K-wire migration to unexpected site

Distant migration of a broken guide pin following femoral neck fixation: a case report

INTRODUCTION

Kirschner wires are frequently employed in orthopedic procedures. While most complications are minor, rare instances of distant pin migration can occur. Such migration is more prevalent in the shoulder region but has been reported elsewhere.

CASE PRESENTATION

A 50-year-old Persian male with a right femoral neck fracture (Garden type IV) underwent closed reduction and internal fixation with three cannulated screws. During the procedure, a guide pin broke and remained lodged. Follow-up radiographs revealed the migrated pin in the patient's chest wall near the 11th rib, necessitating surgical removal via thoracotomy.

CONCLUSION

This case underscores the potential for orthopedic implant migration. While often associated with smaller pins, the risk exists for all sizes. The timeframe for diagnosis varies significantly and in some cases it can be asymptomatic and discovered incidentally.

Use of Kirschner wire for immediate interim reconstruction of continuity defect of mandible in resource poor setting: Our experience

Background

Reconstruction of continuity defect of mandible is challenging, and there has been a lot of advancement in this field with variety of options for restoration. However, choice often becomes restricted in resource limited settings due to lack of trained manpower, time, infrastructure, supply of graft materials, etc. In this context, we aim to test the reliability of Kirschner wire (K-wire) with adaptation of looped-end for immediate interim reconstruction of continuity defect of mandible.

Methods

Retrospectively, medical records of 10 years data were reviewed to include 22 patients who underwent immediate interim reconstruction of mandible with K-wire with looped-end adaptation for continuity defect of mandible. Data regarding patient demographic, type and length of mandibular defect, diameter of the wire and complications were recorded.

Result

Among 22 patients within a follow-up period of 1-60 months (median 7.5), complications developed in 7 (31.8%) patients. Three patients (13.6%) had major complications which required interventions, and 5 patients (22.3%) with minor complications were managed conservatively. Total wire removal in our study is only 9%, which is lowest among the reported literature, migration or extrusion through bone was nil, and overall aesthetic and functional result was good in majority except few where either wire had to be removed or got deformed.

Conclusion

Kirschner wire (K-wire) should be considered in resource limited setting as an immediate interim reconstructive method of mandible for being cheap and widely available. Our technique of looped-end adaptation results in better stabilisation leading to less removal rate, migration or extrusion.

Toward Innovation and Policies: Mapping the Demand of Orthopedic Implants in Public Hospital Margono Purwokerto, Central Java, Indonesia

Most of the needs for orthopedic implants in Indonesia are met by the imported product. So that innovation is needed to produce local products that suit the needs of the Indonesian people. The first step before innovating is the need analysis. It is necessary to map and forecast certain implant products to understand which products that are important to be developed before they become a national innovation. In addition, there has not been an article yet that reported data regarding implant product and their forecasting. The main objective of this research is to capture the actual demand product by mapping and forecasting the orthopedic implants in a public hospital. The mapping process was carried out using the descriptive analysis method to organize and summarize the data to get more information about the orthopedic implants that were widely used. In addition, the mapping process is also carried out using the double moving average method to see the trend of demand for orthopedic implants in the future. The data used in this research was the number of orthopedic implants used by the Margono hospital for five years starting from 2016 to 2020. Based on the collected data, forty-two varieties of orthopedic implants had been mapped regarding implant demand. Furthermore, twenty-two of forty-two implants had been analyzed based on several applications that always appeared within five years. This research type of implant is classified into five categories which are screw, plate, wire, rod, and prosthesis. It is found that cortical screw, straight plate, K wire, rod union, and bipolar cemented were noted as the highest demand implant represent their category. The demand forecasting process is carried out for cortical screw, K wire, and rod union. By using the double moving average method and MAPE for measuring the accuracy, it was found that the method has a significant result because the MAPE value is still quite good. The value of MAPE for cortical screw, K wire, and rod union are 0.3985, 1.0726, and 0.4332, respectively. The trend of increasing demand occurs in the product cortical screw and rod union. This data could perform as the recommendation and references leading to the research road map, especially in the orthopedic research field in Indonesia.

Intracardic migration of Kirschner wire from the right sternoclavicular joint: a case report

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.

Migration of K-wire into the cavum pleura after the reduction of acromioclavicular dislocation, a case report and review of literature

INTRODUCTION

The use of K-wire (Kirschner wire) in acromioclavicular dislocation was the first trans-articular fixation technique to be described.

PRESENTATION OF CASE

A 40-years-old man was presented to the emergency room (ER) with shortness of breath. He had a history of acromioclavicular dislocation two years ago, which had been treated using two K-wires and tension band wiring. The plain x-ray revealed left side pneumothorax with K-wire migrated into the left hemithorax. CT scan showed that K-wire migrated into the posterior cavum pleura. A chest tube was then inserted, and the removal of K-wire was performed using thoracoscopic assisted surgery followed by the removal of the remaining K-wire in the left shoulder. Three days post-surgery, the chest tube was removed, and the patient was discharged from the hospital.

DISCUSSION

This technique is easy and cheap, but it can cause lethal complications. K-wire can migrate into the area of vital organs, including the liver, heart, neck lung subclavian artery, and aorta.

CONCLUSION

K-Wire should be used cautiously for treating upper extremity injury, especially acromioclavicular dislocation, due to its lethal complications. This method is outdated and should be restricted as much as possible.