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Prabhat V, Kumar K, Gaurav K, Topno R. Retrieval of Broken Guidewire from the Hip Joint Protruding inside the Pelvic Cavity: A Rare Case Report. Ann Afr Med 2024; 23:737-739. [PMID: 39138936 DOI: 10.4103/aam.aam_51_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 04/09/2024] [Indexed: 08/15/2024] Open
Abstract
Hardware breakage in the form of guide wire or drill bit is a devastating complication particularly if occurs around hip joint during cephalo-medullary nailing. It should be removed on urgent basis as it can migrate to the pelvic cavity and damages adjacent neuro-vascular bundle and visceral organ immediately as well joint arthritis later on. There are very few cases report available in the literature with retrieval techniques by using disc forceps, pituitary forceps, oversized reamers, arthrotomy with joint dislocation and through ilioinguinal approaches occasionally. We are presenting an interesting and rare case of broken guide wire inside hip joint protruding into the pelvic cavity which got retrieved through lower midline open laparotomy approach.
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Affiliation(s)
- Vinay Prabhat
- Department of General Surgery, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
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Zhang MR, Huang TS, Zhao K, Guo JL, Zeng X, Hu JH. Minimally invasive retrieval of intramedullary broken guidewire in distal tibia: An innovative technique. Trauma Case Rep 2023; 44:100804. [PMID: 36851910 PMCID: PMC9958467 DOI: 10.1016/j.tcr.2023.100804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2023] [Indexed: 02/19/2023] Open
Affiliation(s)
- Mei-Ren Zhang
- Guangzhou University of Traditional Chinese Medicine Second Affiliated Hospital (Guangdong Provincial Hospital of Traditional Chinese Medicine), Orthopedics Trauma Department Zhuhai Branch, Jingle Road Number 53, XiangZhou District, ZhuHai City, Guangdong Province 519015, China
| | - Tao-Sheng Huang
- Department of Orthopaedics, The Second Hospital of Xiangzhou District, Nanquan Road Number 21, Xiangzhou District, ZhuHai City, Guangdong Province 519015, China
| | - Kui Zhao
- Guangzhou University of Traditional Chinese Medicine Second Affiliated Hospital (Guangdong Provincial Hospital of Traditional Chinese Medicine), Orthopedics Trauma Department Zhuhai Branch, Jingle Road Number 53, XiangZhou District, ZhuHai City, Guangdong Province 519015, China
| | - Jiang-Long Guo
- Guangzhou University of Traditional Chinese Medicine Second Affiliated Hospital (Guangdong Provincial Hospital of Traditional Chinese Medicine), Orthopedics Trauma Department Zhuhai Branch, Jingle Road Number 53, XiangZhou District, ZhuHai City, Guangdong Province 519015, China
| | - Xiao Zeng
- Guangzhou University of Traditional Chinese Medicine Second Affiliated Hospital (Guangdong Provincial Hospital of Traditional Chinese Medicine), Orthopedics Trauma Department Zhuhai Branch, Jingle Road Number 53, XiangZhou District, ZhuHai City, Guangdong Province 519015, China
| | - Jian-Hui Hu
- Guangzhou University of Traditional Chinese Medicine Second Affiliated Hospital (Guangdong Provincial Hospital of Traditional Chinese Medicine), Orthopedics Trauma Department Zhuhai Branch, Jingle Road Number 53, XiangZhou District, ZhuHai City, Guangdong Province 519015, China
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Beheshti Fard S, Moharrami A, Mirghaderi SP, Mortazavi SJ. Broken pin removal from hip joint using arthroscopic grasper - A technical note and review of literature. Injury 2022; 53:3853-3857. [PMID: 36088126 DOI: 10.1016/j.injury.2022.08.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 08/21/2022] [Accepted: 08/23/2022] [Indexed: 02/02/2023]
Abstract
Guidewire breakage during a surgical procedure is uncommon but still challenging for orthopedic surgeons. Due to the potential for harmful complications, surgeons prefer to remove broken wires near the joint surface or neurovascular bundle in the hip region. Due to the depth of the location, the retrieval procedure is arduous, time-consuming, and potentially dangerous. This study describes a case of a sub-capital femoral neck fracture that was fixed with a cannulated screw. However, three years later, the distal portion of the guidewire broke and migrated into the hip joint, where it became entrapped. This study describes a method for removing a broken wire from the hip region and a relevant literature review. In brief, initially, we untightened the screw and removed it. Afterward, the broken wire was reached by reaming in the direction of the screw. Ultimately, we advanced the arthroscopic grasper to the broken wire for removal under fluoroscopic guidance. The study's findings indicate that this method could provide a promising outcome with minimal complications.
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Affiliation(s)
| | - Alireza Moharrami
- Joint Reconstruction Research Center (JRRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Peyman Mirghaderi
- Students' Scientific Research Center (SSRC), Joint Reconstruction Research Center (JRRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Sm Javad Mortazavi
- Hip and knee surgeon, Joint Reconstruction Research Center (JRRC), Tehran University of Medical Sciences, Address: Joint Reconstruction Research Center (JRRC), Imam Complex Hospital, End of Keshavarz Blvd, Tehran, Iran.
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Minimally invasive removal of intra-articular hip fragments under navigation guidance. Orthop Traumatol Surg Res 2022; 108:103205. [PMID: 35074537 DOI: 10.1016/j.otsr.2022.103205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 10/01/2021] [Accepted: 11/09/2021] [Indexed: 02/03/2023]
Abstract
The interposition of foreign bodies between the femoral head and the acetabulum represents a danger to the articular cartilage with a definite progression to osteoarthritis. Their removal is necessary and usually involves two surgical techniques: by open arthrotomy or under arthroscopy. The present article proposes a new surgical technique allowing the removal of intra-articular foreign bodies from the hip by a minimally invasive approach and aCT-guided navigation system. This technique is a good alternative that overcomes some shortcomings of other minimally invasive techniques, which struggle to access the fragment. It can also avoid specific complications of these procedures, such as the risk of abdominal compartment syndrome with arthroscopy, in the case of an associated acetabulum fracture.
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Abstract
Hardware breakage during orthopaedic surgery especially closed intramedullary nailing is a nightmare for orthopaedic surgeons. During hip fracture surgery a mechanical failure of the guidewire or the reamer poses an additional risk of intrapelvic migration and neurovascular or visceral injury which can lead to devastating complications and litigation. We report a case of removal of the broken guidewire using a cannulated reamer & discectomy forceps and recommend some suggestions for prevention of this catastrophe.
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Dharmshaktu G, Adhikari N, Mourya P, Bhandari S, Singh P. Intraoperative instrument breakage during the orthopedic elective procedures: A retrospective single-center experience. JOURNAL OF ORTHOPAEDICS AND SPINE 2020. [DOI: 10.4103/joasp.joasp_18_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kumar A, Jain A, Saurabh S, Trikha V, Mittal S. Technical tip for removal of broken cephalomedullary reamer tip in cases of proximal femoral nailing. J Clin Orthop Trauma 2019; 10:969-971. [PMID: 31528077 PMCID: PMC6739251 DOI: 10.1016/j.jcot.2019.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 01/14/2019] [Indexed: 11/24/2022] Open
Abstract
Instrumentation breakage around hip joint can pose a challenging situation considering its vicinity to several vital structures. Broken fragments carry the risk of migration and thus should be removed as early as possible. A case of successful retrieval of broken tip of cephalomedullary lag screw reamer of a cephalomedullary nail, in basicervical region of femoral neck, during fixation of a subtrochanteric femoral fracture has been reported. Literature review has been done to suggest techniques to tackle similar situations using simple and commonly available instruments.
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Affiliation(s)
- Arvind Kumar
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Aditya Jain
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Suman Saurabh
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Vivek Trikha
- JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Samarth Mittal
- JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India,Corresponding author.
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Barquet A, Gelink A, Giannoudis PV. Proximal femoral fractures and vascular injuries in adults: Incidence, aetiology and outcomes. Injury 2015; 46:2297-313. [PMID: 26521991 DOI: 10.1016/j.injury.2015.10.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Vascular injuries (VI) presenting during internal fixation (IF) of proximal femoral fractures (PFF) are potentially limb- and life-threatening. The purpose of this systematic review of the literature is to report on their incidence, associated complications and to give special emphasis in their prevention. MATERIALS AND METHODS A comprehensive review of the literature was undertaken using the PRISMA guidelines with no language restriction. Case reports of VIPFF-IF and series of PFF-IF with cases of VI published between inception of journals to March 2015 were eligible for inclusion. Relevant information was divided in two parts. Part I included the analysis of cases of VIPFF-IF, with the objective of establishing the frequency of injury of each vessel, the types and mechanisms of injury, the diagnostic and therapeutic modalities, and the outcomes. Part II analysed series of PFF-IF, which included case(s) of VI for assessing the incidence of VIPFF-IF. RESULTS Overall 160 articles with 182 cases of VIPFF-IF met the inclusion criteria. The injuries to extrapelvic vessels prevailed over those of intrapelvic vessels. There was a higher frequency of injury to the deep femoral artery and its branches in extrapelvic vessels and of external iliac artery and vein in intrapelvic vessels. The types of injury were: compression, intimal flap tear, disruption of the intimal layer with thrombosis, laceration with haemorrhage, and puncture or progressive erosion leading to a pseudoaneurysm (PSA) or arteriovenous fistula (AVF), with high prevalence for PSA, followed by lacerations. PSAs were more frequent in extrapelvic lesions and lacerations in the intrapelvic vessels. There were 7 non-iatrogenic injuries, produced by a displaced lesser trochanter fragment or other bone fragments, and 175 iatrogenic injuries (96.15%). The intrapelvic intraoperative protrusion of instruments or implants, or the post-operative migration of implants produced the injuries of intrapelvic vessels. For iatrogenic injuries of extrapelvic vessels the prevalent mechanism was a displaced lesser trochanter fragment, either intra- or postoperatively, followed by injuries by an overshot drill bit or a protruding screw; several other mechanisms completed the list. The clinical and radiological investigations were similar to those of VI elsewhere. VI occurred either at the time of fracture, during surgery or after it, early or late, weeks, months or even years after IF. The diagnostic and therapeutic modalities were most diverse, and the incidence of morbidity and mortality was 18.06%. The overall incidence of VIPFF-IF was 0.49%. CONCLUSION The incidence of VIPFF-IF is low, though it will probably rise because of the increasing frequency of PFF. With few exceptions, these injuries, which are potentially limb and life-threatening, are iatrogenic, resulting of errors in IF, with different types of lesions to intra- and extrapelvic vessels running in close proximity to the bone. Although the surgeon should bear in mind this possibility and achieve early diagnosis and prompt accurate treatment, there is no consensus as to what is the best diagnostic or therapeutic modality. A precise diagnosis of the preoperative vascular status of the limb, monitoring of the displacement of the lesser trochanter fragment, careful and gentle reduction of the fracture, and precise handling of instruments and implant selection and placement during IF, are factors to consider in order to prevent this complication, which should never be underestimated.
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Affiliation(s)
| | - Andrés Gelink
- Department of Traumatology, AEPSM, Montevideo, Uruguay
| | - Peter V Giannoudis
- Academic Department of Trauma & Orthopaedic Surgery, University of Leeds, Clarendon Wing, Floor A, Great George Street, Leeds General Infirmary, LS1 3EX Leeds, UK; NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, West Yorkshire, LS7 4SA Leeds, UK.
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Salunke AA, Menon PH, Nambi GI, Tan J, Patel V, Chen Y, Kumar J. Removing a broken guidewire in the hip joint: treatment options and recommendations for preventing an avoidable surgical catastrophe. A case report. SAO PAULO MED J 2015; 133:531-4. [PMID: 26465811 PMCID: PMC10496552 DOI: 10.1590/1516-3180.2014.9061512] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 09/11/2014] [Accepted: 09/25/2014] [Indexed: 11/21/2022] Open
Abstract
CONTEXT Hardware breakage during hip surgery can pose challenging and difficult problems for orthopedic surgeons. Apart from technical difficulties relating to retrieval of the broken hardware, complications such as adjacent joint arthritis and damage to neurovascular structures and major viscera can occur. Complications occurring during the perioperative period must be informed to the patient and proper documentation is essential. The treatment options must be discussed with the patient and relatives and the implant company must be informed about this untoward incident. CASE REPORT We report a case of complete removal of the implant and then removal of the broken guidewire using a combination of techniques, including a cannulated drill bit, pituitary forceps and Kerrison rongeur. CONCLUSIONS We suggest some treatment options and recommendations for preventing an avoidable surgical catastrophe.
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Affiliation(s)
- Abhijeet Ashok Salunke
- MD. Clinical Fellow, Division of Musculoskeletal Oncology, National University Hospital, Singapore. Assistant Professor, Department of Orthopedics, Pramukswami Medical College, Karamsad, Anand, Gujarat, India
| | - Prem Haridas Menon
- MD. Clinical Fellow, Department of Orthopedics, National University Hospital, Singapore.
| | - Gurunathampalayam Ilango Nambi
- MD. Consultant, Department of Plastic & Reconstructive Microvascular Services, Kovai Medical Center & Hospital, Coimbatore, Tamil Nadu, India.
| | - Junhao Tan
- Medical Student, Yong Lin Loo School of Medicine, National University of Singapore, Singapore.
| | - Vivek Patel
- MD. Assistant Professor, Department of Orthopedics and Traumatology, Pramukswami Medical College, Karamsad, Anand, Gujarat, India.
| | - Yongsheng Chen
- MD. Resident, Hand & Reconstructive Microsurgery Cluster, Department of Orthopedics, National University Hospital, Singapore.
| | - Jay Kumar
- MD. Resident, Department of Orthopedics and Traumatology, Pramukswami Medical College, Karamsad, Anand, Gujarat, India.
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Roy SP, Lim CT, Tan KJ. A useful surgical technique for retrieval of a broken guide pin in the midfoot. J Foot Ankle Surg 2013; 53:120-3. [PMID: 23871172 DOI: 10.1053/j.jfas.2013.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Indexed: 02/03/2023]
Abstract
Perioperative instrument breakage is not an infrequent occurrence, even for experienced surgeons. The most commonly reported instrument breaks in orthopedic procedures are drill bits, followed by Kirschner wires and cannulated guide pins. The reasons for failure include improper technique and repetitive use. The retrieval of broken hardware can be technically challenging, particularly if the fragment has become embedded in bone. Retrieval methods have been described for cannulated guide pin fragments in the hip; however, no specific techniques have been described for the retrieval of guide pin fragments embedded in the bones of the foot. In the present report, we describe a technique we have found useful for retrieval of a guide pin fragment that had broken off during a Lisfranc fracture repair 6 weeks earlier. The technique was used in a delayed situation; however, we believe it would be even easier to use during an intraoperative breakage.
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Affiliation(s)
- Shuvendu Prosad Roy
- Clinical Fellow, Adult Reconstruction, Foot and Ankle Division, Department of Orthopedics, National University Hospital, Singapore.
| | - Chin Tat Lim
- Resident, Department of Orthopedics, National University Hospital, Singapore
| | - Ken Jin Tan
- Consultant, Foot and Ankle Division, Department of Orthopedics, National University Hospital, Singapore
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Venkata GR, Mootha AK, Thayi C, Parekh VG, Ramireddy VK. Concomitant laparoscopy: an effective technique for successful retrieval of intra pelvic migrated broken guide pin. Injury 2012; 43:526-9. [PMID: 22209170 DOI: 10.1016/j.injury.2011.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 08/16/2011] [Accepted: 11/11/2011] [Indexed: 02/02/2023]
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Abstract
Removing a broken guide wire is difficult and challenging. This article reports a method that was used to successfully remove a broken guide wire in 3 patients who underwent operative treatment for intertrochanteric fractures of the femur. Under general anesthesia, the first patient was placed on the orthopedic fracture table, and closed reduction of the hip fracture was performed under the image intensifier. A 2-mm non-threaded pin was used in the center of the femoral neck, and the amount of reaming required was determined. The reaming proceeded without any difficulty until the reamer failed to progress, which was attributed to the presence of a sclerotic or calcar region. Under fluoroscopy, on an anteroposterior view, the pin was parallel with the reamer; however, the authors failed to check the lateral image. After reaming through the hard tissue, the reamer suddenly passed through easily. On checking under the scope, it was noted that the pin was broken. The tip of the pin passed the acetabulum but did not enter the pelvis. Efforts to remove the broken pin failed. An attempt to reach the pin using a dynamic hip screw reamer also failed. Ultimately, the broken pin was removed using a 2-mm cannulated drill bit under fluoroscopy. After the experience with the first patient, in the other 2 cases, the authors used a cannulated drill bit to avoid any extensive reaming and trauma to the tissues. With this method, the authors were able to remove the broken pin easily in a few minutes.
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