Migrating foreign body in mediastinum--intravascular Steinman pin

Migrated subcutaneous sharp foreign body in the anterior chest wall: An unusual presentation

Key Clinical Message

Migration of any foreign body can cause potentially life threatening complications and should be reviewed by a multidisciplinary approach for the management. Diagnosis can be challenging; a history of foreign body injury could be suspicious.

Abstract

Foreign body injury to the chest wall can be an emergency situation and require a multidisciplinary approach for the management of the condition. Migration of the foreign body, though rare, can lead to potentially life threatening complications and require a multidisciplinary approach for the localization of the foreign body and subsequent management of the condition. A 50-year-old male presented to the emergency department with the complaint of left sided chest pain. Upon examination, the patient was found to have a penetrating injury 6 years back by a sharp object. Radiological investigations helped in the localization of the migrating foreign body, which was removed with effective surgical intervention. The postoperative chest x-ray was normal, the patient was asymptomatic and thus the patient was discharged on the same day following surgery.

Thirteen years of migration of Kirschner wires: A mediastinal foreign body

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.

Another Use for EUS: Removal of a Transesophageal-Migrated Mediastinal Foreign Body

Removal of foreign bodies from the upper gastrointestinal tract, though a common occurrence, can be technically challenging and risky. We report the case of a young man that, after eating a pizza cooked in a wood-burning oven, reported a sense of foreign body. Though the first evaluation by fiberoptic laryngoscopy found no foreign body, after a few weeks, the patient was readmitted from the ER for worsening symptoms and fever. A CT scan showed a metallic mediastinal foreign body inside a large fluid collection. After multidisciplinary evaluation, an endoscopic removal was attempted by accessing the mediastinal collection through EUS-guided positioning of a Hot Axios™ stent. The cavity was drained by naso-esophageal suction. The foreign body was a fragment of the brush used to clean the oven. The patient is now doing well after 7 months.

Broken Kirschner Wires Can Migrate: A Case Report and Review of Literature

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.

Chronic impalement- Case report of a knitting needle 33 years' ascension

Background

We report the case of a 72-year-old female complaining of hemoptysis due to a thoracic-abdominal knitting needle inserted 33 years ago for self-induced abortion.

Case Presentation

The PA/LL chest x-ray showed a metallic foreign body on thorax extending into the abdomen. An CT examination confirmed the transdiaphragmatic knitting needle extending from liver into right upper lobe.

Conclusions

Surgical removal of the foreign body and wedge resection were performed with good follow-up results.

Smooth Pins Reinforcing Static Cement Spacers for Infected Total Knee Arthroplasty Are Not Safe

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.].

Intrathoracic migration of an unbent Steinmann pin

Steinmann pins are known to be used as a shoulder stabilisation device in recurrent dislocation. Although rare, their potential to migrate within the thorax has been reported. We present the case of an 87-year-old man who was treated for recurrent left shoulder dislocation with pinning using a Steinmann pin. He presented eight days postoperatively with the pin impaling the aortic adventitia. To our knowledge, this is only the fifth case report of such an event. Awareness of this complication and attempts to prevent its occurrence are critical as the outcome can be fatal.

A novel technique for ligamentous reconstruction of the sternoclavicular joint

The technique presented is a departure from previous attempts to standardize the treatment of sternoclavicular dislocations. It offers stability without requiring extra dissection around vital intrathoracic structures and greatly decreases the risk of migration of the implant used for fixation.

Migration of trochanteric cerclage cable debris to the knee joint

Migrating orthopedic hardware has widely been reported in the literature. Most reported cases of migrating hardware involve smooth Kirschner wires or loosening/fracture of hardware involved with joint stabilization/fixation. It is unusual for hardware to migrate within the soft tissues. In some cases, smooth Kirschner wires have migrated within the thoracic cage—a proposed mechanism for this phenomenon is the negative intrathoracic pressure. While wires have also been reported to gain access to circulation, transporting them over larger distances, the majority of broken or retained wires remain local. We report a case of a 34-year-old man in whom numerous fragments of braided cable migrated from the hip to the knee.