Concomitant laparoscopy: An effective technique for successful retrieval of intra pelvic migrated broken guide pin

Abstract

Many devices are used for fixation of fractures around hip need guide pins for accurate positioning of the final implants. Breakage of these guide pins during surgery is one of the most dreaded complications of such surgeries. The true incidence of this complication is not known and remains under-reported. The most common causes of breakage of guide pins are re-use of the guide pins, blockade of the cannulated drills, and mismatch between the guide pins and cannulated drills. Most commonly, the guide pin breaks either during drilling over the guide pin or during manoeuvring the hip. Such broken guide pins can migrate into pelvis and can cause a variety of complications. At the same time retrieval of such broken guide pins can be a challenge to the treating surgeon, especially if they are found transfixing the hip joint. Techniques described for retrieval of migrated and broken guide pins vary from exploration of the fracture site, creating a window in the femoral neck, hip arthroscopy, extra peritoneal exploration by ilio-inguinal approach to laparotomy. In this report, we document a novel technique for retrieving a broken guide pin that was transfixing the hip joint and protruding in to the pelvis. We retrieved the guide pin from the abdomen via laparoscopy after laparoscopic-guided pushing from the neck of femur. Whilst laparoscopic retrieval of freely migrating k-wires from the pelvis has been documented in the past, this is the first ever documentation of a novel technique used to retrieve intra pelvic migrated broken guide pin.