Intravascular migration of a broken cerclage wire into the left heart

A Monocortical Screw for Preventing Trochanteric Escape in Extended Trochanteric Osteotomy: A Simple Solution to a Complicated Problem?

Extended trochanteric osteotomy (ETO) is an established method in revision total hip arthroplasty. Proximal migration of the greater trochanter fragment and the resulting non-union of the osteotomy remains a major problem, and several techniques have been developed to prevent its occurrence. This paper describes a novel modification of the original surgical technique in which a single monocortical screw is placed distally to one of the cerclages used for the fixation of the ETO. The contact between the screw and the cerclage counteracts the forces applied on the greater trochanter fragment and prevents trochanteric escape under the cerclage. The technique is simple and minimally invasive, does not require special skills or additional resources, or add to surgical trauma or operating time, and therefore represents a simple solution to a complicated problem.

Broken pin removal from hip joint using arthroscopic grasper - A technical note and review of literature

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.

Entrapment of a metal foreign body in the heart during surgical procedure: A case report and literature review

A rongeur had been used to remove thin bones in both orthopedic surgery and neurosurgery, featured with a tip holding and cutting bone effectively while protecting the underlying instruments. The authors describe a case of a 40-year-old man who proceeded with the second lumbar vertebrae osteotomy and presented to be ankylosing spondylitis with kyphosis and limited mobility for 10 years. During the surgery, we found that the rongeur tip was missing. C-arm fluoroscopy showed the high-density body just in front of the vertebral body intraoperatively. However, the CT scan showed the foreign body migrated to the right auricle of the heart postoperatively. This case is unique in that there was no exact vessel injury detected intraoperatively. There were few reports about the surgical instrument migrating to the heart. Our case showed the rare experience of the function of multidisciplinary collaboration in the migration of foreign bodies in the cervical spinal canal.

Fixation options for reconstruction of the greater trochanter in unstable intertrochanteric fracture with arthroplasty

INTRODUCTION

With the aggravation of population aging, the incidence of intertrochanteric fracture also increases dramatically. Patients are often elderly accompany with severe osteoporosis and various complications. Therefore, we should select an individualized treatment based on the each patient's state. Arthroplasty is recommended for unstable fractures with obvious osteoporosis, ipsilateral femoral head necrosis or arthritis. Rigid fixation of the greater trochanter with arthroplasty is challenging because of the powerful pulling forces created by multiple muscles being transmitted to the greater trochanter. Currently, there are few contemporary literatures on the evaluation of unstable intertrochanteric fracture with efficient fixation of the greater trochanter. Moreover, there is no consensus to choose which implant to immobilize the greater trochanter. The purpose of this study was to review previous literatures and provide a valuable guidance.

CONCLUSIONS

The locking plate, which not only provides rigid fixation but also results in lower rate of postoperative complications. However, further prospective randomized and cohort studies are needed.

Intracardic migration of Kirschner wire from the right sternoclavicular joint: a case report

Background

Migration of wires and pins within the heart is an uncommon complication. Intracardic migration of Kirschner wire can cause several complications.

Case presentation

A 55-year-old male patient was admitted to the emergency service with dyspnea, stabbing chest pain. The patient’s medical history showed that he had undergone a fixation operation using Kirschner wire and plate for treatment of the right sternoclavicular joint dislocation about 5 months prior. Chest computerized tomography revealed a metallic foreign body locating in the pericardium between the aorta and the right ventricle. There were not any serious complications occurred before operation due to the timely detection of potential risks. Removal of the wire was performed via median sternotomy under general anesthesia without cardiopulmonary bypass. The symptoms of dyspnea and chest pain were relieved after surgery, and the patient recovered without any complications.

Conclusion

The Kirschner wire should be used judiciously in amphiarthrosis in orthopedic surgery for the risk of breakage and migration. The possibility of intracardiac migration of wire should be considered when chest symptoms presenting after surgery with the Kirschner wire. Migrated wires must be removed immediately to prevent serious complications. Regular follow-up and early removal of fixation wires are recommended to prevent migration of wires.

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.

Fixation Options Following Greater Trochanteric Osteotomies and Fractures in Total Hip Arthroplasty: A Systematic Review

BACKGROUND

The optimal system for greater trochanteric fixation following osteotomy or fracture remains unknown. This systematic review aims to synthesize the available English-language literature on 5 commonly reported trochanteric fixation methods to quantify and compare rates of complications and reoperation.

METHODS

A comprehensive search of MEDLINE and Embase databases from January 1946 to June 2017 was performed for articles in English describing fixation of trochanteric osteotomies and fractures using wires, cables, cable-plate devices, claw or locking plates, and trochanteric bolts. Pooled mean rates of complications and reoperation with 95% confidence intervals (CIs) were analyzed using a random-effects model.

RESULTS

Fifty-seven studies involving 10,956 hips were eligible for inclusion. Five studies had Level-III evidence and 52 had Level-IV evidence. The pooled mean rate of nonunion was 4.17% (95% CI, 3.21% to 5.13%; I = 79%) for wires, 5.07% (95% CI, 0.37% to 9.77%; I = 74%) for cables, 16.11% (95% CI, 10.85% to 21.37%; I = 89%) for cable-plate systems, 9.60% (95% CI, 2.23% to 16.97%; I = 59%) for claw or locking plates, and 12.42% (95% CI, 3.41% to 21.43%; I = 75%) for trochanteric bolts. Substantial heterogeneity in the data precluded formal statistical comparison of outcomes and complications between implants.

CONCLUSIONS

Available literature on the various trochanteric fixation implants is heterogeneous and consists primarily of retrospective case series. Based on the current literature, it is difficult to support the use of one implant over another. Despite superior mechanical properties, rates of complication and reoperation following cable-plate fixation remains suboptimal, especially in complex revision scenarios. Additional rigorous prospective randomized and cohort studies are needed to make definitive recommendations regarding the most reliable method of trochanteric fixation.

LEVEL OF EVIDENCE

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Technical note and surgical outcomes of percutaneous cable fixation in subtrochanteric fracture: A review of 51 consecutive cases over 4 years in two institutions

BACKGROUND

The main purpose of this study is to introduce our surgical technique and report surgical outcomes for percutaneous cable fixation in the treatment of subtrochanteric femoral fractures.

METHODS

Between May 2013 and April 2017, 51 patients with subtrochanteric femoral fractures treated with closed intramedullary nailing and percutaneous cable fixation were enrolled in this study. Postoperative angulation, union rate, time from injury to union, and femoral shortening were also evaluated to assess radiologic outcomes. Clinical outcomes, including range of hip flexion, walking ability, and Harris hip score at the last follow-up were evaluated.

RESULTS

Average coronal and sagittal angulation after surgery were 0.9 (range 0-5) and 0.3 (range 0-5), respectively. There was no postoperative angulation of more than 5°. Average shortening of the femur at 1-year follow-up was 2.7 mm (range 0-15). Bone union was achieved in 50 patients (98.0%) and average time to union was 18.6 weeks (range 12-48). Hip flexion, walking ability and Harris hip score at the last follow up were 115.6° (90-120), 7.9 (5-9), and 88.3 (65-100), respectively.

CONCLUSION

Percutaneous cerclage cable fixation can provide a greater likelihood of achieving anatomical reduction and increased stability of fracture, while preserving biology around the fracture site. Thus, percutaneous cerclage cable fixation can be an effective surgical technique for the treatment of complex subtrochanteric fractures.

Vascular complication after percutaneous femoral cerclage wire

Cerclage wire is an effective fracture fixation method. However, its mechanical benefits are countered by local ischemia. Its efficacy for treating femoral periprosthetic fractures has been demonstrated since femoral fixation is possible even there is a stem in the diaphysis. It securely holds the proximal femur typically with an additional plate. The development of minimally-invasive surgery with plate fixation has led to the cerclage wire being inserted percutaneously. Here, we report on a case of secondary femoral ischemia following percutaneous cerclage wire of a periprosthetic femoral fracture. This was a Vancouver type B1 fracture. On the 3rd day after admission, minimally-invasive fixation with a femoral locking plate was performed with five cerclage wires added percutaneously. During the immediate postoperative course, the patient developed ischemia of the operated leg that required vascular surgery after confirmation by CT angiography. An arterial stop was visible with deviation of the superior femoral artery, which was not properly surrounded by the cerclage wire. The latter pulled perivascular tissues towards the femur. When combined with reduced arterial elasticity due to severe atherosclerosis, it resulted in arterial plication. The postoperative course was marked by multiple organ failure and death of the patient. Percutaneous surgery is an attractive option but has risks. The presence of severe atherosclerosis is a warning sign for loss of tissue elasticity. This complication can be prevented by preparing the bone surfaces and carefully positioning the patient on the traction table to avoid forced adduction. The surgeon must also be familiar with alternative techniques to cerclage wire such as polyaxial screws and additional plates.

Asymptomatic Migration of a Kirschner Wire from the Proximal Aspect of the Humerus to the Thoracic Cavity: A Case Report

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.

Death Due to Intra-aortic Migration of Kirschner Wire From the Clavicle: A Case Report and Review of the Literature

Migration of orthopedic fixation wires into the ascending aorta though a rare occurrence can have devastating consequences. Therefore, prompt recognition, with immediate and cautious retrieval of the implant is paramount in averting these complications.We present a case of a 5-year-old boy with the intra-aortic migration of a K-wire used for the treatment of a right clavicle fracture. He was transferred to us with a history of syncope, chest pain, and shortness of breath 7 days after K-wire placement, which was performed at another hospital. On CT scan, the wire was found to be partially inside the ascending aorta, which was associated with massive hemopericardium and cardiac tamponade. The patient was taken up for emergency surgery for the removal K-wire and for the management of cardiac temponade. However, the patient developed cardiac arrest during the induction of intravenous anesthesia and endotracheal intubation. The K-wire was retrieved from the thorax via thoracotomy. However, the patient died 10 days after the surgery.As the migration of wires and pins during orthopedic surgery can cause potentially fatal complications, these should be used very cautiously, especially for percutaneous treatment of shoulder girdle fractures. The patients with such implants should be followed frequently, both clinically and radiographically. If migration occurs, the patient should be closely monitored for emergent complications and the K-wire should be extracted immediately.