Navigating challenges: a case report on complications in clavicle fracture management with 'K' wire fixation

Authors

  • G. Lakshman Prasath Department of Orthopaedics, Annapoorana Medical College and Hospital, Salem, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20234068

Keywords:

Broken K-wire, Intrathoracic migration, Clavicle fracture, Shoulder girdle, Orthopaedic pins

Abstract

Orthopaedic metallic pins and wires are commonly used for the fixation of fractures and dislocations, with the shoulder girdle being one of the common areas for their application. Despite recent precautionary measures, complications related to migration of these devices into the pleural cavity continue to be reported. We present a case of a Kirschner wire (K-wire) migration from a left clavicle fracture to the first rib, highlighting the importance of vigilance and immediate intervention in such cases. A 35-year-old female, previously operated for a left clavicle fracture using K-wire and tension band wiring, presented with left shoulder and chest pain eight years later. Radiological investigations revealed a broken K-wire in the pleural cavity, with one portion near the acromio-clavicular region and the other at the posterior aspect of the first rib. Surgical intervention was performed, involving the removal of the K-wire from the chest cavity and clavicle, with subsequent patient recovery. The migration of orthopaedic pins and wires into the chest cavity is a rare but well-documented complication. Previous reports have demonstrated severe consequences, including cardiovascular complications and fatalities. Theories explaining wire migration include muscle action, shoulder mobility, negative intrathoracic pressure during respiration, regional bone resorption, gravitational forces, and even capillary action. To minimize such complications, subcutaneous K-wire ends should be bent, and restraining devices should be used. Close clinical and radiographic follow-up is essential until the pins and wires are removed after achieving the therapeutic goal. In case of migration, prompt removal is necessary to prevent fatal complications. This case report emphasizes the significance of vigilance and proper precautions when using orthopaedic pins and wires for shoulder girdle fractures. Timely intervention is crucial to mitigate severe complications associated with migration. Sharing experiences and lessons learned can contribute to the safer application of these fixation devices in orthopaedic practice.

References

Tan L, Sun DH, Yu T, Wang L, Zhu D, Li YH. Death Due to Intra-aortic Migration of Kirschner Wire From the Clavicle: A Case Report and Review of the Literature. Medicine (Baltimore). 2016;95(21):e3741.

Regel JP, Pospiech J, Aalders TA, Ruchholtz S. Intraspinal migration of a Kirschner wire 3 months after clavicular fracture fixation. Neurosurg Rev. 2002;25(1-2):110-2.

Loncán LI, Sempere DF, Ajuria JE. Brown-Sequard syndrome caused by a Kirschner wire as a complication of clavicular osteosynthesis. Spinal Cord. 1998;36(11):797-9.

Mellado JM, Calmet J, García Forcada IL, Saurí A, Giné J. Early intrathoracic migration of Kirschner wires used for percutaneous osteosynthesis of a two-part humeral neck fracture: a case report. Emerg Radiol. 2004;11(1):49-52.

Ballas R, Bonnel F. Endopelvic migration of a sternoclavicular K-wire. Case report and review of literature. Orthop Traumatol Surg Res. 2012;98(1):118-21.

Foster GT, Chetty KG, Mahutte K, Kim JB, Sasse SA. Hemoptysis due to migration of a fractured Kirschner wire. Chest. 2001;119(4):1285-6.

Lyons FA, Rockwood CA. Migration of pins used in operations on the shoulder. J Bone Joint Surg Am. 1990;72(8):1262-7.

Lindsey RW, Gutowski WT. The migration of a broken pin following fixation of the acromioclavicular joint. A case report and review of the literature. Orthopedics. 1986;9(3):413-6.

Leppilahti J, Jalovaara P. Migration of Kirschner wires following fixation of the clavicle--a report of 2 cases. Acta Orthop Scand. 1999;70(5):517-9.

N'da HA, Drogba KL, Konan LM, Haidara A, Varlet G. Spinal kirschner wire migration after surgical treatment of clavicular fracture or acromioclavicular joint dislocation: Report of a case and meta-analysis. Interdiscip Neurosurg. 2018;12:36-40.

Fransen P, Bourgeois S, Rommens J. Kirschner wire migration causing spinal cord injury one year after internal fixation of a clavicle fracture. Acta Orthop Belg. 2007;73(3):390-2.

Batın S, Ozan F, Gürbüz K, Uzun E, Kayalı C, Altay T. Migration of a Broken Kirschner Wire after Surgical Treatment of Acromioclavicular Joint Dislocation. Case Rep Surg. 2016;2016:6804670.

Jung S, Lim H, Koh SH, Jung SW. Management of Foreign Object Migration and Surgical Removal with C-Arm Fluoroscopy. Arch Plast Surg. 2015;42(4):492.

Downloads

Published

2023-12-29