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Xin H, Wang X, Zhang S, Lin L, Chen H, Hong H. Novel sternoclavicular hook plate for the treatment of posterior sternoclavicular dislocation: a retrospective study. J Orthop Surg Res 2023; 18:945. [PMID: 38071288 PMCID: PMC10709940 DOI: 10.1186/s13018-023-04436-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/01/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Controversies regarding the optimal internal fixation method for posterior sternoclavicular dislocation (SCD) exist. Therefore, this study aimed to investigate the clinical efficacy of a new type of sternoclavicular hook plate for treating posterior SCD. METHODS Eleven patients (eight men and three women) with posterior SCD who underwent treatment with the new sternoclavicular hook plate from June 2011 to January 2022 were retrospectively analyzed. The patients' ages ranged from 33 to 71 years (54.91 ± 13.58 years). Operation time, blood loss, length of hospital stay, and postoperative complications were recorded. Postoperative joint reduction and healing were evaluated using radiography and computed tomography. The Constant-Murley and Rockwood sternoclavicular joint scores were used to evaluate the functional recovery of the affected limb 12 months after surgery. RESULTS All 11 patients were followed up for 12-24 months (18.00 ± 3.74 months). All incisions healed by first intention. The healing time ranged from 9 to 13 days (10.82 ± 1.54 days), and the joint healing time was 3-4 months (3.55 ± 0.52 months). The operation time was 45-75 min (59.55 ± 11.06 min), intraoperative blood loss was 22-58 mL (39.91 ± 11.07 mL), and the length of hospitalization was 6-14 days (9.91 ± 3.27 days). There were no complications such as infections, internal fixation failure, or nerve injury. The Constant-Murley score was 93.64 ± 9.01 at 12 months postoperatively. The Rockwood score was 13.36 ± 1.86, of which nine cases were excellent, one case was good, and one case was fair. CONCLUSION The novel sternoclavicular hook plate is effective for the treatment of posterior SCD. This novel device can facilitate early joint functional exercises and good functional recovery.
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Affiliation(s)
- Hanlong Xin
- Department of Orthopaedic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Xingui Wang
- Department of Orthopaedic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Shaohua Zhang
- Intensive Care Unit (ICU), Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Lie Lin
- Department of Orthopaedic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Haixiao Chen
- Department of Orthopaedic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Huaxing Hong
- Department of Orthopaedic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China.
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2
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Özbey M, Türkmen U, Şahin E. Thirteen years of migration of Kirschner wires: A mediastinal foreign body. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2023; 31:412-415. [PMID: 37664779 PMCID: PMC10472458 DOI: 10.5606/tgkdc.dergisi.2023.21980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/09/2021] [Indexed: 09/05/2023]
Abstract
Kirschner wires used for orthopedic fixation can rarely migrate over time. A 26-year-old male patient in whom two Kirschner wires were inserted 13 years ago for the stabilization of the right sternoclavicular joint dislocation and migrated into the anterior mediastinum and left hilum was admitted to our clinic. Incidentally detected Kirschner wires on chest radiography were removed by superior mini-sternotomy. In conclusion, since migration of Kirschner wires may cause serious complications, these patients should be followed closely and the wires should be removed once migration is detected.
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Affiliation(s)
- Mahmut Özbey
- Department of Thoracic Surgery, Sivas Cumhuriyet University Faculty of Medicine, Sivas, Türkiye
| | - Ufuk Türkmen
- Department of Cardiovascular Surgery, Hitit University Erol Olcok Training and Reserch Hospital, Çorum, Türkiye
| | - Ekber Şahin
- Department of Thoracic Surgery, Sivas Cumhuriyet University Faculty of Medicine, Sivas, Türkiye
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3
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Han Y, Cho EH, Martinez A, Martineau PA. Sternoclavicular Joint Reconstruction with Semitendinosus Allograft and Suture Anchors after Recurrent Posterior Dislocation in a Professional North American Football Player. Open Orthop J 2022. [DOI: 10.2174/18743250-v16-e2208180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
Background:
Posterior sternoclavicular joint dislocations are an extremely rare but potentially life-threatening injury that can occur in sports. A variety of surgical procedures have been proposed, but there is no consensus on the treatment of choice. It is also largely unknown if a safe return to high-risk sports is possible.
Case Presentation:
We present a case of a posterior sternoclavicular joint dislocation in a 22-year-old male professional North American football player who had a recurrent irreducible posterior dislocation after initial injury management by closed reduction. The patient’s desire to return to football presented unique challenges to management. His sternoclavicular joint was subsequently reconstructed with semitendinosus allograft in a figure-of-eight augmented with suture anchors. After recovery, he returned to play as a running back in professional football symptom-free.
Conclusion:
Our patient's successful return to playing professional football after the sternoclavicular joint reconstruction suggests that this should be considered an effective treatment option when managing posterior sternoclavicular dislocation in high level contact sports players.
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Harmouchi H, Bouazzaoui AE, Bensalah A, Badr A, Lakranbi M, Ouadnouni Y, Bouarhroum A, Smahi M. Intratracheal migration of two Kirschner wires after surgery for a clavicle fracture. Asian Cardiovasc Thorac Ann 2021; 29:428-430. [PMID: 33412892 DOI: 10.1177/0218492320987933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Kirschner wire is frequently used in orthopedic surgery, and migration is not exceptional. Intrathoracic migration is well-known, especially after surgery on the shoulder girdle, however, intratracheal migration is extremely rare. We describe a case of intratracheal migration of two Kirschner wires in a 41-year-old man who had them placed two years previously for a right clavicle fracture. He experienced chest pain followed by hemoptysis. Thoracic computed tomography revealed intratracheal migration. Remove of the Kirschner wires was performed by a cervical-sternotomy approach. Prompt removal of migrated Kirschner wires must be carried out urgently to avoid fatal complications.
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Affiliation(s)
| | - Abderahime El Bouazzaoui
- Department of Anesthesiology and Intensive Care A4, CHU Hassan II, Fez, Morocco.,Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdallah University, Fez, Morocco
| | | | - Alami Badr
- Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdallah University, Fez, Morocco.,Department of Radiology, CHU Hassan II, Fez-Morocco
| | - Marwane Lakranbi
- Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdallah University, Fez, Morocco
| | - Yassine Ouadnouni
- Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdallah University, Fez, Morocco
| | - Abdellatif Bouarhroum
- Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdallah University, Fez, Morocco.,Department of Vascular Surgery, CHU Hassan II Fez, Morocco
| | - Mohammed Smahi
- Department of Thoracic Surgery, CHU Hassan II, Fez, Morocco.,Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdallah University, Fez, Morocco
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5
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Sadat-Ali M, Shehri AM, AlHassan MA, AlTabash K, Mohamed FAM, Aboutaleb MM, AlGhanim AA. Broken Kirschner Wires Can Migrate: A Case Report and Review of Literature. J Orthop Case Rep 2020; 10:11-14. [PMID: 34169009 PMCID: PMC8046445 DOI: 10.13107/jocr.2020.v10.i09.1884] [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] [Indexed: 11/30/2022] Open
Abstract
Introduction Kirschner wires are in use in orthopedic and trauma surgery since the past 80 years. These wires can break due to metal fatigue and migrate which can cause lethal complications. Case Report A 27-year-old female sickle cell patient with avascular necrosis of the head of femur, drilling, and injection of the osteoblasts in the head of femur was being performed. A 2 cm of 2.0 mm proximal tip of the guide wire broke. Discussion started whether to leave the wire and the young decided to leave the broken wire, but the wisdom directed us to remove it. Conclusion Migration of wires does occur, we believe not only broken wires should be removed but also even the unbroken wire to be removed once the purpose of use is achieved.
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Affiliation(s)
- Mir Sadat-Ali
- Department of Orthopaedic Surgery, King Fahd Hospital of the University, Imam Abdul Rahman Bin Faisal University, AlKhobar, Saudi Arabia
| | - Abdullah M Shehri
- Department of Orthopaedic Surgery, King Fahd Hospital of the University, Imam Abdul Rahman Bin Faisal University, AlKhobar, Saudi Arabia
| | - Mohammed A AlHassan
- Department of Orthopaedic Surgery, King Fahd Hospital of the University, Imam Abdul Rahman Bin Faisal University, AlKhobar, Saudi Arabia
| | - Khalid AlTabash
- Department of Orthopaedic Surgery, King Fahd Hospital of the University, Imam Abdul Rahman Bin Faisal University, AlKhobar, Saudi Arabia
| | - Fatema Abdul Mohsen Mohamed
- Department of Orthopaedic Surgery, King Fahd Hospital of the University, Imam Abdul Rahman Bin Faisal University, AlKhobar, Saudi Arabia
| | - Mohamed Mokhles Aboutaleb
- Department of Orthopaedic Surgery, King Fahd Hospital of the University, Imam Abdul Rahman Bin Faisal University, AlKhobar, Saudi Arabia
| | - Ali A AlGhanim
- Department of Orthopaedic Surgery, King Fahd Hospital of the University, Imam Abdul Rahman Bin Faisal University, AlKhobar, Saudi Arabia
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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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7
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Ko HY, Lee KW. Contralateral migration of Kirschner wire from right acromioclavicular joint to left side of neck: a case report. J Med Case Rep 2019; 13:375. [PMID: 31823820 PMCID: PMC6905056 DOI: 10.1186/s13256-019-2279-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 09/27/2019] [Indexed: 11/10/2022] Open
Abstract
Background Kirschner wire migration is one of the most common complications after internal fixation of fracture or dislocation in the shoulder region. However, cases of contralateral wire migration are rare. We present a case of contralateral loosened Kirschner wire migration from the right acromioclavicular joint to the left side of the neck without damage to any important structures or great vessels. Case presentation We report a case of a loosened Kirschner wire migrating from the right acromioclavicular joint to the left side of the neck in a 34-year-old Taiwanese man following a route of transversal, descendant, and then ascendant directions. The Kirschner wire was removed by exploratory neck dissection under C-arm fluoroscopy assistance without complication. Conclusion Wire migration may occur after surgical treatment with or without clinical complaint. Several hypotheses for the mechanism of wire migration have been postulated, including muscular activity, respiratory motion, gravity, and motion of upper extremity. Therefore, the importance of follow-up should be communicated to the patient. Once wire loosening or migration is noted, the implant should be removed immediately under intraoperative C-arm fluoroscopy or ultrasound assistance.
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Affiliation(s)
- How-Yun Ko
- Department of Otorhinolaryngology - Head and Neck Surgery, Kaohsiung Medical University Hospital, No.100, TzYou 1st Road, Kaohsiung City, 807, Taiwan
| | - Ka-Wo Lee
- Department of Otorhinolaryngology - Head and Neck Surgery, Kaohsiung Medical University Hospital, No.100, TzYou 1st Road, Kaohsiung City, 807, Taiwan. .,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Department of Otorhinolaryngology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.
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8
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Vitali M, Drossinos A, Pironti P, Pesce E, Salini V. The management of Salter-Harris type II fracture with associated posterior sternoclavicular joint displacement using a locking compression plate: A 14-year-old adolescent's case report. Medicine (Baltimore) 2019; 98:e18433. [PMID: 31861012 PMCID: PMC6940059 DOI: 10.1097/md.0000000000018433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
RATIONALE Posterior sternoclavicular joint dislocations (PSCJDs) are particularly rare injuries, accounting for 3% to 5% of sternoclavicular joint dislocations. With very few cases reported in the literature, these injuries are often misdiagnosed and imaging is not always clear, thus making physicians often unaware of them. The present case report aims to investigate a rare case involving a clavicular Salter-Harris II fracture with associated posterior displacement of the diaphysis, a term coined a "pseudodislocation." PATIENT CONCERNS We present a case of a 14-year-old adolescent who sustained a traumatic injury to the shoulder while falling during a soccer match. His main concern was about recovery time and the return to daily life activities. DIAGNOSES Multiple imaging studies imaging (X-rays, computed tomography, magnetic resonance imaging) revealed a Salter-Harris II fracture of the right clavicle with posterior displacement of the diaphysis. INTERVENTIONS The patient underwent primary surgery to reduce the fracture, using an articular locking compression plate, and secondary surgery to remove the hardware. OUTCOMES Following the removal of the hardware at 60 days after the initial surgery and a number of cycles of physiotherapy the patient reported a pain-free range of motion with slight limitation at extremes. Full return to recreational and everyday life activities were achieved at 3 months from the initial surgery. LESSONS The PSCJDs are challenging injuries, as they are surrounded by delicate structures inside the mediastinum. Attention must be taken while diagnosing and treating these injuries as the risk of complications and iatrogenic injuries is high. To the author's knowledge, this case is one of the first of its kind described in the literature where we have a Salter-Harrys type II fracture associated with a posterior pseudodislocation of the lateral clavicle. Given the positive results of the case, we recommend the above-mentioned treatment protocol in PSCJD with associated Salter-Harris II fractures in adolescent patients.
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Affiliation(s)
- Matteo Vitali
- Department of Orthopedics and Traumatology, San Raffaele Scientific Institute
| | - Andreas Drossinos
- Department of Orthopedics and Traumatology, San Raffaele Scientific Institute
| | - Pierluigi Pironti
- Department of Orthopedics and Traumatology, San Raffaele Scientific Institute
| | - Elisa Pesce
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
| | - Vincenzo Salini
- Department of Orthopedics and Traumatology, San Raffaele Scientific Institute
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9
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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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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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Migration of a Broken Kirschner Wire after Surgical Treatment of Acromioclavicular Joint Dislocation. Case Rep Surg 2016; 2016:6804670. [PMID: 28058127 PMCID: PMC5183800 DOI: 10.1155/2016/6804670] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 11/27/2016] [Indexed: 11/29/2022] Open
Abstract
Kirschner wire (K-wire) is one of the commonly used implants in orthopaedics practice. Migration of the wire is one of the most frequently reported complications after fixation by the K-wire. In particular, it has been reported that a greater range of motion in the shoulder, negative intrathoracic pressure associated with respiration, gravitational force, and muscular activities may cause migration from the upper extremities. In general, thin and long foreign bodies with smooth surfaces that are localized within the tendon sheath and at an upper extremity can migrate more readily and can reach longer distances. Here, we present a patient with long-term migration of a broken K-wire who underwent fixation for acromioclavicular joint dislocation 5 years ago.
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12
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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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13
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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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14
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Management and functional outcomes following sternoclavicular joint dislocation. Injury 2015; 46:1906-13. [PMID: 26169233 DOI: 10.1016/j.injury.2015.05.050] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 05/14/2015] [Accepted: 05/31/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The aim of this study is to describe the demographics, management and functional outcomes of patients presenting with a sternoclavicular joint (SCJ) dislocation. METHODS A retrospective medical record review was conducted examining patients with SCJ dislocation admitted to an adult level 1 trauma centre between 2004 and 2012. Patient demographics, symptoms, associated injuries, imaging technique used in diagnosis, surgical data and neurovascular complications were recorded. Patients received a single-page questionnaire to assess physical function using two validated shoulder questionnaires. RESULTS A total of 22 patients were identified, out of which 77% sustained a posterior dislocation. Mean age was 30 years (range 16-65), and the most common cause of injury was a direct blow during sport (n=11). Open reduction and internal fixation were performed in 13 patients, definitive closed reduction used in seven and two patients were managed expectantly. Functional outcomes for patients were excellent, with American Shoulder and Elbow Society (ASES) and Subjective Shoulder Value (SSV) scores >80 in 87.5% of cases. There were preoperative symptoms consistent with mediastinal compression in 50% and one delayed presentation with thoracic outlet syndrome. No patient had neurovascular compromise or functional deficit post-operatively, regardless of joint congruency. CONCLUSION This is the largest case series from a single institution currently available examining SCJ dislocation. We recommend an initial trial of closed reduction, followed by open reduction and internal fixation if there is joint instability or malreduction. Functional outcome following both closed and open reduction of the SCJ is excellent.
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Tepolt F, Carry PM, Heyn PC, Miller NH. Posterior sternoclavicular joint injuries in the adolescent population: a meta-analysis. Am J Sports Med 2014; 42:2517-24. [PMID: 24569702 DOI: 10.1177/0363546514523386] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Sternoclavicular dislocations are relatively infrequent and are generally divided into anterior and posterior disruptions, the former being the most common. While posterior sternoclavicular joint (PSCJ) injuries are very rare, they may be associated with life-threatening complications. The ideal management of these injuries, particularly in the adolescent population, has not been well described. PURPOSE Through a meta-analysis of PSCJ injuries in the adolescent, we aimed to (1) describe the epidemiology of PSCJ injuries in relation to the mechanism of injury, associated complications, and treatment preferences; (2) compare the success of closed reduction when attempted <48 versus >48 hours after the initial injury; and (3) compare the outcomes of closed versus open treatment. STUDY DESIGN Meta-analysis. METHODS A thorough review of the English literature was performed to identify all cases of PSCJ dislocations or medial clavicular physeal fractures in patients aged 12 to 18 years. Patient-level data for 140 patients were extracted from 79 studies. RESULTS The mean age of the patients was 15.24 years. Forty-nine patients (35.00%) underwent closed treatment only, 42 (30.00%) open treatment alone, and 47 (33.57%) closed treatment followed by open treatment. Also, 55.8% of closed reductions performed within 48 hours were successful compared with 30.8% of those performed more than 48 hours after injury. After initial treatment, 92.31% of patients treated with closed reduction regained full function without recurrence as compared with 95.83% of patients treated operatively. CONCLUSION Closed and open methods have proven highly effective for the treatment of PSCJ injuries. However, follow-up data reported in the literature vary considerably. Closed reduction is most effective when attempted less than 48 hours after the initial injury.
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Warth RJ, Lee JT, Millett PJ. Anatomy and Biomechanics of the Sternoclavicular Joint. OPER TECHN SPORT MED 2014. [DOI: 10.1053/j.otsm.2013.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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