Hemoptysis Due to Migration of a Fractured Kirschner Wire

Foster, Guy T.; Chetty, Kota G.; Mahutte, Kees; Kim, Janet B.; Sasse, Scott A.

doi:10.1378/chest.119.4.1285

Cited by 38 publications

(22 citation statements)

References 5 publications

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“…Numerous cases of foreign-body migration after mediastinoscopy, cardiothoracic and orthopaedic procedures, as well as its features and facilitating factors, have been debated [5][6][7][8][9]. A ubiquitous orthopaedic procedure -correction of scoliosis with VDS implant alterates topographic and dynamic relations of thoracic vertebrae to adjacent structures and between themselves.…”

Section: Discussionmentioning

confidence: 99%

Late Bronchus Perforation due to Spinal Implant Compression

Sokolović

Slobodnjak

Mažuranić

2016

JACCOA

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We report a rare case of perforation of the intermediate bronchus by a loosened osteosynthetic implant, 8 years after the patient had undergone surgery for right thoracic scoliosis with the VDS instrumentation. Due to chronic lung inflammatory alteration caused by bronchial obstruction, lower bi-lobectomy was performed. We believe that spinal growth and progression of idiopathic scoliosis can lead to implant failure, while the variance in intrathoracic topographic relations and respiratory excursion facilitate it's penetration into the bronchus. In order to impede foreign body perforation of mediastinal structures and to reduce its complications, preventive methods, along with timely diagnostics, are required. Atelectatic and chronic inflammatory alterations that compromise adequate lung ventilation could require a resection procedure.Keywords: Foreign body; Lobectomy; Thoracic scoliosis; VDS instrumentation of complications, such as: lethal outcome in less than 1%, neurological damage, irreversible loss of the normal active range of the movement in the vertebral column, strain on unfused vertebrae, post-surgery pain (19% of patients required re-operation within 2 to 8 years after surgery), deep wound infections (5-10%), bone deterioration due to inflammatory response to metallic implant, curvature progression due to failure of instrumentation, decompensation and increased sagittal deformity (˝flat back˝), torso deformity (˝flail chest˝) [1]. A choice of treatment for thoracic scoliosis is anterior instrumentation surgery because better correction can be obtained with shorter fusion levels [2]. However, anterior instrumentation carries a greater risk for penetration of vital structures by sprung fragment of inner vertebral fixator, as well as the effect of disrupted chest cage on pulmonary function.Spinal fusion surgery is recommended when the magnitude of curvature exceeds 45°, but it is expected for 1/3 of patients to lose all postoperative correction within 1-10 years post-surgery [3]. It has been noted that 1.5% of the screws inserted in the thoracic level were displaced, but they did not cause any adversely effect on long-term results [1]. We present a rare case of erosion of the intermediate bronchus caused by dislocated osteosynthetic material implanted for the treatment of thoracic scoliosis in 1995. To our knowledge, only one case of erosion of the bronchus after surgical treatment of scoliosis has been reported [4]. Both of patients presented with long-time history of cough, haemoptysis and dyspnoea. Case PresentationIn June of 1995 a 17-year-old patient underwent spinal instrumentation and fusion through placement of VDS implants for the treatment of idiopathic right thoracic scoliosis. The type of curve by Lenke classification system for scoliosis was 2AN (curve length from the 5th thoracic through the 1st lumbar vertebra), with measured Cobb's angle of 90°. The operation was performed through a right thoracotomy. The VDS implants were inserted laterally on the convex side of the vertebral bo...

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Section: Discussionmentioning

confidence: 99%

Late Bronchus Perforation due to Spinal Implant Compression

Sokolović

Slobodnjak

Mažuranić

2016

JACCOA

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“…Migration within hours has also been reported [10]. The short time interval may suggest that migration of orthopedic wires is a technique-related problem (i.e., inadequate engagement of the orthopedic wire in the bone cortex), although many factors (e.g., respiratory excursion, physical activities or gravitational forces) migration may contributed to such a complication [1,3].…”

Section: Survivedmentioning

confidence: 99%

“…Although migration of orthopedic wires to the trachea [3,4] or arch vessels [5][6][7][8][9] has been reported, such a complication involving both the trachea and arch vessels has not previously been described. Our report corroborated the potential danger of Kirschner wire migration, as reported previously [1,[3][4][5][6][7][8][9]. The incidence of iatrogenic injury due to orthopedic wire migration is believed to be underestimated because of the potential for subsequent litigation.…”

Section: Survivedmentioning

confidence: 99%

Tracheoinnominate artery fistula caused by migration of a Kirschner wire

Lai

Luo

et al. 2009

European Journal of Cardio-Thoracic Surgery

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Iatrogenic injury is an underreported but potentially devastating complication of orthopedic wire migration. We report a 48-year-old man with a tracheoinnominate artery fistula caused by migration of a Kirschner wire that was inserted for fixation of a left clavicle fracture nine years before. Following surgical removal of the wire and repair of both trachea and innominate artery, the patient recovered eventually. Although migration of orthopedic wire to the trachea has been reported twice in previous literature, such a complication involving both the trachea and arch vessel was not previously described. Physicians who care for patients with orthopedic wires in place should be aware of migration with tracheoinnominate artery fistula and other iatrogenic injuries as potentially lethal complications.

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“…There are several reports in the literature describing fatal complication following distant migration of a K-wire to vital structures such as the heart, thoracic big vessels and lungs. [1][2][3][4][5][6][7][8] Minor complications could be important factors in enhancing parental anxiety and prolonging patients' recovery; however, they are extremely under-reported.…”

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confidence: 99%

A Review of K-wire Related Complications in the Emergency Management of Paediatric Upper Extremity Trauma

Sharma

Taylor

Clarke

2007

annals

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INTRODUCTION Kirschner wires (K-wires) are immensely versatile in fracture fixation in the paediatric population. Complications associated with the K-wiring procedure vary from minor to a life-threatening. The aim of this study was to analyse the outcome of fracture fixation using K-wires in all types of upper-extremity fractures in children in order to assess the incidence and type of complication critically.PATIENTS AND METHODS Between September 1999 and September 2001, we retrospectively reviewed a consecutive series of 105 fractures in 103 paediatric trauma cases (below 12 years) treated with K-wires in a university teaching hospital. The case notes and radiographs were reviewed by an independent single assessor. All paediatric, acute, upper-extremity, displaced and unstable fractures were included. All elective procedures using K-wires were excluded. RESULTS We observed an overall 32.3% complication rate associated with the K-wiring procedure affecting 34 pins (24 patients). Wound-related complications included over-granulation in 13 cases, pin tract infection in 6 cases and hypersensitive scar in 1 case. Neurapraxia was found in 3 patients and axonotmesis in 1 patient. Wire loosening at the time of removal in 14 cases and retrograde wire migration in 4 cases were observed. There were 2 cases of penetrating tendonitis and 1 case of osteomyelitis. There was a higher complication rate in terms of wire loosening and pin tract infection when the K-wires: (i) were left outside the skin compared with those placed under the skin; (ii) stayed longer in the patients; and (iii) did not traverse both cortices. There were more complications in complex operations performed by senior surgeons (P = 0.056). The duration of K-wire stay, associated co-morbidity and anatomical location were statistically insignificant.CONCLUSIONS Complications are part of operative procedures; an important point to consider is what causes them in order to take preventative measures. We recommend that the risks and complications should be explained to parents during the consenting process to allay their anxiety, irrespective of the fact that most complications are minor and of short duration.

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Hemoptysis Due to Migration of a Fractured Kirschner Wire

Cited by 38 publications

References 5 publications

Late Bronchus Perforation due to Spinal Implant Compression

Late Bronchus Perforation due to Spinal Implant Compression

Tracheoinnominate artery fistula caused by migration of a Kirschner wire

A Review of K-wire Related Complications in the Emergency Management of Paediatric Upper Extremity Trauma

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