Asian Cardiovasc Thorac Ann 1999;7:319-320
© 1999 Asia Publishing EXchange Pte Ltd
Intrathoracic Migration of a Kirschner Wire
Ö Naci Emiro
ullari, MD,
Cemal Kahraman, MD,
Kutay Ta
demir, MD,
Fahri Ouzkaya, MD
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Department of Thoracic & Cardiovascular Surgery Erciyes University Medical School Kayseri, Turkey
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For reprint information contact: Ö Naci Emiroullari, MD Tel: 90 352 437 4910 Fax: 90 352 437 5285 Department of Thoracic & Cardiovascular Surgery, Erciyes University Medical School, Kayseri 38038, Turkey.
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Abstract
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Intrathoracic migration of a Kirschner wire is a serious complication and immediate removal of the wire is mandatory. We describe a case of Kirschner wire migration from the left shoulder to the thorax. The wire was successfully retrieved from the intrapleural cavity.
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Introduction
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Pins and wires are used extensively for internal fixation of bones and joints. Some of these appliances have a tendency to migrate. Serious complications such as pin migration are extremely rare. The explanation for the propensity of pins to migrate from the shoulder region remains obscure. Various theories have been proposed, including muscular activity, respiratory excursion, capillary action, electrolysis, regional resorption of bone, gravitational forces, and the greater freedom of motion of the upper extremity.1
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Case Report
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A 45-year-old male underwent surgery for bilateral subcapital humerus fractures. Five Kirschner wires were used for fixation (Figure 1
). Three were inserted in the right shoulder and removed at the first follow-up examination one month later. At the second follow-up examination at 2 months postoperatively, chest radio-graphy showed that one of the wires had migrated into the left thoracic cavity and the other was within the subcutaneous tissue in the thoracic wall but there was no evidence of pneumothorax (Figures 2 and 3). The latter was removed under local anesthesia and the patient underwent surgery to remove the wire that had migrated into the thorax. A left posterolateral thoracotomy through the 5th intercostal space was performed. The wire was within the intrapleural cavity, in front of the lower lung lobe, with the sharp end downwards. There was no damage to the lung. The wire was removed and the thoracotomy was closed with a drainage tube left in situ for 24 hours. The patient made a rapid and uncomplicated recovery and was discharged on the 9th postoperative day. Subsequent chest radiographs were normal.
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Figure 2. Two months later, one of the Kirschner wires is within the left hemithorax, the other is within the subcutaneous tissue.
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Discussion
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A review of the literature takes us back to 1943 when Mazet2 reported the first two cases of migration of a Kirschner wire from the shoulder region. Sporadic case reports have subsequently recorded remarkable journeys of such wires from the shoulder region to the spinal canal, trachea, spleen, pulmonary artery, ascending and abdominal aorta, the heart, mediastinum, lung, and subclavian artery.1,3–8 In the case reported by Richon and Richon,8 one of the wires had broken and migrated into the lung, then through the mediastinum into the opposite lung.
In the cited reports, the patients had repeatedly failed to return for follow-up examinations and the pins were not removed when the desired therapeutic effect had been attained.1 In some cases, it was reported that the physician did not have a record of the number of pins that had been inserted and thus did not realize that one pin was missing.1 The outcome may be fatal if a pin is not removed after migration into the thoracic cavity and urgent operation is essential.4,8
From these experiences, the following guidelines are recommended.1,3,4 Wires must be used with the extreme caution in the shoulder girdle, the ends of the wires must be bent, the patient should be followed up both clinically and radiographically until all the wires are removed, and if follow-up radiographs show any migration of a pin or wire, it must be removed as a matter of urgency, regardless of a lack of symptoms.
Presented at the 5th Annual National Thoracic & Cardiovascular Surgery Meeting, Antalya, Turkey, October 20–24, 1998.
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References
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Lyons FA, Rockwood CA Jr. Migration of pins used in operations on the shoulder. J Bone Joint Surg [Am] 1990;72:1262–7.[Free Full Text]
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Mazet RJR. Migration of a Kirschner wire from the shoulder region into the lung. J Bone Joint Surg [Am] 1943;25:477–483.[Abstract/Free Full Text]
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Potter FA, Fiorini AJ, Knox J, Rajesh PB. The migration of a Kirschner wire from shoulder to spleen. Brief report. J Bone Joint Surg [Br] 1988;70:326–7.
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Janssens de Varebeke B, Van Osselear G. Migration of Kirschner's pin from the right sternoclavicular joint resulting in perforation of the pulmonary artery main trunk. Acta Chirurgica Belgica 1993;93:287–91.[Medline]
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Liu HP, Chang CH, Lin PJ, Chu JJ, Hsieh HC, Chang JP, et al. Pulmonary artery perforation after Kirschner wire migration. Case report and review of the literature. J Trauma 1993;34:154–6.[Medline]
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Naidoo P. Migration of a Kirschner wire from the clavicle into the abdominal aorta. Arch Emerg Med 1991;8:292–5.[Medline]
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Haapaniemi TA, Hermansson US. Cardiac arrhythmia caused by a Kirschner wire inside the heart. An unusual complication of finger osteosynthesis. J Hand Surg [Br] 1997;22:402–4.[Medline]
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Richon J, Richon CA. Migration intrathoracique d'une broce mètallique après cure chirurgicale d'une luxation sternoclaviculaire. Lyon Chir 1986;82:119–20.
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Abstract
Introduction
