID: 26146579 PMCID: PMC4469786 DOI: 10.1155/2015/207078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 05/21/2015] [Indexed: 11/18/2022] Open
Abstract
Background. K-wires are thought to be extremely safe implants and complications as a result of direct insertion or migration are very rare. Complications may be life-threatening in some instances where migration results in injury to vital organs. We report one such case where antegrade migration of K-wire from the hip resulted in injury to external iliac artery and formation of external iliac artery-appendicular fistula. No such complication due to migration has ever been reported in the literature. Case Description. A 15-year-old boy presented with lower abdominal pain, right lower limb swelling and pain, inability to walk, and rectal bleeding for 1 month after 2 K-wires had been inserted in his right hip joint for treatment of slipped capital femoral epiphysis the previous year. On investigation, he was diagnosed to have external iliac artery-appendicular fistula for which he was surgically treated. Clinical Relevance. Antegrade migration of K-wire from hip joint may lead to life-threatening injuries which can be minimized by bending the end of the K-wire, keeping the tip protruding outside the skin wherever possible and by early removal of K-wire once its purpose has been achieved.
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14
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Leonardi F, Rivera F. Intravascular migration of a broken cerclage wire into the left heart. Orthopedics 2014; 37:e932-5. [PMID: 25275983 DOI: 10.3928/01477447-20140924-90] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 03/04/2014] [Indexed: 02/03/2023]
Abstract
This article describes a patient in whom a broken cerclage wire migrated from the left hip into the left ventricle. A 71-year-old woman was admitted to the authors' hospital for preoperative examination before femoral hernia repair. Chest radiograph showed a metallic wire in the left ventricle. Twenty-four years earlier, she had a revision arthroplasty. During revision surgery, fragments of the osteotomy were fixed to the femur with multiple cerclage wires. During the past 5 years, radiographic follow-up showed progressive multiple ruptures of cerclage wires. The cerclage wiring was not removed because the patient had no related clinical symptoms. Radiograph of the left hip showed a well-fixed cemented acetabular ring and an uncemented femoral stem with a healed trochanteric osteotomy. All cerclage wires were broken into multiple parts, and it was very difficult to determine which part had migrated into the heart. Thoracic computed tomography scan showed wire that had migrated into the anterior left ventricular myocardial wall at the atrioventricular level. The patient had no clinical symptoms. Electrocardiogram showed a normal sinus rhythm and right bundle branch block. Because of the high risk of surgical left ventriculotomy associated with searching for wire that had migrated into the myocardial wall, patient monitoring was planned. Definitive management of this complication constitutes a dilemma. Although this complication is highly unusual, the possibility of intracardiac migration of broken wire should be considered when deciding on prophylactic surgical removal of hardware after fracture or osteotomy healing.
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15
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Lin HY, Wong PK, Ho WP, Chuang TY, Liao YS, Wong CC. Clavicular hook plate may induce subacromial shoulder impingement and rotator cuff lesion--dynamic sonographic evaluation. J Orthop Surg Res 2014; 9:6. [PMID: 24502688 PMCID: PMC3922330 DOI: 10.1186/1749-799x-9-6] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Accepted: 01/28/2014] [Indexed: 01/28/2023] Open
Abstract
Background Clavicular hook plates are effective fixation devices for distal clavicle fractures and severe acromioclavicular joint dislocations. However, increasing number of studies has revealed that subacromial portion of the hook may induce acromial bony erosion, shoulder impingement, or even rotator cuff damage. By sonographic evaluation, we thus intended to determine whether the presence of hook plate may induce subacromial shoulder impingement and its relationship relative to surrounding subacromial structures. Methods We prospectively followed 40 patients with either distal clavicle fracture or acromioclavicular joint dislocation that had surgery using the Arbeitsgemeinschaft für Osteosynthesefragen (AO) clavicular hook plate. All patients were evaluated by monthly clinical and radiographic examinations. Static and dynamic musculoskeletal sonography examinations were performed at final follow-up before implant removal. Clinical results for pain, shoulder function, and range of motion were evaluated using Constant-Murley and Disability of Arm, Shoulder, and Hand (DASH) scores. Results Clinically, 15 out of 40 patients (37.5%) presented with subacromial impingement syndrome and their functional scores were poorer than the non-impinged patients. Among them, six patients were noted to have rotator cuff lesion. Acromial erosion caused by hook pressure developed in 20 patients (50%). Conclusions We demonstrated by musculoskeletal sonography that clavicular hook plate caused subacromial shoulder impingement and rotator cuff lesion. The data also suggest an association between hardware-induced impingement and poorer functional scores. To our knowledge, the only solution is removal of the implant after bony consolidation/ligamentous healing has taken place. Thus, we advocate the removal of the implant as soon as bony union and/or ligamentous healing is achieved.
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Affiliation(s)
| | | | | | | | | | - Chin-Chean Wong
- Department of Orthopaedic Surgery, Wan Fang Hospital, Taipei Medical University, No, 111, Sec, 3, Xinglong Road, Taipei 11696, Taiwan.
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Zhang W, Song F, Yang Y, Tang J. Asymptomatic intracardiac migration of a Kirschner wire from the right rib. Interact Cardiovasc Thorac Surg 2014; 18:525-6. [PMID: 24384499 DOI: 10.1093/icvts/ivt539] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We report the case of a 50-year old man diagnosed with intracardiac migration of a Kirschner wire (K-wire). The patient had undergone surgical fixation of rib fracture 32 months previously. Chest roentgenograms, chest computed tomographic scans and echocardiography revealed that one of the K-wires had migrated to the right ventricle. The K-wire was removed immediately. To the best of our knowledge, this is the first reported instance of asymptomatic intracardiac migration of a K-wire from the right rib.
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Affiliation(s)
- Weizhi Zhang
- Department of Cardiothoracic Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
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Abstract
Although there are many methods for the treatment of developmental dysplasia of the hip, Salter innominate osteotomy is a surgical technique presently used successfully worldwide. However, several complications can be found after Salter innominate osteotomy. Kirschner (K) wire migration into the pelvic cavity is not a common occurrence and is also rarely reported in the literature. Here, we report the case of a patient who was admitted to the emergency department of our hospital with acute abdominal pain because of K wire migration into the pelvis. We recommend bending the proximal end of the K wires or using threaded K wires to prevent this complication.
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Innocenti M, Carulli C, Civinini R, Matassi F, Tani M, Muncibì F. Displaced fragility fractures of proximal humerus in elderly patients affected by severe comorbidities: percutaneous fixation and conservative treatment. Aging Clin Exp Res 2013; 25:447-52. [PMID: 23760947 DOI: 10.1007/s40520-013-0063-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 02/04/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Proximal humerus is a common site of fracture in elderly patients, mainly related to bone fragility. Comorbidities are often present in these patients and may limit the surgical options. Not or minimal invasive treatments are commonly indicated however with variable results. The authors present their experience with conservative approach and percutaneous fixation by K-wires, focusing on their indications and main advantages on this population: mini-invasivity, acceptable reduction and recovery, and low costs. METHODS A study group of 51 consecutive patients with a mean age of 75.5 and affected by severe comorbidities (mainly cardiac, circulatory, pneumologic, neurologic, metabolic, and nephrologic pathologies) were evaluated clinically (ASA score, VAS, muscular strength, Constant-Murley score), and with radiologic analysis: 28 patients were treated by percutaneous fixation, while 23 subjects were treated conservatively. RESULTS Fractures treated by K-wires fixation healed after a mean interval of 8.2 weeks in all fractures but one, with improvements in mean Constant-Murley score (up to 80.6 points), in mean VAS (2.9), in muscular strength (4.1), and in range of motion. Fractures treated by brace healed in a mean time of 10.2 weeks. Mean Constant-Murley score improved to 76.4 points, VAS to 3.0, muscular strength to 3.8 points, and significant recovery of range of motion. CONCLUSIONS Results of the study confirm that both percutaneous fixation and conservative treatment may represent suitable options for proximal humerus fragility fractures in elderly patients, not candidated to open surgery for severe associated comorbidities. LEVEL OF EVIDENCE IV (case series study).
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Affiliation(s)
- Massimo Innocenti
- Orthopaedic Clinic, University of Florence, Largo P. Palagi 1, 50139 Florence, Italy
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Management of displaced surgical neck fractures of the humerus: health related quality of life, functional and radiographic results. Injury 2012; 43 Suppl 2:S12-9. [PMID: 23622986 DOI: 10.1016/s0020-1383(13)70174-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION There is no controversy about the need for surgical treatment of the displaced surgical neck fractures of the humerus, but there are few studies comparing the results of the three preferred types of surgical treatment. To expand the knowledge needed in decision making, a patient series is reviewed using health related quality of life (HRQoL), functional and radiographic data from patients treated with percutaneous pinning, locking plates or intramedullary nails. MATERIALS AND METHODS Retrospective observational cohort study of patients who underwent internal fixation of fractures of the surgical neck of the humerus between 2004 and 2009 (mean follow-up 40.67 ± 17.93 months). Fifty patients fulfilled the inclusion criteria (mean age 70.04 ± 13.15 years). Nine had been treated by percutaneous pinning, fifteen with locking plates and twenty-six with intramedullary nails. We compared the results between the three groups of the HRQoL with the EuroQol5D questionnaire; the functional capacity of the operated and non-operated shoulder with the Constant score; and the radiographic result with plain X-rays. RESULTS Forty-eight patients had achieved fracture healing. The plating and nailing groups had a better fracture reduction compared with the pinning group (p <0.05). The EuroQol-5D did not discriminate between groups (mean 0.65 ± 0.26; p >0.05). The mean Constant score of the K-wire group (47.67 ± 22.42) was lower than those of the plating (82.45 ± 17.69) and nailing groups (72.72 ± 15.96) (p = 0.001), with no differences between plates and nails. There was positive correlation between the EuroQol-5D result and the Constant score (r = 0.490; p <0.005). The fractured shoulder was worse in each item of the Constant score than the non-operated one in patients treated with pins and nails. Patients treated with plates achieved similar results between operated and non-operated shoulder in three items: arm positioning, internal and external rotation. Seventeen patients (six re-operated) had some kind of complication during follow-up. CONCLUSION Patients treated with pinning achieved a worse radiographic and Constant score than patients treated with plates or nails. Although we did not find differences between the plating and nailing groups, patients treated with plates got a Constant score more similar to the non-operated shoulder.
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Removal of an intra-abdominal Kirschner wire under digital subtraction angiography: a pediatric case report. J Pediatr Orthop B 2012; 21:164-6. [PMID: 21422950 DOI: 10.1097/bpb.0b013e328344c4df] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Intra-abdominal migration of Kirschner wire is unusual in children. We present a case of intra-abdominal migration of Kirschner wire used for stabilization of the hip joint during pelvic osteotomy, and its successful removal under digital subtraction angiography.
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Mian MK, Nahed BV, Walcott BP, Coumans JV. Intraspinal migration of a clavicular Steinmann pin: case report and management strategy. J Clin Neurosci 2012; 19:310-3. [DOI: 10.1016/j.jocn.2011.05.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Accepted: 05/17/2011] [Indexed: 10/15/2022]
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Ballas R, Bonnel F. Endopelvic migration of a sternoclavicular K-wire. Case report and review of literature. Orthop Traumatol Surg Res 2012; 98:118-21. [PMID: 22209044 DOI: 10.1016/j.otsr.2011.09.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Revised: 08/21/2011] [Accepted: 09/08/2011] [Indexed: 02/02/2023]
Abstract
We report a unique case, never before published, of sternoclavicular joint fixation K-wire migration to the pelvic region, in a 56 year-old man. Two years previously, sternoclavicular dislocation had been fixed by three wires. A transitory episode of precordial thoracic pain followed by iterative abdominal pain accompanied the migration. Extraction was performed five years later. Scapular K-wire migration is frequent. The proximity of cardiovascular structures may have fatal consequences. This type of internal fixation raises questions, and migration prevention needs to be taken into account. Medical complications and the legal context are major factors leading us to abandon this type of osteosynthesis. Once migration has been diagnosed, the wire should be removed without delay.
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Affiliation(s)
- R Ballas
- Beau-Soleil Private Hospital, Orthopedics Department, Montpellier, France.
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Muncibì F, Paez DC, Matassi F, Carulli C, Nistri L, Innocenti M. Long term results of percutaneous fixation of proximal humerus fractures. Indian J Orthop 2012; 46:664-7. [PMID: 23325969 PMCID: PMC3543884 DOI: 10.4103/0019-5413.104203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Proximal humerus fracture in elderly osteoporotic patients usually leads to severe displaced and multifragmentary fractures. Associated comorbidities may limit surgical options and conservative treatment is commonly indicated, however, with variable results. In most cases, surgery is the treatment of choice in order to restore anatomical integrity, and allow early functional recovery. Several techniques were used over the years, each with specific indication. Percutaneous pinning after closed reduction, a mini-invasive technique and fixation by use of K-wires is not preferred commonly. We present our experience with this approach, focusing on its indications and advantages. PATIENTS AND METHODS A study group of 41 consecutive patients with a mean age of 65.5 years were evaluated clinically (VAS, Constant-Murley score, range of motion), and with radiological analysis: 35 patients finally completed a minimum followup of 24 months. RESULTS K-wires were removed after a mean interval of 4 weeks. Clinical and radiographic healing occurred in a mean time of 8.2 weeks in all fractures but one, with improvements in mean Constant-Murley score of 87.6 points, mean VAS of 2.3. In 33 patients, the reduction was considered satisfactory. In two cases, reduction was poor, but the patients however presented acceptable functional outcome. CONCLUSIONS Percutaneous pinning may represent a suitable option of treatment for 2-or 3-part proximal humerus fractures in selected subjects.
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Affiliation(s)
- Francesco Muncibì
- Orthopaedic Clinic, University of Florence (Chief: Prof. M. Innocenti), Largo P. Palagi, 1 – 50139 Florence, Italy
| | - Diana Chicon Paez
- Orthopaedic Clinic, University of Florence (Chief: Prof. M. Innocenti), Largo P. Palagi, 1 – 50139 Florence, Italy
| | - Fabrizio Matassi
- Orthopaedic Clinic, University of Florence (Chief: Prof. M. Innocenti), Largo P. Palagi, 1 – 50139 Florence, Italy
| | - Christian Carulli
- Orthopaedic Clinic, University of Florence (Chief: Prof. M. Innocenti), Largo P. Palagi, 1 – 50139 Florence, Italy,Address for correspondence: Dr. Christian Carulli, Orthopaedic Clinic, University of Florence, Largo P. Palagi, 1 – 50139, Florence, Italy E-mail:
| | - Lorenzo Nistri
- Orthopaedic Clinic, University of Florence (Chief: Prof. M. Innocenti), Largo P. Palagi, 1 – 50139 Florence, Italy
| | - Massimo Innocenti
- Orthopaedic Clinic, University of Florence (Chief: Prof. M. Innocenti), Largo P. Palagi, 1 – 50139 Florence, Italy
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Park SY, Kang JW, Yang DH, Lim TH. Intracardiac migration of a Kirschner wire: case report and literature review. Int J Cardiovasc Imaging 2011; 27 Suppl 1:85-8. [PMID: 22101576 DOI: 10.1007/s10554-011-9977-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 11/02/2011] [Indexed: 11/28/2022]
Affiliation(s)
- Sun-Young Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-gil, Songpa-gu, Seoul 138-736, Korea
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Connelly CL, Archdeacon MT. Pulsatile lavage irrigator tip, a rare radiolucent retained foreign body in the pelvis: a case report. Patient Saf Surg 2011; 5:14. [PMID: 21619681 PMCID: PMC3117682 DOI: 10.1186/1754-9493-5-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Accepted: 05/28/2011] [Indexed: 11/10/2022] Open
Abstract
Retained foreign bodies after surgery have the potential to cause serious medical complications for patients and bring fourth serious medico-legal consequences for surgeons and hospitals. Standard operating room protocols have been adopted to reduce the occurrence of the most common retained foreign bodies. Despite these precautions, radiolucent objects and uncounted components/pieces of instruments are at risk to be retained in the surgical wound. We report the unusual case of a retained plastic pulsatile lavage irrigator tip in the surgical wound during acetabulum fracture fixation, which was subsequently identified on routine postoperative computed tomography. Revision surgery was required in order to remove the retained object, and the patient had no further complications.
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Affiliation(s)
- Camille L Connelly
- Department of Orthopaedic Surgery, University of Cincinnati, P.O. Box 670212, Cincinnati, OH, 45267-0212, USA
| | - Michael T Archdeacon
- Department of Orthopaedic Surgery, University of Cincinnati, P.O. Box 670212, Cincinnati, OH, 45267-0212, USA
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Firth GB, Roy A, Moroz PJ. Foreign body migration along a tendon sheath in the lower extremity: a case report and literature review. J Bone Joint Surg Am 2011; 93:e38. [PMID: 21508273 DOI: 10.2106/jbjs.j.00902] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Gregory B Firth
- Department of Orthopaedic Surgery, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada
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Sharma R, Tam RK. Migrating foreign body in mediastinum--intravascular Steinman pin. Interact Cardiovasc Thorac Surg 2011; 12:883-4. [PMID: 21297134 DOI: 10.1510/icvts.2010.256503] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report a case of migration of a Steinman pin to the innominate vein. A pin was used to fix a shoulder separation but a broken piece was left unattended at the time of removal of the pin. How this piece made its way in to innominate vein is puzzling. To our knowledge migration of fixation wires to the innominate vein has not been reported previously.
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Affiliation(s)
- Rajiv Sharma
- Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, QLD 4102, Australia.
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Mieno S, Ozawa H, Katsumata T. Ascending aortic injury caused by a fractured sternal wire 28 years after surgical intervention of pectus excavatum. J Thorac Cardiovasc Surg 2010; 140:e18-20. [DOI: 10.1016/j.jtcvs.2009.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Accepted: 07/05/2009] [Indexed: 11/27/2022]
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Veres L, Kiss R, Boros M, Enyedi A, Takács I, Kollár S, Damjanovich L, Sz Kiss S. [Intrathoracic migration of Kirschner wires]. Magy Seb 2009; 62:353-356. [PMID: 19945939 DOI: 10.1556/maseb.62.2009.6.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Orthopedic surgeons apply metallic pins to stabilize the clavicule and humerus on a daily basis. Migration of these pins into the thoracic cavity is rare. We present the case of an elderly female patient, whose right humeroscapular joint was fixed with Kirschner wires due to recurrent luxation. Six weeks later, a follow-up X-ray revealed that the pins have migrated into the right thoracic cavity, confirmed by a CT chest. Videothoracoscopic removal of the metallic pins was not possible because of dense adhesions. Right anterolateral thoracotomy was carried out, and after pneumolysis one pin was taken out from the 2nd lung segment. The other one, which was running along the cupola and entering the spinal cord, was also removed. There was no postoperative surgical complication. The authors review the literature of this rare complication and point out that pins migrating into the thoracic cavity should be removed to avoid life threatening complications.
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Affiliation(s)
- Lukács Veres
- Debreceni Egyetem, Orvos- és Egészségtudományi Centrum Sebészeti Intézet, Mellkassebészeti Központ, Debrecen.
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Migration intrarachidienne d’une broche de Kirschner après une cure de pseudarthrose de la clavicule. Cas clinique et revue de la littérature. ACTA ACUST UNITED AC 2009; 28:367-9. [DOI: 10.1016/j.main.2009.08.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2009] [Revised: 08/15/2009] [Accepted: 08/29/2009] [Indexed: 11/19/2022]
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Blonna D, Rossi R, Fantino G, Maiello A, Assom M, Castoldi F. The impacted varus (A2.2) proximal humeral fracture in elderly patients: is minimal fixation justified? A case control study. J Shoulder Elbow Surg 2009; 18:545-52. [PMID: 19482488 DOI: 10.1016/j.jse.2009.02.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Revised: 12/14/2008] [Accepted: 02/08/2009] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this retrospective case control study was to assess the outcome of K-wire osteosynthesis of a varus displaced proximal humeral fracture in patients over 65 years old, compared to a control group treated nonoperatively. METHODS The patient cohort was taken from our database in the period 2003-2007. After data extraction, the patients were re-examined and scored by the Constant score (CS), modified Constant score (MCS), and the QuickDASH score. The control group was carefully selected and matched to the surgical one for age, type of fracture, and degree of displacement. Minimum follow-up was 12 months, with a mean of 30 months in the surgery group, and 27 months in the nonoperative group. RESULTS K-wire osteosynthesis in our series yielded consistently good results in older patients who sustained an A2.2 proximal humeral fracture, with an average MCS of 88 points and a QuickDASH score of 15. The surgery group had a statistically significant higher CS and modified Constant score at follow-up than did the conservatively treated group (p = .03). CONCLUSION Operative treatment of varus displaced proximal humerus fractures treated with K-wire osteosynthesis yields good results that are superior to those treated nonoperatively. LEVEL OF EVIDENCE Level 3; Case control study, treatment study.
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Affiliation(s)
- Davide Blonna
- University of Turin Medical School, Mauriziano Umberto I Hospital, Turin, Italy.
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A fortune unfortunate. South Med J 2009; 102:443. [PMID: 19279519 DOI: 10.1097/smj.0b013e31819bcf3a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pichler W, Mazzurana P, Clement H, Grechenig S, Mauschitz R, Grechenig W. Frequency of instrument breakage during orthopaedic procedures and its effects on patients. J Bone Joint Surg Am 2008; 90:2652-4. [PMID: 19047710 DOI: 10.2106/jbjs.h.00163] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND While breakage of an orthopaedic instrument is a relatively rare occurrence, orthopaedic surgeons need to be familiar with this complication and how to deal with it. Relatively little information about this subject has been published. METHODS Every case of instrument breakage during orthopaedic procedures performed in two hospitals during a two-year period was documented prospectively. All patients were followed for a postoperative period ranging from twelve to thirty-six months, during which radiographs in two planes were made to assess changes in, or migration of, the broken object. RESULTS During the observation period, 11,856 surgical procedures were performed in the two hospitals. The overall rate of instrument breakage was 0.35%. The broken piece was removed in five cases, and the broken instrument was left in situ in thirty-seven cases. During the follow-up period, none of the patients had any symptoms. CONCLUSIONS In most cases, breakage of an orthopaedic instrument is not a problem. Any instance of instrument breakage should be fully documented in the surgical report.
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Affiliation(s)
- Wolfgang Pichler
- Department of Traumatology, Medical University of Graz, Auenbruggerplatz 7a, A-8036 Graz, Austria.
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Marchi E, Reis MP, Carvalho MV. Transmediastinal migration of Kirschner wire. Interact Cardiovasc Thorac Surg 2008; 7:869-70. [DOI: 10.1510/icvts.2008.185850] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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