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Medial Migration of a Broken Trochanteric Cable. Case Rep Orthop 2018; 2018:4590105. [PMID: 30155328 PMCID: PMC6098876 DOI: 10.1155/2018/4590105] [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: 05/10/2018] [Accepted: 07/24/2018] [Indexed: 11/22/2022] Open
Abstract
Background Cerclage wires or cables are commonly being used in hip reconstruction procedures like primary (especially in patients with developmental hip dysplasia) or revision arthroplasty. Local or distant migration of a broken cable or wire is a complication that might lead to devastating situations depending on the route of migration. Case Presentation We report a case of a 40-year-old female who underwent bilateral total hip arthroplasty surgery due to bilateral developmental hip dysplasia. Trochanteric osteotomy was needed in her right hip to advance trochanter major distally. Trochanteric fixation was achieved by a cerclage cable system. Four years after the surgery, the patient referred to the hospital with a prominence and pain in her right inguinal area. Radiographies revealed medial migration of a broken trochanteric cable part. The possible route of the cable was through medial adductor muscles, posterior to the femoral neurovascular bundle and anterior to the sciatic nerve. Both migrated and remaining parts of the cable were extracted under general anesthesia. Conclusion Broken cables should be followed carefully due to their sharpness and possible serious complications secondary to distant migration. Extraction might be inevitable in case of a close relation with neurovascular structures.
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Pientka WF, Bates CM, Webb BG. Asymptomatic Migration of a Kirschner Wire from the Proximal Aspect of the Humerus to the Thoracic Cavity: A Case Report. JBJS Case Connect 2018; 6:e77. [PMID: 29252654 DOI: 10.2106/jbjs.cc.16.00032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
CASE A 78-year-old man presented with an open fracture of the proximal aspect of the humerus and an axillary artery laceration; the fracture was treated provisionally with Kirschner wires (K-wires). Forty-five days postoperatively, he presented with pin prominence at the lateral aspect of the arm, and was incidentally noted to have migration of a separate K-wire to the left lung. He underwent successful thoracotomy and lung wedge resection for wire removal. CONCLUSION K-wires used in the fixation of fractures of the proximal aspect of the humerus may migrate into the thoracic cavity. No modification of this technique, including the use of threaded, terminally bent, or external pins that are visibly secured, eliminates the potential for devastating complications.
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Affiliation(s)
- William F Pientka
- Department of Orthopaedic Surgery, John Peter Smith Hospital, Fort Worth, Texas
| | - Christopher M Bates
- Department of Orthopaedic Surgery, John Peter Smith Hospital, Fort Worth, Texas
| | - Brian G Webb
- Department of Orthopaedic Surgery, John Peter Smith Hospital, Fort Worth, Texas.,Department of Orthopaedic Surgery, University of North Texas Health Science Center, Fort Worth, Texas
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Irianto KA, Edward M, Fiandana A. K-wire migration to unexpected site. INTERNATIONAL JOURNAL OF SURGERY OPEN 2018. [DOI: 10.1016/j.ijso.2018.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Matsumoto H, Yo S, Fukushima S, Osawa M, Murao T, Ishii M, Fujita M, Shiotani A. Forgotten Kirschner wire passing across the sigmoid colon. Clin J Gastroenterol 2017; 10:154-156. [PMID: 28110444 DOI: 10.1007/s12328-017-0713-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 01/06/2017] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Hiroshi Matsumoto
- Division of Gastroenterology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 7100011, Japan.
| | - Shogen Yo
- Division of Gastroenterology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 7100011, Japan
| | - Shinya Fukushima
- Division of Gastroenterology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 7100011, Japan
| | - Motoyasu Osawa
- Division of Gastroenterology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 7100011, Japan
| | - Takahiro Murao
- Division of Gastroenterology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 7100011, Japan
| | - Manabu Ishii
- Division of Gastroenterology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 7100011, Japan
| | - Minoru Fujita
- Division of Gastroenterology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 7100011, Japan
| | - Akiko Shiotani
- Division of Gastroenterology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 7100011, Japan
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Kassé AN, Limam SOM, Diao S, Sané JC, Thiam B, Sy MH. [Fracture-separation of the medial clavicular epiphysis: about 6 cases and review of the literature]. Pan Afr Med J 2016; 25:19. [PMID: 28154711 PMCID: PMC5268753 DOI: 10.11604/pamj.2016.25.19.8787] [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] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 03/28/2016] [Indexed: 11/11/2022] Open
Abstract
This study aims to describe the epidemiological characteristics and the different anatomo-clinical entities of the fracture-separation of the medial clavicular epiphysis but also to relate the morphological and functional results of bloody reduction followed by osteosuture using non absorbable thread. Five boys and one girl (mean age 14 years) showed a closed and isolated shoulder girdle trauma. Clinical examination and medical imaging, especially CT scan, allowed the diagnosis of epiphyseal separation and to classify the degree of medial clavicular epiphysiseal ossification indicating the direction of displacement as well as the nature of displacement according to the Salter-Harris classification. Bloody reduction followed by osteosuture using non absorbable thread (No. 1 decimal) was performed in 3 patients. One patient underwent cross-pinning the two younger patients were treated orthopedically. The displacement of the clavicle stump was anterior in 3 patients and retro-sternal in 3 patients. Posterior forms were complicated by odynophagia (n = 2) and asymptomatic compression of the subclavian vein (n = 1). One of the posterior forms was associated with an ipsilateral fracture of the medial one third of the clavicle. Consolidation was achieved in all patients with preservation of shoulder mobility. The fracture-separation of the medial end of the clavicle mimes clinically and radiologically the sternoclavicular dislocation. It can be serious because of the risk of visceral and vascular compression in its posterior form. Tomdensitometry is irreplaceable for an accurate diagnosis. Our preference is for bloody reduction followed by osteosuture using non metallic thread.
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Affiliation(s)
- Amadou Ndiassé Kassé
- Service d'Orthopédie-Traumatologie de l'Hôpital Général de Grand Yoff, Dakar, Sénégal
| | | | - Souleymane Diao
- Service d'Orthopédie-Traumatologie de l'Hôpital Général de Grand Yoff, Dakar, Sénégal
| | - Jean Claude Sané
- Service d'Orthopédie-Traumatologie de l'Hôpital Général de Grand Yoff, Dakar, Sénégal
| | - Babacar Thiam
- Service d'Orthopédie-Traumatologie de l'Hôpital Général de Grand Yoff, Dakar, Sénégal
| | - Mouhamadou Habib Sy
- Service d'Orthopédie-Traumatologie de l'Hôpital Général de Grand Yoff, Dakar, Sénégal
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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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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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Forgotten Kirschner wire causing severe hematuria. Case Rep Urol 2014; 2014:305868. [PMID: 25136472 PMCID: PMC4127247 DOI: 10.1155/2014/305868] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 05/31/2014] [Indexed: 12/05/2022] Open
Abstract
Kirschner wire (K-wire) is commonly used in the treatment of hip fracture and its migration into pelvis leading to bladder injury is a very rare complication. Nonremoval of these devices either because of lack of followup or because of prolonged requirement due to disease process is associated with this complication. We report a case of a patient who presented with acute onset severe hematuria with clot retention secondary to perforation of bladder by a migrated K-wire placed earlier, for the treatment of hip fracture. Initial imaging showed its presence in the soft tissues of the pelvis away from the major vascular structures. Patient was taken for emergency laparotomy and wire was removed after cystotomy. Postoperative period was uneventful and patient was discharged in satisfactory condition. K-wires are commonly used in the management of fracture bones and their migration has been reported in the literature although such migration in the intrapelvic region involving bladder is very rare. Early diagnosis and prompt removal of such foreign bodies are required to avert potentially fatal involvement of major structures.
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Ozarslan F, Arıkan O, Acat M, Arıkan M, Temel V. Intrathoracic migration of a Kirschner wire. J Surg Case Rep 2014; 2014:rjt132. [PMID: 24876333 PMCID: PMC3913435 DOI: 10.1093/jscr/rjt132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Kirschner (K) wires can easily migrate, resulting in serious complications. We report a 49-year-old woman who had a rare and late complication related to the migration of K wire. It had been used for left hip replacement 8 years ago. The patient admitted to our hospital with breathing-dependent chest pain and increasing dyspnea for ∼2 h. Chest X-ray and chest computed tomographic scans revealed the presence of a metallic image of ∼5–6 cm in the right hemithorax. There was a large hemothorax but no pneumothorax. A right thoracotomy was performed and the wire was removed without complications. Surprisingly, no injury was noted to any intervening abdominal structure intra-operatively. Patients, who are treated with K wire, should be informed of the risk of wire migration and should undergo regular postoperative follow-ups including radiography.
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Affiliation(s)
- Fatma Ozarslan
- Department of Thoracic Surgery, Karabük State Hospital, Karabük, Turkey
| | - Osman Arıkan
- Department of Orthopedic Surgery, Karabük State Hospital, Karabük, Turkey
| | - Murat Acat
- Department of Chest Diseases, Faculty of Medicine, Karabük University, Karabük, Turkey
| | - Müge Arıkan
- Department of Anesthesia, Faculty of Medicine, Karabük University, Karabük, Turkey
| | - Volkan Temel
- Department of Anesthesia, Karabük State Hospital, Karabük, Turkey
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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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Hamman D, Lindsey D, Dragoo J. Biomechanical analysis of bicortical versus unicortical locked plating of mid-clavicular fractures. Arch Orthop Trauma Surg 2011; 131:773-8. [PMID: 21069362 DOI: 10.1007/s00402-010-1212-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Operative fixation of displaced mid-shaft clavicle fractures has been shown to improve the functional outcomes and decrease the likelihood of non-union; however, little is known about the need for locking screws versus traditional screws. We, therefore, evaluated the strength of unicortical locked plating versus traditional bicortical non-locking fixation methods. METHODS Ten matched pairs of fresh, frozen cadaver clavicle specimens were obliquely osteotomized through the mid-shaft to represent the most common fracture pattern. After randomization, the clavicles were repaired using pre-contoured plates with either standard bicortical non-locking screws or unicortical locking screws. The constructs were then potted in cement and tested on a MTS machine using a custom gimble and evaluated for load to failure and axial and rotational stiffness. RESULTS There was no significant difference between the constructs in terms of axial stiffness (locking 688.3 ± 306.2 N/mm, non-locking 674.5 ± 613.0 N/mm; p = 0.77) or load to failure (locking 720.1 ± 232.0 N, non-locking 664.8 ± 167.5 N; p = 0.46). However, rotational stiffness varied significantly (locking 1.70 ± 0.91 N-m/mm, non-locking 2.49 ± 0.78 N-m/mm, p = 0.049) with bicortical non-locking constructs exhibiting higher torque values. CONCLUSIONS Unicortical fixation using pre-contoured plates and locking screws has a similar biomechanical profile compared to gold standard non-locked bicortical screws in cyclic axial compression and axial load to failure. Non-locking constructs were stiffer under rotational testing. This technique may provide a suitable biomechanical environment for bony healing. This may also improve the safety of clavicle plating by protecting infraclavicular structures from injury during drilling or screw penetration as it obviates the need for bicortical fixation.
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Affiliation(s)
- Daniel Hamman
- Orthopedic Physicians of Colorado, 799 E. Hampden Ave, #400, Englewood, CO 80113, USA.
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Sharma R, Tam RK. Migrating foreign body in mediastinum--intravascular Steinman pin. Interact Cardiovasc Thorac Surg 2011; 12:883-4. [PMID: 21297134 DOI: 10.1510/icvts.2010.256503] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report a case of migration of a Steinman pin to the innominate vein. A pin was used to fix a shoulder separation but a broken piece was left unattended at the time of removal of the pin. How this piece made its way in to innominate vein is puzzling. To our knowledge migration of fixation wires to the innominate vein has not been reported previously.
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Affiliation(s)
- Rajiv Sharma
- Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, QLD 4102, Australia.
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Veres L, Kiss R, Boros M, Enyedi A, Takács I, Kollár S, Damjanovich L, Sz Kiss S. [Intrathoracic migration of Kirschner wires]. Magy Seb 2009; 62:353-356. [PMID: 19945939 DOI: 10.1556/maseb.62.2009.6.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Orthopedic surgeons apply metallic pins to stabilize the clavicule and humerus on a daily basis. Migration of these pins into the thoracic cavity is rare. We present the case of an elderly female patient, whose right humeroscapular joint was fixed with Kirschner wires due to recurrent luxation. Six weeks later, a follow-up X-ray revealed that the pins have migrated into the right thoracic cavity, confirmed by a CT chest. Videothoracoscopic removal of the metallic pins was not possible because of dense adhesions. Right anterolateral thoracotomy was carried out, and after pneumolysis one pin was taken out from the 2nd lung segment. The other one, which was running along the cupola and entering the spinal cord, was also removed. There was no postoperative surgical complication. The authors review the literature of this rare complication and point out that pins migrating into the thoracic cavity should be removed to avoid life threatening complications.
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Affiliation(s)
- Lukács Veres
- Debreceni Egyetem, Orvos- és Egészségtudományi Centrum Sebészeti Intézet, Mellkassebészeti Központ, Debrecen.
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Intrathoracic migration of a Steinman wire: a case report and review of the literature. CASES JOURNAL 2009; 2:8321. [PMID: 19830066 PMCID: PMC2740030 DOI: 10.4076/1757-1626-2-8321] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Accepted: 07/07/2009] [Indexed: 11/08/2022]
Abstract
Introduction Migration of orthopaedic fixation wires into the thoracic cavity occurs infrequently, but can have dire consequences. Although rare, intrathoracic migration is a serious complication that demands immediate removal. Case presentation We present a case of a 59-year-old man with an intrathoracic migration of a Steinman wire used for the treatment of a shoulder fracture. Surprisingly, the migration was asymptomatic. The Steinman wire was successfully retrieved from the thorax via thoracotomy. Conclusion The migration of pins and wires can cause fatal complications and should be considered as very hazardous. Therefore, if wires need to be used, terminally threaded pins are safer and the free end should be bent. The patients should be frequently followed, both clinically and radiographically, until all the wires are removed.
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