Forgotten Kirschner wire causing severe hematuria

Migrated K-wire in the urinary bladder not causing symptoms: A rare case report

INTRODUCTION AND IMPORTANCE

Kirschner wires (K-wires) are commonly used implants in the treatment of bony fracture. The migration of K-wire has been reported in the literature, but such migration into the urinary bladder is extremely rare.

PRESENTATION OF CASE

We report a case of an asymptomatic patient with a migrating K-wire in the urinary bladder, who came to our follow-up clinic after treatment of a hip fracture. The patient was absolutely fine but follow-up image showed K-wire in the urinary bladder. In view to prevent further migration and injuries, the laparotomy was planned and wire has been removed under the C-arm image guidance. Postoperative period was uneventful and patient was discharged.

CLINICAL DISCUSSION

The aim of reporting this case was to spread the awareness about mandatory follow-up after K-wire placement, its migration, and the recommendation to remove it at earliest. As per my best knowledge, this is the first and unique case of K-wire migration into the urinary bladder, detected on follow-up image without symptoms.

CONCLUSION

Bending the end of the K-wires after insertion, the restriction of joint movement, and removal of migrated K-wires at earliest are the key points in a patients with K-wire insertion. The mandatory follow-up in cases of K-wire placement for treatment of bone fracture, and early diagnosis prevent the potentially fatal complications.

Intra-abdominal and intra-pelvic complications following operations around the hip: causes and management-a review of the literature

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.

Forgotten Kirschner wire passing across the sigmoid colon

The Kirschner wire (K-wire) is used in the treatment of hip fractures, and migration of a K-wire into the pelvis with resultant colon injury is a very rare complication. We report a case in which a forgotten K-wire passing across the sigmoid colon was accidentally found by screening colonoscopy in a patient with no abdominal symptoms. Surgery was performed to remove the K-wire. Although the migration of a K-wire is extremely rare, it is important for it to be considered in patients with a history of orthopedic surgery.