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Al-Sawat A, Lee SJ, Lee CS. Laparoscopic removal of a migrating acupuncture needle from the obturator muscle: A case report. Asian J Surg 2021; 44:1330-1331. [PMID: 34340898 DOI: 10.1016/j.asjsur.2021.06.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 10/20/2022] Open
Affiliation(s)
- Abdullah Al-Sawat
- Department of Surgery, College of Medicine, Taif University, Taif, Saudi Arabia.
| | - Sung Jong Lee
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Chul Seung Lee
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Yamamoto A, Hiro J, Omura Y, Ichikawa T, Ide S, Imaoka H, Yasuda H, Fujikawa H, Okita Y, Yokoe T, Ohi M, Toiyama Y. Laparoscopic removal of an aberrant acupuncture needle in the gluteus that reached the pelvic cavity: a case report. Surg Case Rep 2021; 7:51. [PMID: 33595766 PMCID: PMC7889768 DOI: 10.1186/s40792-020-01065-8] [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: 06/29/2020] [Accepted: 11/04/2020] [Indexed: 11/10/2022] Open
Abstract
Background Intrapelvic aberrant needles are rare in clinical practice. Long-term foreign bodies in the abdominal cavity may form granulation tissue or an abscess, and may cause organ injury. Therefore, such foreign bodies need prompt removal. Case presentation A 26-year-old male athlete was referred to our hospital for investigation of an aberrant acupuncture needle in the gluteus. The needle was unable to be removed during acupuncture treatment, and the end broke off and remained in the gluteus. Abdominal X-ray examination showed a thin, 40-mm-long, metallic foreign body resembling an acupuncture needle. Abdominal computed tomography showed an abnormal shadow in the gluteus. However, it was unclear whether the tip of the needle reached the pelvic cavity. Thus, it was decided to surgically extract the needle via laparoscopic surgery under X-ray guidance as a safe and minimally invasive method. Although X-ray fluoroscopy confirmed that the aberrant needle was located in the gluteus, the needle could not be felt with the forceps, as the peritoneum surrounding the needle had granulomatous changes due to inflammation. Therefore, the retroperitoneum was further dissected to search for the needle. Once the needle was identified, its flexibility enabled it to be easily removed by grasping it directly with a needle holder. The length of the aberrant needle was 40 mm. The postoperative course was uneventful, and the patient was discharged from hospital on postoperative day 2. Conclusions When a foreign body remains in the gluteus and its tip touches intrapelvic organs, such as the rectum, it is critical to determine the best approach for its safe removal. Given the anatomical location of the foreign body and the patient background, laparoscopic removal was considered the best approach in the present case.
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Affiliation(s)
- Akira Yamamoto
- Division of Reparative Medicine, Department of Gastrointestinal and Pediatric Surgery, Institute of Life Sciences, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Junichiro Hiro
- Division of Reparative Medicine, Department of Gastrointestinal and Pediatric Surgery, Institute of Life Sciences, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Yusuke Omura
- Division of Reparative Medicine, Department of Gastrointestinal and Pediatric Surgery, Institute of Life Sciences, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Takashi Ichikawa
- Division of Reparative Medicine, Department of Gastrointestinal and Pediatric Surgery, Institute of Life Sciences, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Shozo Ide
- Division of Reparative Medicine, Department of Gastrointestinal and Pediatric Surgery, Institute of Life Sciences, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Hiroki Imaoka
- Division of Reparative Medicine, Department of Gastrointestinal and Pediatric Surgery, Institute of Life Sciences, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Hiromi Yasuda
- Division of Reparative Medicine, Department of Gastrointestinal and Pediatric Surgery, Institute of Life Sciences, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Hiroyuki Fujikawa
- Division of Reparative Medicine, Department of Gastrointestinal and Pediatric Surgery, Institute of Life Sciences, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Yoshiki Okita
- Division of Reparative Medicine, Department of Gastrointestinal and Pediatric Surgery, Institute of Life Sciences, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Takeshi Yokoe
- Division of Reparative Medicine, Department of Gastrointestinal and Pediatric Surgery, Institute of Life Sciences, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Masaki Ohi
- Division of Reparative Medicine, Department of Gastrointestinal and Pediatric Surgery, Institute of Life Sciences, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Yuji Toiyama
- Division of Reparative Medicine, Department of Gastrointestinal and Pediatric Surgery, Institute of Life Sciences, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
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A Rare Case of an Iliac Fracture at the Iliac Fossa Immediately after Salter Innominate Osteotomy. Case Rep Orthop 2021; 2021:6653726. [PMID: 33575049 PMCID: PMC7857925 DOI: 10.1155/2021/6653726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/15/2021] [Accepted: 01/20/2021] [Indexed: 11/17/2022] Open
Abstract
This report presents the unusual case of a 5-year-old girl with iliac fracture just after Salter innominate osteotomy for developmental dysplasia of the hip. The iliac fracture was diagnosed two days after Salter innominate osteotomy, and computed tomography (CT) revealed that it was at the extremely thin portion of the iliac wing called the "iliac fossa." We were able to reduce the fracture by pulling the left leg distally, and after reducing the iliac bone, the ilium was fixed by Kirschner wire from the anteroinferior iliac spine and anterosuperior iliac spine. The patient was in a hip-spica cast for 6 weeks postoperatively and allowed to walk from 3 months after the surgery. At the last follow-up one year after the surgery, bone union was completely obtained, and she had no complications. The cause of the fracture seems to be the stress concentration on the iliac fossa due to the cranked iliac osteotomy line passing through the iliac fossa. The current case indicates the importance of careful evaluation by CT before surgery and ensuring that the osteotomy line does not extend near the iliac fossa.
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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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Hedelin H, Larnert P, Hebelka H, Brisby H, Lagerstrand K, Laine T. Innominate Salter osteotomy using resorbable screws: a retrospective case series and presentation of a new concept for fixation. J Child Orthop 2019; 13:310-317. [PMID: 31312271 PMCID: PMC6598047 DOI: 10.1302/1863-2548.13.180195] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The Salter innominate osteotomy (SIO) in children is traditionally stabilized by Kirschner-wires, which have issues regarding stability, infection and the need to be extracted. To counter these disadvantages, we present a surgical method to stabilize SIO with modern resorbable poly lactic-co-glycolic acid screws. Using a case series of 21 patients treated with SIO for developmental dysplasia of the hip or Legg-Calvé-Perthes disease we evaluate the feasibility of the method. METHODS The integrity of the osteotomy was interpreted by radiological measurements of acetabular index, centre-edge angle and Reimer's index. Perioperative and postoperative complications were evaluated. RESULTS Radiographic evaluation revealed a stable osteotomy and favourable development in all measured parameters with the exception of one patient who fell out of bed the first day postoperatively. No other perioperative surgical complications were observed and there were no local reactions to the resorbable screws. CONCLUSION Modern resorbable screws carry multiple benefits both for the patient and the surgeon. In our case series the implants provided sufficient stability and the implants caused no local reactions. The use of resorbable implants gave the surgeon a wider range of possible screw placements and avoided the need for implant removal. LEVEL OF EVIDENCE Level IV - Case series.
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Affiliation(s)
- H. Hedelin
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden,Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Correspondence should be sent to Henrik Hedelin, Department of Orthopedics, Pediatric Section, Sahlgrenska University Hospital, 41678 Gothenburg, Sweden. E-mail:
| | - P. Larnert
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden,Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - H. Hebelka
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - H. Brisby
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden,Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - K. Lagerstrand
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Department of Medical Physics and Biomedicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - T. Laine
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden,Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Anastasopoulos PP, Lepetsos P, Leonidou AO, Gketsos A, Tsiridis E, Macheras GA. Intra-abdominal and intra-pelvic complications following operations around the hip: causes and management-a review of the literature. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 28:1017-1027. [PMID: 29435655 DOI: 10.1007/s00590-018-2154-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 02/06/2018] [Indexed: 01/08/2023]
Abstract
Although successful and well-established procedures, hip operations whether elective or trauma are coupled with a variety of complications. Among the most uncommon complications are injuries to intra-abdominal or intra-pelvic organs which could prove potentially life-threatening. While there are various reports of such injuries in the literature, we aimed to perform a systematic review in order to examine the causes and relationships between intra-abdominal and intra-pelvic complications and the mechanism of injury, the pattern of presentation, identification, the course of management and outcomes. We identified 69 reports describing a total of 84 complications in intra-pelvic and intra-abdominal contents in 75 patients. These involved six major categories, including the intestinal tract, the urinary tract, the genital tract, the vascular system, the viscera and peripheral nerves. The most commonly injured system was the urinary (33.33%), followed by the vascular (29.76%) and the intestinal (22.62%). Among these systems, the most prevalent complications involved injury to the urinary bladder (32.14%), the large intestine (68.42%) and the external iliac artery (44%). The majority of recorded complications were postoperative with 71 incidents in 63 cases (84.52%). In intra-operative complications the most prevalent injury was due to hardware penetration (53.85%), while in postoperative it was due to hardware migration (92.06%). The management of injuries varied widely, with the most common approach being open exploration and direct repair (77.33%). The reported management outcomes included death (8%) and Girdlestone resection (2.67%), while the majority of the patients healed uneventfully (82.67%) owing mostly to immediate intervention. Despite being rare, such complications may still occur in a variety of settings and may subsequently lead to potential life-threatening situations. Thus, in order to avoid catastrophic outcomes we emphasize the need for prompt identification, immediate intervention and a multidisciplinary approach when necessary.
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Affiliation(s)
| | - Panagiotis Lepetsos
- 4th Department of Trauma and Orthopaedics, KAT Hospital, Nikis 2, Kifissia, 14561, Athens, Greece.
| | - Andreas O Leonidou
- Third Academic Department of Orthopaedics and Trauma, Aristotle University Medical School, RingRoad, N. Efkarpia, 56403, Thessaloníki, Greece
| | - Anastasios Gketsos
- 4th Department of Trauma and Orthopaedics, KAT Hospital, Nikis 2, Kifissia, 14561, Athens, Greece
| | - Eleftherios Tsiridis
- Third Academic Department of Orthopaedics and Trauma, Aristotle University Medical School, RingRoad, N. Efkarpia, 56403, Thessaloníki, Greece
| | - George A Macheras
- 4th Department of Trauma and Orthopaedics, KAT Hospital, Nikis 2, Kifissia, 14561, Athens, Greece
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Hug KT, Fernando ND. Intra-abdominal migration of a k-wire during revision total hip arthroplasty. Arthroplast Today 2017; 3:3-5. [PMID: 28377998 PMCID: PMC5365414 DOI: 10.1016/j.artd.2016.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 09/02/2016] [Accepted: 09/06/2016] [Indexed: 11/29/2022] Open
Abstract
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.
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Affiliation(s)
- Kevin T Hug
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Navin D Fernando
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
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Llado RJ, Banerjee S, Khanuja HS. Smooth Pins Reinforcing Static Cement Spacers for Infected Total Knee Arthroplasty Are Not Safe. Orthopedics 2016; 39:e553-7. [PMID: 27045481 DOI: 10.3928/01477447-20160324-05] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Accepted: 07/06/2015] [Indexed: 02/03/2023]
Abstract
Prosthetic joint infection is one of the most dreaded complications following elective lower extremity primary total joint arthroplasty, resulting in substantial pain, disability, and health care costs. Both static and articulating antibiotic-impregnated spacers have been used in the management of 2-stage revision for infected total knee arthroplasty, which remains the gold standard for treatment of these infections. Articulating spacers may provide theoretical benefits with regard to improved range of motion after reimplantation secondary to less scar formations and soft tissue contractures. However, static spacers may be necessary to overcome instability associated with substantial bone defects, incompetent extensor mechanisms, and collateral ligament insufficiencies. In these scenarios, static spacers are often reinforced with intramedullary rods or Steinmann pins to provide additional knee stability, improve construct strength, maintain extension, and avoid flexion contractures. This case report describes an extremely rare case of migration of smooth pins through the posterior tibia into the calf following static spacer use in a 48-year-old man. Various mechanical and systemic complications have been reported in up to 50% of patients with the use of polymethyl methacrylate spacer devices, such as acute renal failure, allergic reactions from antibiotic use, stiffness, bone loss, fractures, and dislocations. However, to the best of the authors' knowledge, this complication of hardware migration has not been reported previously in the literature. The authors believe that orthopedic surgeons should consider the use of threaded pin dowels or intramedullary rods to avoid this potential untoward complication. [Orthopedics. 2016; 39(3):e553-e557.].
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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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Fatal hemorrhage following sacroiliac joint fusion surgery: A case report. Leg Med (Tokyo) 2015; 26:102-105. [PMID: 26141952 DOI: 10.1016/j.legalmed.2015.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 06/16/2015] [Accepted: 06/18/2015] [Indexed: 11/20/2022]
Abstract
Threaded pins and wires are commonly used in orthopedic practice and their migration intra- or post-operatively may be responsible for potentially serious complications. Vascular and visceral injury from intra-pelvic pin or guide-wire migration during or following hip surgery has been reported frequently in the literature and may result in progression through soft tissues with subsequent perforation of organs and vessels. In this report, we describe an autopsy case involving a 40-year old man suffering from chronic low back pain due to sacroiliac joint disruption. The patient underwent minimally invasive sacroiliac joint arthrodesis. Some intra-operative bleeding was noticed when a drill was retrieved, though the patient died postoperatively. Postmortem investigations allowed the source of bleeding to be identified (a perforation of a branch of the right internal iliac artery) and a potentially toxic tramadol concentration in peripheral blood to be measured.
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