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Migration of K-wire into the cavum pleura after the reduction of acromioclavicular dislocation, a case report and review of literature. Int J Surg Case Rep 2020; 74:192-195. [PMID: 32890895 PMCID: PMC7481493 DOI: 10.1016/j.ijscr.2020.08.004] [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: 06/21/2020] [Revised: 08/07/2020] [Accepted: 08/07/2020] [Indexed: 11/23/2022] Open
Abstract
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 This method is outdated and should be restricted as much as possible.
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Intraoperative Kirschner Wire Migration during Robotic Minimally Invasive Spine Surgery. Case Rep Anesthesiol 2019; 2019:9581285. [PMID: 31871795 PMCID: PMC6906877 DOI: 10.1155/2019/9581285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 09/17/2019] [Accepted: 10/08/2019] [Indexed: 11/28/2022] Open
Abstract
We present the case of a 58-year-old woman who underwent a minimally invasive robotic-assisted L4-S1 instrumentation and fusion which was complicated by a Kirschner wire (K-wire) fracture and migration into the abdominal cavity necessitating emergent exploratory laparotomy. Retrieval of the K-wire proceeded without incident, and the patient had an otherwise uneventful surgery and recovery. This is the first such case description reported in the literature. As minimally invasive robotic-assisted spine procedures become more common, it is essential for the anesthesiologist to be familiar with potential complications to manage such patients in the perioperative period optimally.
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N'da HA, Drogba KL, Konan LM, Haidara A, Varlet G. Spinal kirschner wire migration after surgical treatment of clavicular fracture or acromioclavicular joint dislocation: Report of a case and meta-analysis. INTERDISCIPLINARY NEUROSURGERY 2018. [DOI: 10.1016/j.inat.2017.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Reghine ÉL, Cirino CCI, Neto AA, Varallo FR, Évora PRB, de Nadai TR. Clavicle Kirschner Wire Migration into Left Lung: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:325-328. [PMID: 29559613 PMCID: PMC5881454 DOI: 10.12659/ajcr.908014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patient: Female, 65 Final Diagnosis: Clavicle Kirschner wire migration into left lung Symptoms: No symptoms Medication: — Clinical Procedure: Thoracotomy Specialty: Surgery
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Affiliation(s)
| | | | | | | | - Paulo Roberto Barbosa Évora
- Department of Surgery and Anatomy, Ribeirão Preto School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Tales Rubens de Nadai
- Américo Brasiliense State Hospital, São Paulo, SP, Brazil.,Department of Surgery and Anatomy, Ribeirão Preto School of Medicine, University of São Paulo, São Paulo, SP, Brazil
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Furuhata R, Nishida M, Morishita M, Yanagimoto S, Tezuka M, Okada E. Migration of a Kirschner wire into the spinal cord: A case report and literature review. J Spinal Cord Med 2018; 43:272-275. [PMID: 29334327 PMCID: PMC7054924 DOI: 10.1080/10790268.2017.1419915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
CONTEXT A Kirschner wire (K-wire) is a stainless steel pin with at least one sharpened tip that is mainly used for the internal fixation of bone fractures. While some cases of K-wire dislocation and migration have been reported as complications after fracture surgery, the intraspinal migration of a K-wire is rare. Herein, we report a case in which a K-wire used for sternal fixation 7 years earlier migrated into the spinal canal. FINDINGS A 68-year-old male suddenly sustained severe radiating pain and numbness in his left upper extremity, and walked to our hospital. He had mild weakness in the left wrist extensor muscles and the left extensor digitorum. CT-myelography revealed a K-wire penetrating into the spinal cord at C5-6. There was no injury of the trachea, esophagus, or blood vessels. The patient had a history of surgical infection after cardiovascular surgery seven years before, and had undergone surgical debridement and sternum fixation with two K-wires. One K-wire had broken, and part of it migrated upward. Using an anterior approach, we detected the tip of K-wire below the left sternocleidomastoid muscle. We cut the K-wire into 1 to 2-cm pieces and removed it piece by piece. His postoperative course was uneventful and the symptoms improved markedly after the surgery. CONCLUSION This is the first report of a K-wire that had been used for sternal fixation migrating into the spinal cord. This case illustrates that although rare, it is possible for a K-wire to migrate upward after sternal fixation.
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Affiliation(s)
- Ryogo Furuhata
- Department of Orthopaedic Surgery, Saiseikai Central Hospital, Tokyo, Japan
| | - Mitsuhiro Nishida
- Department of Orthopaedic Surgery, Saiseikai Central Hospital, Tokyo, Japan
| | - Midori Morishita
- Department of Orthopaedic Surgery, Saiseikai Central Hospital, Tokyo, Japan
| | - Shigeru Yanagimoto
- Department of Orthopaedic Surgery, Saiseikai Central Hospital, Tokyo, Japan
| | - Masaki Tezuka
- Department of Orthopaedic Surgery, Saiseikai Central Hospital, Tokyo, Japan
| | - Eijiro Okada
- Department of Orthopaedic Surgery, Saiseikai Central Hospital, Tokyo, Japan,Correspondence to: Eijiro Okada, Department of Orthopaedic Surgery, Saiseikai Central Hospital, 1-4-17, Mita, Minato-ku, Tokyo, 108-0073, Japan.
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Transclavicular Osseous Sutures for the Treatment of Displaced Distal Clavicular Fractures in Children. J Orthop Trauma 2016; 30:e181-5. [PMID: 27101169 DOI: 10.1097/bot.0000000000000527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We describe a novel surgical technique for the treatment of displaced distal clavicular fractures in children. These fractures are rare, and recommendations on treatment vary. Conservative treatment might lead to persistent deformity and limitations of function. Previous reports of surgical treatment involve fracture fixation with K-wires. This requires a routine sequential reoperation to remove the implant and has been associated with serious complications in some patients. The surgical technique described here is based on osseous sutures through the clavicular shaft and coracoclavicular ligaments and is found successful for the treatment of distal clavicular fractures in children and may also be feasible for true acromioclavicular dislocations. The main principle of the technique is a fixation of the displaced clavicle through transclavicular drill holes, against the intact inferior periosteal sleeve at the insertion of the coracoclavicular ligaments. No temporary K-wire fixation is needed. To date, we have treated 7 patients with this technique. All fractures healed uneventfully with an excellent functional result and without skeletal deformity.
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Minić L, Lepić M, Novaković N, Mandić-Rajčević S. Symptomatic migration of a Kirschner wire into the spinal canal without spinal cord injury: case report. J Neurosurg Spine 2016; 24:291-294. [DOI: 10.3171/2015.5.spine1596] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The migration of Kirschner wires (K-wires) is a rare but significant complication of osteosynthesis interventions, and numerous cases of wire migrations have been reported in the literature. Nevertheless, migration into the spinal canal is very rare, with only 10 cases reported thus far. The authors present a case of K-wire migration into the spinal canal, together with a review of the relevant literature.
A 30-year-old male who had suffered a right clavicle fracture in a motorcycle accident was treated with 2 K-wires. Four months after the initial fixation, while he was lifting his child, he experienced short-term pain in his back, numbness in all 4 extremities, followed by a spontaneous decrease in numbness affecting only the ulnar nerve dermatomes bilaterally, and a persistent headache. No urinary incontinence was present.
Simple radiography studies of the cervical spine revealed a wire in the spinal canal, penetrating the T-2 foramen and reaching the contralateral foramen of the same vertebra. Computerized tomography showed the wire positioned in front of the spinal cord. Surgery for wire extraction was performed with the patient under general anesthesia, and he experienced relief of the symptoms immediately after surgery.
This case is unique because the wire caused no damage to the spinal cord but did cause compression-related symptomatology and headache, which have not been reported in osteosynthesis wire migration to the thoracic region.
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Affiliation(s)
- Ljubodrag Minić
- 1Department of Neurosurgery, Military Medical Academy, Belgrade, Serbia; and
| | - Milan Lepić
- 1Department of Neurosurgery, Military Medical Academy, Belgrade, Serbia; and
| | - Nenad Novaković
- 1Department of Neurosurgery, Military Medical Academy, Belgrade, Serbia; and
| | - Stefan Mandić-Rajčević
- 2Department of Health Sciences of the University of Milan, International Centre for Rural Health of the University Hospital San Paolo, and Laboratory for Analytical Toxicology and Metabolomics, Milano, Italy
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Harrasser N, Banke IJ, Kirchhoff C, Biberthaler P, Huber-Wagner S. [Bent titanium elastic nail in clavicular non-union. Case report and review of the literature]. Unfallchirurg 2014; 118:638-42. [PMID: 25342501 DOI: 10.1007/s00113-014-2644-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Fractures of the clavicle can often be treated conservatively. For severely dislocated but simple fractures in which conservative treatment often fails, intramedullary nailing with titanium elastic nails (TEN) shows similar results to stable plate osteosynthesis. We present the case of a 28-year-old female patient who had been treated with TEN osteosynthesis 4 years previously but clavicular non-union developed. Due to a new traumatic incident, the implanted intramedullary titanium nail was bent and migrated into the manubrium sterni. We were able to remove the wire and stable plate osteosynthesis was carried out. Bending and migration of titanium wires used in clavicular fractures are relatively rare complications and patients must be informed accordingly. These complications can be avoided by removal of the wire 3-12 months after implantation when the fracture has healed.
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Affiliation(s)
- N Harrasser
- Klinik und Poliklinik für Unfallchirurgie, Überregionales Traumazentrum, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
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Gianaris TJ, Helbig GM, Horn EM. Percutaneous pedicle screw placement with computer-navigated mapping in place of Kirschner wires: clinical article. J Neurosurg Spine 2013; 19:608-13. [PMID: 24010897 DOI: 10.3171/2013.7.spine121157] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Percutaneous pedicle screw insertion techniques are commonly used to treat a variety of spinal disorders. Typically, Kirschner (K)-wires are used to guide the insertion of taps and screws during placement since the normal anatomical landmarks are not visualized. The use of K-wires adds risks, such as vascular and nerve injuries as well as increased radiation exposure given the use of fluoroscopy. The authors describe a series of patients who had percutaneous pedicle screws placed using a new computer-assisted navigation technique without the need for K-wires. METHODS Minimally invasive percutaneous pedicle screw placement in the thoracic and lumbar spine was performed in a consecutive series of 15 patients for a variety of spinal pathologies. Intraoperative 3D CT images were obtained and used with a computer-assisted navigation system to insert an awl-tap into each pedicle. The tap location in the pedicle was marked with the navigation software, and the awl-tap was then removed. The navigation system was used to identify each landmark to insert the pedicle screw. Connecting rods were then inserted percutaneously under fluoroscopic guidance. Postoperative CT scans were obtained in each patient to evaluate screw placement. RESULTS On postprocedure scanning, only 1 screw had a minor lateral and superior breach that was asymptomatic. To date, there have been no hardware failures. CONCLUSIONS Percutaneous pedicle screws can be placed effectively and safely without the use of K-wires.
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Affiliation(s)
- Thomas J Gianaris
- Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana
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Barlow T, Beazley J, Barlow D. A systematic review of plate versus intramedullary fixation in the treatment of midshaft clavicle fractures. Scott Med J 2013; 58:163-7. [DOI: 10.1177/0036933013496960] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The best method of fixation for clavicle fractures is not known. The purpose of this review was to examine the evidence comparing plate and intramedullary fixation for midshaft clavicle fractures. A search of MEDLINE in September 2011 identified five papers that compared plate and intramedullary fixation, and fulfilled our eligibility criteria, consisting of; one randomised controlled trial, two quasi-randomised controlled trials, and two retrospective studies. Level of evidence was assessed using the Scottish Intercollegiate Guidelines Network guidance and the Cochrane Bone, Joint and Muscle Trauma Group’s quality assessment tool. No attempt at meta-analysis was made due to the heterogeneity of the study populations and interventions. We found no difference between intramedullary fixation and plate fixation. There was a trend towards a lower complication rate with intramedullary fixation. On the basis of the available evidence, we would advocate both techniques for the treatment of midshaft clavicle fractures.
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Affiliation(s)
- T Barlow
- Academic Clinical Fellow, University Hospitals of Coventry and Warwickshire NHS Trust, UK
| | - J Beazley
- Speciality Trainee, University Hospitals of Coventry and Warwickshire NHS Trust, UK
| | - D Barlow
- Speciality Trainee, University Hospital of North Staffordshire NHS Trust, UK
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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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Outcome of distal clavicular fracture separations and dislocations in immature skeleton. Injury 2011; 42:376-80. [PMID: 21055749 DOI: 10.1016/j.injury.2010.09.036] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2010] [Revised: 09/18/2010] [Accepted: 09/27/2010] [Indexed: 02/02/2023]
Abstract
BACKGROUND There are only a few studies with long-term follow-up of distal clavicular injuries in children and their treatment is not clearly defined. The purpose of our study is to suggest a new classification system according to the fracture pattern and the degree of the displacement, to evaluate the long-term follow-up and also to propose an algorithm for treatment. METHODS We conducted a retrospective study from 1983 to 2008. Seventy-five children and adolescents, age ranging from 3 to 16 years (46 >8 years), were treated in our department. We classified all these injuries into five groups according to the fracture pattern and into subgroups according to the displacement of the bony particles: greenstick fractures as group I, transverse fractures as group II, oblique fractures as group III (IIa and IIIa: undisplaced, IIb and IIIb: displaced), comminuted fractures as group IV and true dislocation of the acromioclavicular joint as group V. Sixty-three patients were treated conservatively, while 12 sustained surgical treatment. RESULTS Fifty-nine patients were re-examined after 2-18 years. All the patients included in groups I, IIa and IIIa had no loss in the motion of their shoulder. Seven of the 29 patients in groups IIb, IIIb, IV and V appeared to have minor loss of motion. A constant score was noted in 52 patients and the results were excellent. None of the patients complained of limitations in daily activities, while five patients, who were treated conservatively, complained of visible prominence at the fracture site. One of them had a clavicular duplication, while another patient treated surgically complicated with coracoclavicular synostosis. CONCLUSION The aforementioned proposed classification of these injuries is based on the fracture pattern and is simple, leading to decision making concerning therapy of these injuries. The functional results after a distal clavicle fracture will be excellent, either after conservative or surgical treatment. Older patients (>8 years) from groups IIb, IIIb, IV and V, with greater displacement, could be treated surgically to have better cosmetic results.
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