Abstract
Kirschner wires have been used for fracture osteosynthesis since 1909. Migration, extrusion and breakage of Kirschner wires are recognized complications with reports of migration to the thorax, spinal cord and abdomen. Several reasons have been postulated for wire migration including gravity, electrolysis and bony resorption, prolonged implantation time and repetitive joint motion.A 33 year old right hand dominant lumberjack sustained a fracture‐dislocation of the right ring and little finger metacarpals treated with closed reduction and percutaneous Kirschner wire fixation. The proximal oblique Kirschner wire broke following a fall. The asymptomatic retained broken wire was left in‐situ. Ten weeks postoperatively he developed paraesthesia in the Ulnar nerve distribution with associated pain and reduced grip strength.Repeat radiographic examination revealed that the broken wire had migrated to the palmar and Ulnar aspect of the hand through the intercarpal space which explained the clinical findings. At surgery for wire removal he had developed Median neuropraxia. Image intensification confirmed migration towards carpal tunnel area. A standard open carpal tunnel approach showed the wire to be located at the transverse carpal ligament.This unusual case illustrates the benefit of having a low threshold for repeat radiographic evaluation of retained broken Kirschner wires in the hand. Due to repetitive joint motion, the risk of retained wires migrating, even when asymptomatic, may be reduced if the involved joint is immobilized during the healing phase and removed as soon as practicable.
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