Tracheoinnominate artery fistula caused by migration of a Kirschner wire

Abstract

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.

Transaortic migration of a Steinman wire from the shoulder

“…The most frequent mechanical complication after such migrations is hemothorax or pneumothorax resulting from intercostal vessel damage or lung laceration. Injuries of the trachea, the arch vessels, the pulmonary artery, the heart, the spleen, and the esophagus have been also reported [4][5][6][7]. In a comprehensive review of 47 cases of migrated devices from the shoulder area, a major cardiovascular structure was affected in 17 cases and fatal outcomes occurred in eight cases [2].…”

The migration of Kischner wire from clavicle into pericardium and liver hilum: a 30-year journey

“…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.…”

“…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.…”

Intrathoracic and pelvic migration of humeral fixation wires

“…Both locations have yielded wires migrating predominately into adjacent body cavities and into vital organs [1][2][3][4][5][6][7][8][9]. There have also been reports of pins traveling long distances against gravity from the pelvis into the mediastinum [8].…”