Migration of a Kirschner wire from the sternum to the right ventricle

Abstract

Associates , Lake Charles , LouisianaWires and pins are some of the appliances most widely used by orthopaedic surgeons to obtain fixation. The migratory tendency of these implants has also been documented, especially around the shoulder. 1,6,7,9,12,14 This case report emphasizes the hazards of migration of pins used for sternoclavicular joint stabilization. CASE REPORTA 45-year-old woman sustained a traumatic anterior dislocation of her right sternoclavicular joint. At another institution, she had a closed reduction and percutaneous pinning using two smooth Kirschner wires.Approximately 5 weeks after the operation she complained of retrosternal discomfort and pain in the left third intercostal area. Roentgenograms of the chest showed mediastinal migration of one of the Kirschner wires ( Fig. 1). Computerized tomography demonstrated the pin in the mediastinum, parallel to the aorta (Fig. 2). She was referred to our institution for further treatment.Vital signs were normal on admission. Examination was unremarkable except for erythema, mild swelling, and mild tenderness around the right sternoclavicular joint. In addition, there was mild tenderness at the left third intercostal area. The patient was admitted for elective thoracotomy to be done the next morning.Shortly after admission, she developed signs and symptoms of cardiac tamponade, as demonstrated by tachypnea, severe retrosternal pressure, hypotension, and jugular venous distension. An emergency thoracotomy was performed through a median sternotomy. A large pericardial hematoma Figure 1. Chest radiograph showing migration of Kirschner wire into mediastinum.was encountered as well as a laceration in the right ventricle secondary to the Kirschner wire, which was in the right ventricle. The Kirschner wire was removed, and the myocardial laceration was repaired.In addition, the right sternoclavicular joint was explored and the remaining Kirschner wire was removed. Debridement of the joint was done, and a Gram's stain of the material showed Gram-positive cocci. Intravenous antibiotics were given and cultures showed Staphylococcus epidermidis. Antibiotic treatment was rendered. Her postoperative course was uneventful, and she was discharged from the hospital approximately 11 days after the operation.Six weeks after the operation, she had full range of motion of her shoulder without pain and demonstrated no instability of the sternoclavicular joint.t Address correspondence and reprint requests to: David Drez, Jr., MD, 2615 Enterprise Boulevard, Lake Charles, LA 70601.

Migration of a Kirschner Wire Used in the Fixation of a Subcapital Humeral Fracture, Causing Cardiac Tamponade

“…Often, the first sign of such a migration is a routine radiograph of the fixation site showing a missing device, 2 or nonspecific symptoms such as arrhythmia, chest pain, hemoptysis, etc. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] The causes for said migration are still obscure. Several theories have been proposed, including muscular activity, respiratory exertion, negative intrathoracic pressure, regional resorption of bone, gravitational forces, and the great freedom of motion of the upper extremity.…”

“…Since then, other papers have been published, reporting more cases [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] in which pins migrated from the site of insertion around the shoulder girdle to an extraordinary variety of anatomic locations in the chest cavity, including the major vascular structures, the lung, the mediastinum, the heart, the trachea, and even the breast and the neck. Rajesh and Nair 21 have even reported a case in which a Kirschner wire migrated from the right shoulder to the spleen within 12 hours.…”

Fratture dell’omero prossimale. La sintesi percutanea: ha ancora un ruolo?

“…Oltre alla scomposizione secondaria della frattura e alla protrusione di impianti metallici nello spazio articolare, la migrazione dei fili a distanza può avere gravi conseguenze in relazione alla sede anatomica interessata. Mazet nel 1943 [19] per primo ha descritto la migrazione intratoracica di un filo di Kirschner; inoltre in letteratura sono state descritte penetrazioni in distretti diversi: spazio pleurico [20], parenchima polmonare [21], mediastino [22], cuore [23], aorta toracica [24], arteria polmonare [25], retroperitoneo [26] e regione cervicale [22]. Nella nostra esperienza la deformazione elastica dei fili da 2 mm, indotta con l'introduzione retrograda nel canale omerale, ha permesso di evitare la migrazione di questi mezzi di sintesi in una serie consecutiva di 65 pazienti, indipendentemente dall'età.…”

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

“…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.…”