Intrathoracic migration of a Steinman wire: a case report and review of the literature

Sergides, Neoptolemos; Nikolopoulos, Dimitrios; Yfadopoulos, Dimitrios K; Novi, Evanthia; Kanata, Maria P

doi:10.4076/1757-1626-2-8321

Cited by 8 publications

(6 citation statements)

References 9 publications

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“…Despite being rare, transthoracic migration of Steinmann pins has been reported in the literature, 4 sometimes with fatal effect. 5 The learning point from this case is that irrespective of the fixation device used, it must be secured at the skin, by bending or with a collar lock.…”

Section: Discussionmentioning

confidence: 99%

Intrathoracic migration of an unbent Steinmann pin

Mozaffari

Estfan

Sarkar

2014

annals

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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. KEYWORDSSteinmann pin/wire -Recurrent shoulder dislocation -Intrathoracic migration Case HistoryAn 87-year-old man was referred to the orthopaedic department with a dislocated left shoulder (Fig 1). As well as recurrent atraumatic dislocation of the left shoulder, he had multiple co-morbidities including ischaemic heart disease, atrial fibrillation, a previous stroke and dementia. However, he had developed persistent pain in the joint and an operation was therefore deemed suitable. He underwent manipulation under anaesthesia and stabilisation of the glenohumeral joint in January 2013. Although we would typically use a thin Steinmann pin for shoulder fixation, none were available and so a larger (6mm) Steinmann pin was used. Figure 2 shows the intraoperative radiography of the reduced shoulder and Steinmann pin in situ. It was not possible to bend the exposed end of the larger pin. As a result, the pin was left straight.The patient presented to the emergency department three days later following a fall. Figure 3 shows the radiography at this time. The shoulder joint was dislocated and the Steinmann pin had retracted out of the glenoid. He was discharged from the emergency department and an orthopaedic opinion was not sought at this point.Five days later, the patient re-presented to the fracture clinic for a follow-up appointment complaining of chest pain and shortness of breath. Figure 4 shows the radiography revealing a left-sided pneumothorax with the pin reaching the mediastinal space. Such an injury would probably have developed into a life threatening tension pneumothorax. Further computed tomography showed the pin to be resting in the aortic adventitia, at the level of the arch between the arch and the pulmonary artery branch (Fig 5).The patient was tachycardic (heart rate 110bpm) but normotensive with an oxygen saturation of 90% on air. A chest drain was immediately inserted and he was resuscitated with high flow oxygen. He was transferred to a cardiothoracic unit where the pin was found to be impaling but not penetrating the aortic adventitia. It was removed via video assisted thoracic surgery (VATS) and he was further managed with a chest drain. A left-sided pneumothorax was the only complication and he made a swift recovery. He now has a chronically dislocated left shoulder with no movement at the joint. He is, however, pain free and no further surgery is planned.

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Section: Discussionmentioning

confidence: 99%

Intrathoracic migration of an unbent Steinmann pin

Mozaffari

Estfan

Sarkar

2014

annals

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“…8 Migration sites include the spinal canal, trachea, spleen, pulmonary artery, heart, mediastinum, lung, subclavian artery, and ascending and abdominal aorta. 9 Several theories have been proposed to explain the migration of nails and fixation wires, including muscle activity, regional bone resorption, and the great freedom of motion of the shoulder. Muscle activity and regional bone resorption may cause nails and wires to break, which may facilitate their migration.…”

Section: Commentmentioning

confidence: 99%

“…The great freedom of motion of the shoulder may contribute to migration by allowing the nails and wires to move. 9 Although bending the free end of the nails may help prevent migration, it is not always effective. The duration of device implantation is also a risk factor.…”

Section: Commentmentioning

confidence: 99%

Evadiendo lesiones letales de mediastino, migración de clavo de Steinmann

Cuevas-Álvarez,

Martínez-Pérez,

Echeverry-Gutiérrez

et al. 2024

Cirugía Cardiaca en México

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We present the case of a 29-year-old male, who was admitted with respiratory distress with unsatisfactory evolution. With the history and complementary studies, an intrapulmonary foreign body was diagnosed with involvement of the main bronchi. He underwent surgery, extracting a foreign body (Steinmann nail) in the upper lobe of the right lung. Because of its presentation, location and challenging treatment, the case is presented to show the most relevant clinic-surgical and pathological aspects.

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“…Particularly for transfixations of the AC joint, life-threatening dislocations and breakage of the implant have also been described [22][23][24].…”

Section: Introductionmentioning

confidence: 99%

“…vessels [23,27,34,[45][46][47][48], or breakage [49,50] and secondary loss of reduction [10,50]. Another possible complication is early acromioclavicular degeneration, which may not be caused by articular perforation of the K-wires as it has also been reported after conservative treatment and coracoclavicular fixation [43,51].…”

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confidence: 99%

Navigated versus conventional transfixation of AC joint injuries: Feasibility and accuracy

Stübig

Jähnisch

Petri

et al. 2013

Computer Aided Surgery

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Objective: Transfixation of the acromioclavicular (AC) joint is a well-established technique for treating Rockwood IV to VI lesions. However, several complications, including pin breakage or pin migration due to incorrect placement, have been reported in the literature. A cadaveric study was performed to investigate whether the use of 3D navigation might improve the accuracy of AC joint transfixation. Methods: Seventeen transfixations of the AC joint (8 non-navigated, 9 navigated) were performed minimally invasively in cadaveric shoulders. For the navigated procedures, a 3D C-arm (Ziehm Vision FD Vario 3D) and a navigation system (BrainLab VectorVision) were used. Reference markers were attached to the spina scapulae, then a 3D scan was performed and the data transferred to the navigation system. Two Kirschner wires (K-wires) were placed either freehand under fluoroscopic control (in the non-navigated group) or with the use of a navigated drill guide. Radiological analysis was performed with OsiriX software, measuring the distance of the K-wires from the center of the AC joint. For statistical analysis, Student's t-test was performed, with the significance level being set to p < 0.05. Results: The maximum distance of the K-wires from the center of the AC joint was 5.4 AE 1.1 mm for the freehand nonnavigated group and 3.1 AE 1.6 mm for the navigated group (p ¼ 0.0054). The minimum distance of the K-wires from the AC joint center was 3.0 AE 0.6 mm for the freehand group and 1.6 AE 0.6 mm for the navigated group (p ¼ 0.0002). The radiation time was significant lower for the freehand group (41.25 AE 20.4 seconds versus 79.5 AE 13.3 seconds for the navigated group, p ¼ 0.004). There was no statistical difference between the groups with respect to the time required for surgery (11.25 AE 3.6 min for the freehand group and 12.6 AE 4.6 min for the navigated group; p ¼ 0.475). In the freehand group, the AC joint was penetrated by both K-wires in 87.5% of the procedures, compared to 100% in the navigated group. Both K-wires were placed completely intraosseously in the clavicula in 50% of the procedures in the freehand group, compared to 88% in the navigated group. Conclusion: Three-dimensional navigation may improve the accuracy of AC joint transfixation techniques. However, the radiation time is increased when using the navigated procedure, while the overall operation time remains comparable. Nevertheless, a 3D C-arm with a variable isocentric design is recommended for the acquisition of the shoulder scans.

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Intrathoracic migration of a Steinman wire: a case report and review of the literature

Cited by 8 publications

References 9 publications

Intrathoracic migration of an unbent Steinmann pin

Intrathoracic migration of an unbent Steinmann pin

Evadiendo lesiones letales de mediastino, migración de clavo de Steinmann

Navigated versus conventional transfixation of AC joint injuries: Feasibility and accuracy

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