Pins in the Shoulder Girdle: Beware Wayward Wires.

Abstract

As outlined in our January 16, 2013, editorial, “ The Case Report Redefined with JBJS Case Connector ,” 1 important role of JBJS Case Connector is to alert the orthopaedic community about a potentially problematic device or therapy. When 2 or more such cases with similar mechanisms appear, we will identify the procedure or implant as a “watchable” intervention. While this system is not statistically conclusive and may or may not be supported by other published case reports or registry data, the intention is to sharpen the focus of clinicians on the potential for similar problems and thereby enhance clinical outcomes and patient safety. The “Watch” designation may also encourage others to report related difficulties and enlist the orthopaedic community to either demonstrate that these are isolated, unrelated cases or sharpen the focus further on rigorously evaluating the intervention. Where appropriate, we may identify brand, model, or implant-lot specifics. Worldwide, approximately 700,000 proximal humeral fractures occur every year, most of them in patients older than 65 years. The treatment of proximal humeral fractures in the elderly remains controversial. In the U.S., the rate of surgical treatment of these fractures in Medicare patients increased by >25% between 1999 and 2005. This increase in surgical treatment may be explained in part by the advent of locking-plate technology and other device and technique advances. Nevertheless, a substantial number of patients, old and young, who sustain a proximal humeral fracture are still managed with Kirschner wires (K-wires). Surgeons often opt to pin such fractures to protect the repair of a concomitant neurovascular injury, as a temporary strategy to alleviate acute pain, or in cases in which the patient cannot tolerate a more invasive surgery. A frequent and potentially lethal drawback to using wires about the shoulder girdle is the risk of migration. This “Watch” …