Migration of a Kirschner pin from the shoulder to the lung, requiring surgery

Foreign Glass Bodies in Pleura and Pancreas: Systematic Review for Entry Hypotheses and Treatment Options in an Unresolved Case

BACKGROUND

Foreign bodies within the pleura and pancreas are infrequent, and the approaches to their treatment still a subject of debate. There is limited knowledge particularly regarding glass foreign bodies.

METHODS

We present a case involving large glass splinters in the pleura and pancreas, with an unknown entry point. In addition, a systematic review was conducted to explore entry hypotheses and management options.

RESULTS

In addition to our case, our review uncovered eight incidents of intrapleural glass, and another eight cases of glass in other intrathoracic areas. The fragments entered the body through impalement (81%), migrated through the diaphragm after impalement (6%), or caused transesophageal perforation (19%) following ingestion. Eight instances of glass inside the abdominal cavity were documented, with seven resulting from impalement injuries and one from transintestinal migration. There were no recorded instances of glass being discovered within the pancreas. Among the 41 nonglass intrapancreatic foreign bodies found, sewing needles (34%) and fish bones (46%) were the most common; following ingestion, they had migrated through either a transgastric or transduodenal perforation. In all these cases, how the foreign bodies were introduced was often poorly recalled by the patient. Many nonglass foreign bodies tend to become encapsulated by fibrous tissue, rendering them inert, though this is less common with glass. Glass has been reported to migrate through various tissues and cavities, sometimes with a significant delay spanning even decades. There are cases of intrapleural migration of glass causing hemothorax, pneumothorax, and heart and major blood vessels injury. For intrapleural glass fragment management, thoracoscopy proved to be effective in 5 reported cases, in addition to our patient. Most intrapancreatic nonglass foreign bodies tend to trigger pancreatitis and abscess formation, necessitating management ranging from laparoscopic procedures to subtotal pancreatectomy. There have been only four documented cases of intrapancreatic needles that remained asymptomatic with conservative management. There is no direct guidance from the existing literature regarding management of intrapancreatic glass foreign bodies. Consequently, our patient is under observation with regular follow-ups and has remained asymptomatic for the past 2 years.

CONCLUSIONS

Glass foreign bodies in the pleura are rare, and our report of an intrapancreatic glass fragment is the first of its kind. Impalement is the most likely method of introduction. As glass has significant migration and an ensuing complication potential, preventive removal of intrapleural loose glass should be considered. However, intrapancreatic glass fragment management remains uncertain.

Clavicle Kirschner Wire Migration into Left Lung: A Case Report

Patient: Female, 65

Final Diagnosis: Clavicle Kirschner wire migration into left lung

Symptoms: No symptoms

Medication: —

Clinical Procedure: Thoracotomy

Specialty: Surgery

Asymptomatic Migration of a Kirschner Wire from the Proximal Aspect of the Humerus to the Thoracic Cavity: A Case Report

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.

Intra-abdominal migration of a k-wire during revision total hip arthroplasty

Revision total hip arthroplasty in the setting of severe acetabular bone loss is a challenging problem that is becoming more common. Kirschner wires are often used during acetabular revision for temporary fixation of trial components. We describe an intraoperative migration of a Kirschner wire through the acetabulum into the peritoneal cavity, requiring acute laparoscopic removal.

Early asymptomatic intrathoracic migration of a threaded pin after proximal humeral osteosynthesis

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.

Migration of trochanteric cerclage cable debris to the knee joint

Migrating orthopedic hardware has widely been reported in the literature. Most reported cases of migrating hardware involve smooth Kirschner wires or loosening/fracture of hardware involved with joint stabilization/fixation. It is unusual for hardware to migrate within the soft tissues. In some cases, smooth Kirschner wires have migrated within the thoracic cage—a proposed mechanism for this phenomenon is the negative intrathoracic pressure. While wires have also been reported to gain access to circulation, transporting them over larger distances, the majority of broken or retained wires remain local. We report a case of a 34-year-old man in whom numerous fragments of braided cable migrated from the hip to the knee.