Migration of a Kirschner Wire From the Clavicle Into the Intrathoracic Trachea

Nakayama, Mitsuo; Gika, Masatoshi; Fukuda, Hiroki; Yamahata, Takeshi; Aoki, Katsumi; Shiba, Syugo; Eguchi, Keisuke

doi:10.1016/j.athoracsur.2008.12.093

Cited by 39 publications

(29 citation statements)

References 4 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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“…Ortopedik ameliyatlarda tespit amaçlı kullanılan tel ve çivi gibi enstrümanların akciğerler veya vücu-dun başka bölgelerine migrasyon gösterebileceği [1][2][3][4] ilk kez 1943 yılında Mazet [5] tarafından yayınlan-mıştır. Migrasyona uğrayan bu metalik cisimlerin birçok komplikasyona yol açtığı da bilinmektedir.…”

Section: Discussionunclassified

“…Migrasyona uğrayan bu metalik cisimlerin birçok komplikasyona yol açtığı da bilinmektedir. [6] Literatürde trakea perforasyonu, [2] özofagus penetrasyonu, [4] aorta penetrasyon, [6] trakea-brakiyosefalik arter fistülü [7] ve kardiyak perforasyon [8] gibi komplikasyonlar bildirilmektedir. Olguların bir kısmı uygulanan cerrahi tedavi ile iyileşebilir iken, bir kısmı da yaşamını yitirmektedir.…”

Section: Discussionunclassified

“…Genellikle üst ekstremite ve klavikula kırıkları sonrası kullanılan Kirschner tellerinin göç edebileceği bilindiğinden [1][2][3][4][5][6][7][8] ya tedavi bitiminde çıkartılmasının ya da proksimal uçlarının "şemsiye sapı" gibi kıvrılarak migrasyonu engelleyici manevraların yapılmasının, yer çekimine bağlı migrasyonu ve bunun istenmeyen komplikasyonlarını engelleyebileceği kanaatindeyiz.…”

Section: Discussionunclassified

“…[1] Klavikula kırığı sonrası yerleştirilen ve toraks içine migrasyon göste-ren Kirschner telleri literatürde bildirilmiştir. [2][3][4] Bu yazıda, otuz yıl önce klavikula ve kaburga kırığı stabilizasyonu amacı ile kullanılan tellerden birinin perikard içine ve karaciğere migrasyon göstermesi sonucu ameliyat edilen bir olgu sunuldu.…”

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