[box type=”bio”] Learning Point of the Article: [/box]
Wires do break due to metal fatigue and technical difficulty. Broken wires do migrate and should be removed to avoid serious complications. Unbroken wires should also be removed once their pupose is achieved.
Case Report | Volume 10 | Issue 9 | JOCR December 2020 | Page 11-14 | Mir Sadat-Ali, Abdullah M. Shehri, Mohammed A. AlHassan, Khalid AlTabash, Fatema Abdul Mohsen Mohamed, Mohamed Mokhles Aboutaleb, Ali A. AlGhanim. DOI: 10.13107/jocr.2020.v10.i09.1884
Authors: Mir Sadat-Ali1, Abdullah M. Shehri1, Mohammed A. AlHassan1, Khalid AlTabash1, Fatema Abdul Mohsen Mohamed1, Mohamed Mokhles Aboutaleb1, Ali A. AlGhanim1
Department of Orthopaedic Surgery, King Fahd Hospital of the University, Imam Abdul Rahman Bin Faisal University, AlKhobar, Saudi Arabia.
Address of Correspondence:
Dr. Mir Sadat-Ali,
POBOX 40071, King Fahd Hospital of the University, AlKhobar 31952, Saudi Arabia.
Introduction: Kirschner wires are in use in orthopedic and trauma surgery since the past 80 years. These wires can break due to metal fatigue and migrate which can cause lethal complications.
Case Report: A 27-year-old female sickle cell patient with avascular necrosis of the head of femur, drilling, and injection of the osteoblasts in the head of femur was being performed. A 2 cm of 2.0 mm proximal tip of the guide wire broke. Discussion started whether to leave the wire and the young decided to leave the broken wire, but the wisdom directed us to remove it.
Conclusion: Migration of wires does occur, we believe not only broken wires should be removed but also even the unbroken wire to be removed once the purpose of use is achieved.
Keywords: K-Wires, Migration, Complications, Death
Kirschner wires (K-wires) which were developed and popularized its use since 1932 are widely used in orthopedic and trauma surgeries , even though 18% end up in complications related to the K-wires which include infection, loss of fixation, loosening breakage, and migration [2, 3]. Migration of the K-wires away from the site of the insertion to lungs, spinal cord, heart, and abdominal organs has been reported. The question arises if during the insertion if the wire breaks what should be done ? We report a case where the proximal wire broke in the neck of femur and decision was taken to remove, which was done successfully. Later, a review of literature revealed devastating results of migration of the broken K-wires (Table 1).
A 27-year-old female patients with Grade II avascular necrosis of the head of femur secondary to sickle cell disease were taken to operating room for drilling and injection of autologous bone marrow derived osteoblasts and are recommended to use a smaller diameter K-wire for instillation of the cells. During the procedure, two guidewires were passed to centralize the area of injection. A 3.2 mm cannulated drill was used to drill on top of the guidewires. During drilling, 2 cm of the proximal guide wire broke (Fig. 1) and we believe that this happened due to metal fatigue as the wire was used before couple of time. A discussion arose whether to leave the broken wire in situ. The risk of migration was always on the cards, hence, the guidewire was pushed back to the edge of the broken part. A 4.0 mm cannulated drill was used to drill over the broken wire (Fig. 2). The drill was pushed till the subchondral bone and slowly the cannulated drill was withdrawn and with it the broken part came out (Fig. 3). The rest of the procedure was carried out as per our protocol. Figure 4 shows the X-ray the right hip after 16 months of the surgery.
Migration of the broken K-wires and other devices is known to occur without any indication and can cause from death to grievous injuries to the various organs of the body. No doubt this complication is rare but does happen and surgeons should be ready to recognize it and remove the broken implant. We reviewed the literature and in the past 30 years and over 60 cases of migration of the broken K-wires have been described in the English language literature causing 11 deaths and serious injuries with extended morbidity in otherwise healthy patients (Table 1).
Among different areas of surgery vulnerable to migration of the K-wires if used during the procedure was the shoulder region. Acromioclavicular joint dislocations, clavicular fractures, and sternoclavicular joint dislocations constitute the majority of reported cases. Most of the literature on K-wire migration. Lyons and Rockwood reviewed 37 reports of pin migration from the shoulder region and found that in 17 patients caused serious vascular injuries causing 8 deaths . There is no age is bar for migration as K wires from pediatric to adults cases haven reported. Over the years, 10 cases of migration of K-wires have been reported in pediatric age group [5, 6, 7] and in one child ended in the demise of the child in which the wire migrated after 7 days of insertion . The second important aspect to ponder is that the wires have migrated from 4 days to 34 years [8, 9]. Based on our review of literature, it is wise to state that K-wires, broken or unbroken, have a tendency to migrate. Once it is on path to move it can cause significant damage to organs and even death. We believe that every attempt should be made to remove the broken wires which happen during surgery and those wires in place should be bent appropriately, monitored and removed once the purpose of insertion is achieved. This will avoid potential complications and morbidity.
Breakage of the K-wires can occur during surgery either due to metal fatigue or due poor technique. In our case, we believe it happened due to metal fatigue as the wire was used before couple of time. Migration of K-wires occur, more so the broken ones, we believe that K-wires should be removed either broken or unbroken once the purpose of use is achieved, second, it is advisable to limit the reuse of K-wire or guide wires.
K-wires are prone to migrate, more so when they get broken inside the bone due to any cause. Attempts should be made to remove them, if the wire is broken during a procedure, which could be much easier.
1. Kirschner M. Zur behandlung der knochenbrüche. Arch Klein Chir 1931;167:1-2.
2. Stahl S, Schwartz O. Complications of K-wire fixation of fractures and dislocations in the hand and wrist. Arch Orthop Trauma Surg 2001;121:527-30.
3. Botte MJ, Davis JL, Rose BA, Von Schroeder HP, Gellman H, Zinberg EM, et al. Complications of smooth pin fixation of fractures and dislocations in the hand and wrist. Clin Orthop Relat Res 1992;276:194-201.
4. Lyons FA, Rockwood C Jr. Migration of pins used in operations on the shoulder. J Bone Joint Surg Am 1990;72:1262-7.
5. Sharma H, Taylor G, Clarke N. A review of K-wire related complications in the emergency management of paediatric upper extremity trauma. Ann R Coll Surg Engl 2007;89:252-8.
6. Baghdadi T, Baghdadi S, Dastoureh K, Yaseen Khan FM. Unusual migration of a Kirschner wire in a patient with Osteogenesis Imperfecta: A case report. Medicine (Baltimore) 2018;97:e11829.
7. 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:e3741.
8. Irianto KA, Edward M, Fiandana A. K-wire migration to unexpected site. Int J Surg Open 2018;11:18-21.
9. Boasquevisque CH, Lucas G, Santos A, Rocha L. VATS Extraction of a Migrating Kirschner Wire into the Mediastinum and Lung. Available from: https://www.ctsnet.org/January2019.
10. Furuhata R, Nishida M, Morishita M, Yanagimoto S, Tezuka M, Okada E. Migration of a Kirschner wire into the spinal cord: A case report and literature review. J Spinal Cord Med 2020;43:272-5.
11. Palauro FR, Stirma GA, Secundino AR, Riffel GB, Baracho F, Dau L. Kirschner Wire Migration after the treatment of acromioclavicular luxation for the contralateral shoulder-case report. Rev Bras Ortop 2019;54:202-5.
12. Suzuki T, Matsumura N, Iwamoto T, Sato K. Migration of a Kirschner wire into the lung with shoulder dislocation. BMJ Case Rep 2017;2017:bcr 2017221850.
13. Douglas G, Pedro A, Alessandro C, Thiago AF, Felipe BL, Nicandro F. The migration of Kirschner wire from left distal clavicle to the intradural anterior thoracic spine. Open Access J Neurol Neurosurg 2017;2:14.
14. Bang GA, Nanamuluem A, Oumarou BN, Yamben MA, Eone DH. Kirschner wire migration from proximal humerus into the lung: Brief report. Trauma Cases Rev 2017;3:1-4.
15. Matsumoto H, Yo S, Fukushima S, Osawa M, Murao T, Ishii M, et al. Forgotten Kirschner wire passing across the sigmoid colon. Clin J Gastroenterol 2017;10:154-6.
16. Aydın E, Dülgeroğlu TC, Metineren H. Migration of a Kirschner wire to the dorsolateral side of the foot following osteosynthesis of a patella fracture with tension band wiring: A case report. J Med Case Rep 2016;10:41.
17. 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.
18. Kumar S, Sharma SK, Aslam M, Chadha GN. Intra-articular migration of broken patellar tension band wire: A rare case. J Orthop Case Rep 2016;6:41-3.
19. Kong R, Mohamed M, Toh E. An unusual case of Kirschner wire migration in the foot. J Foot Ankle Surg 2016;55:1110-2.
20. Hafez A, Ibrahim T, Raj R, Antinheimo J, Siironen J, Hernesniemi J. Delayed migration of fractured K-wire causing vertebral artery invagination after anterior atlantoaxial fixation: A case report. World Neurosurg 2016;88:695.
21. Leonardi F, Rivera F. Intravascular migration of a broken cerclage wire into the left heart. Orthopedics 2014;37:e932-5.
22. Tamura J, Maruwaka S, Shiroma J, Miyagi S, Orita H, Sakugawa H, et al. An inflammatory polyp in the colon caused by the migration of a Kirschner wire following fixation of a pelvic fracture. Intern Med 2014;53:699-701.
23. Alihanoglu YI, Kilic ID, Yildiz BS. Broken and scattered sternal wires. Eur J Cardiothorac Surg 2013;44:e344.
24. Lee SH, Cho BS, Kim SJ, Lee SY, Kang MH, Han GS, et al. Cardiac tamponade caused by broken sternal wire after pectus excavatum repair: A case report. Ann Thorac Cardiovasc Surg 2013;19:52-4.
25. Meena S, Nag HL, Kumar S, Barwar N, Mittal S, Singla A. Delayed migration of K-wire into popliteal fossa used for tension band wiring of patellar fracture. Chin J Traumatol 2013;16:186-8.
26. Ballas R, Bonnel F. Endopelvic migration of a sternoclavicular K-wire. Case report and review of literature. Orthop Traumatol Surg Res 2012;98:118-21.
27. Konda SR, Dayan A, Egol KA. Progressive migration of broken Kirschner wire into the proximal tibia following tension-band wiring technique of a patellar fracture–case report. Bull NYU Hosp Joint Dis 2012;70:279-82.
28. Türker M, Cirpar M, Yalçınozan M. Migration of broken K-wires into the Achilles tendon from a ostheosynthesed medial malleolar fracture. Eur J Orthop Surg Traumatol 2011;21:55-7.
29. Makki DY, Goru P, Prakash V, Aldam CH. Migration of a broken trochanteric wire to the popliteal fossa. J Arthroplasty 2011;26:504.
30. Daud DF, Campos MM. Migration of a Kirschner wire into the thoracic ascendent aorta artery. Rev Bras Cir Cardiovasc 2011;26:508-10.
31. Sharma R, Tam RK. Migrating foreign body in mediastinum–intravascular Steinman pin. Interact Cardiovasc Thorac Surg 2011;12:883-4.
32. Yurtçu M, Senaran H, Türk HH, Abasıyanık A, Tuncay I. Migration of intra-articular K-wire into the contralateral pelvis after surgery for developmental dysplasia of the hip: A case report. Acta Orthop Traumatol Turc 2010;44:413-5.
33. Botha AH, Du Toit AB. Migration of a Kirschner wire from the wrist to the cubital fossa. S Afr Orthop J 2009;8:90-2.
34. Dhillon R, Williams K, Alkadhi A. Transcarpal migration of a broken Kirschner wire causing ulnar neurapraxia. J Hand Surg Eur Vol 2009;34:552-4.
35. Choi RR, Min KD, Choi SW, Lee BI. Migration to the popliteal fossa of broken wires from a fixed patellar fracture. Knee 2008;15:491-3.
36. Tan KK, Ibrahim S. Kirschner wire migration to the cervical spine: A complication of clavicular fixation in a child. Malay Orthop J 2007;1:45-6.
37. Biddau F, Fioriti M, Benelli G. Migration of a broken cerclage wire from the patella into the heart. A case report. J Bone Joint Surg Am 2006;88:2057-9.
38. Stemberga V, Bosnar A, Bralic M, Medved I, Simic O, Pocekaj L. Heart embolization with the Kirschner wire without cardiac tamponade. Forensic Sci Int 2006;163:138-40.
39. Durpekt R, Vojácek J, Lischke R, Burkert J, Spatenka J. Kirschner wire migration from the right sternoclavicular joint to the heart: A case report. Heart Surg Forum 2006;9:840-2.
40. Marya KM, Yadav V, Rattan KN, Kundu ZS, Sangwan SS. Unusual K-wire migration. Indian J Pediatr 2006;73:1107-8.
41. Kumar P, Godbole R, Rees GM, Sarkar P. Intrathoracic migration of a Kirschner wire. J R Soc Med 2002;95:198-9.
42. Seipel RC, Schmeling GJ, Daley RA. Migration of a K-wire from the distal radius to the heart. Am J Orthop (Belle Mead NJ) 2001;30:147-51.
43. Wirth MA, Lakoski SG, Rockwood CA. Migration of broken cerclage wire from the shoulder girdle into the heart: A case report. J Shoulder Elbow Surg 2000;9:543-4.
44. Hazelrigg SR, Staller B, Migration of sternal wire into ascending aorta. Ann Thorac Surg 1994;57:1023-4.
45. Chou NS, Wu MH, Chan CS, Lai WW, Lin MY. Intrathoracic migration of Kirschner wires. J Formos Med Assoc 1994;93:974-6.
46. Lim AB, Parekh S, Smith DN. Intra-articular migration of broken trochanteric wires. Injury 1993;24:201-2.
47. Janssens de Varebeke B, Van Osselaer G. Migration of Kirschner’s pin from the right sternoclavicular joint resulting in perforation of the pulmonary artery main trunk. Acta Chir Belg 1993;93:287-91.
48. Dayantas J, Lazarides M, Arwanitis D. Delayed femoral artery trauma from migration of a broken wire after total hip replacement. Eur J Vasc Surg 1991;5:597-9.
|Dr. Mir Sadat-Ali||Dr. Abdullah M. Shehri||Dr. Mohammed A. AlHassan||Dr. Kahlid AlTabash||Dr. Fatema Abdul Mohsen Mohamed|
|How to Cite This Article: Sadat-Ali M, Shehri AM, AlHassan MA, Tabash KW, Mohamed FAM, Mokhles Aboutaleb MM, AlGhanim AA. Broken Kirschner Wires Can Migrate: A Case Report and Review of Literature. Journal of Orthopaedic Case Reports 2020 December;10(9): 11-14|
[Full Text HTML] [Full Text PDF] [XML]
Dear Reader, We are very excited about New Features in JOCR. Please do let us know what you think by Clicking on the Sliding “Feedback Form” button on the <<< left of the page or sending a mail to us at firstname.lastname@example.org