Kirschner wire migration from the clavicle to the cervical spine

Jakub Liberski,Krzysztof Ficek

doi:10.5348/ijcri-2013-06-319-cr-4

Abstract

Kirschner wires (K-wires) are often used to treat injury to the shoulder girdle. Often found in such as literature are cases of migration of K-wires to the thoracic organs lungs, esophagus, aorta. This is a potentially a very serious complication that could lead to death. A 31-year-old male patient who was surgically treated for acromioclavicular joint separation on the right side. Six years later, the patient was admitted to the orthopedic department due to severe pain around the right acromioclavicular joint and septic inflammation in the surrounding area. The plain X-ray showed that Weber's cerclage was broken and one of the Kirschner wires had migrated towards the central axis of the body, perpendicular to the spine at the level of (the 7th) cervical vertebra (C7). The angio computed tomography test, using multi-helical amplified contrast, showed that the displaced 6.5 cm long K-wire segment had migrated to the spinal cord canal at the C7 vertebra. The wire passed through the two transverse foramen of C7 and adhered to the posterior surface of the trunk vertebra. The study did not show any pathological symptoms of the nervous system resulting from K-wire migration. The patient did not consent to the removal of the displaced K-wire, due to alcoholism. Patients with K-wire osteosynthesis should be under strict control in the outpatient clinic. The K-wires must be bent at the distal end to prevent dislocations and a potentially fatal wire migration. Consider this type of orthopedic fixation in patients not complying with medical recommendations (alcoholism, mental illness, low IQ).

Highlights

Kirschner wires (Kwires) are often used to treat injury to the shoulder girdle.Often found in such as literature are cases of migration of Kwires to the thoracic organs lungs, esophagus, aorta
In III grade cases, medical opinions begin to diverge as conservative treatment may result in scapular dyskinesis, SICK scapula syndrome, which causes discomfort in the shoulder girdle, weakness, and inability to take part in sporting activities [3]
One approach for the surgical treatment of an acute acromioclavicular separation is the use of Kwires as a stabilizing element to set the clavicle position in relation to the acromion

Summary

INTRODUCTION

The discussion of methods for treating acute acromioclavicular separation is ongoing. One approach for the surgical treatment of an acute acromioclavicular separation is the use of Kwires as a stabilizing element to set the clavicle position in relation to the acromion. A 31yearold male patient was admitted to the orthopaedic department due to severe pain around the right acromioclavicular joint and severely limited active and passive range of motion stemming from septic inflammation in the surrounding area. The patient had been surgically treated six years earlier for acromioclavicular joint separation on the right side (III grade of Rockwood classification). The study case presented a septic fistula in the area of the right acromioclavicular joint and skin tension above the dislocated metallic fusion (Figure 1). After removal of the Kwire, located in the subcutaneous tissue around the acromioclavicular joint, pain subsided, leading to a gradual improvement in range of motion. The patient left the hospital at his own request, and assumed full responsibility/liability

DISCUSSION

CONCLUSION