Wire Migration Research Articles

Feasibility of ultrasound-guided absorbable retaining thread needle localization for nonpalpable breast lesions.

PurposeAbsorbable retaining thread (ART) needle localization utilizes a guiding needle with a thread; this technique was invented to reduce patient discomfort and wire migration. We investigated the feasibility of ultrasound (US)-guided ART needle localization for nonpalpable breast lesions.MethodsART needle localization was performed for 26 nonpalpable breast lesions in 26 patients who were scheduled to undergo surgical excision the day after localization. Seventeen breast lesions were initially diagnosed as invasive ductal carcinoma, six as ductal carcinomas in situ, and one as fibrocystic change. The other two cases without an initial pathologic diagnosis had suspicious US features, and excision was planned concomitantly with contralateral breast cancer surgery. The primary outcome was the technical success rate of ART needle localization confirmed by US immediately after the procedure, and the secondary outcomes were the percentage of clear margins on pathology and the complication rate of ART needle localization.ResultsThe technical success rate of ART needle localization was 96.2% (25 of 26 patients), and the ART was located 1 cm away from the mass in one patient (3.8%). The lesions were successfully removed with clear margins in all 26 patients. No significant complications related to ART needle localization were observed.ConclusionART needle localization can be an alternative to wire needle localization for nonpalpable breast lesions.

Миграция электрода временной электрокардиостимуляции в аорту: редкое осложнение после открытой операции на сердце

Миграция электрода временной электрокардиостимуляции в аорту: редкое осложнение после открытой операции на сердце

Kirschner Wire Migration into SpinaL Canal after Acromioclavicular Joint Fixation (Literature Review and Clinical Case)

Fracture and migration of metal implants is a well-known issue which is especially relevant for actively loaded zones with a high amplitude of physiological movements. The authors analyzed 17 publications dedicated to Kirschner wire migration into the spinal canal after fixation of acromioclavicular joint (ACJ) injury. The present paper contains literature review and own clinical case of the authors. The authors generalize the conceptions of migration causes, surgical tactics and prevention recommendations. The key reason of fracture and migration of Kirschner wires during fixation of ACJ injury is the instability of implants, trans-articular wire insertion during fixation of reduced dislocation of acromial end of the clavicle, insufficient immobilization and untimely implants removal after removal of immobilization. Implants migration into the spinal canal is the indication for their surgical removal irrespective of clinical signs. In the majority of studied publications authors described posterior approach or lateral approach aligned with the migration direction. No grafting techniques for dura mater defects were present in the studied literature. The authors of the current paper justify a surgical procedure for removal of migrated implant using a combined posterior and lateral approach on the own clinical case. The choice of procedure algorithm results from the need for prophylaxis of secondary spinal cord lesion and liquorrhea during removal of migrated implants from spinal canal.

Electronic Properties of Single Atom and Molecule Junctions

AbstractSingle atom and molecule junctions are key components of future ultra‐small electronic devices. The novel properties and functionalities appear in the single atom and molecule junctions reflecting their unique structures. The conductance quantization and quantum interface effects have been reported. In this review, we discuss fabrication and electronic properties of the single atom and molecule junctions, including electrical conductance and thermopower. The single atom and molecule junctions are fabricated in a nanogap prepared by electron migration, self‐breaking and mechanical breaking of metal wires. The electric conductance of the single atom and molecule junctions depends not only the atom and molecule within the junctions, but also on their connectivity to the metal wires at the interface. The conductance fluctuation characteristic of single‐molecule junction reflects the character of the metal‐molecular bond at the interface, which enables us to study the molecular adsorption process during the formation of the junction.

Magseed for wide local excision surgery

Introduction: Wire guided wide local excision surgery has inherent problems with wire migration, scheduling and technical difficulties, particularly in the larger breast. Following a feasibility study in our unit of using a Magnetic seed for localization of breast cancers in women having mastectomy, a CE mark was awarded for Magseed to be used for Wide Local Excision surgery.

Electrolytic Migration of Ag-Pd Alloy Wires with Various Pd Contents

During Ag ion migration in an aqueous water drop covering a pair of parallel Ag-Pd wires under current stressing, hydrogen bubbles form first from the cathode, followed by the appearance of pure Ag dendrites on the cathodic wire. In this study, Ag dendrites with a diameter of 0.2–0.4 μm grew toward the anodic wire. The growth rate (v) of these dendrites decreased with the Pd content (c) with a linear relationship of: $$ v = 10.02 - 0.43 \, c $$ . Accompanying the growth of pure Ag dendrites was the formation of a continuous layer of crystallographic Ag2O particles on the surface of the anodic wire. The deposition of such insulating Ag2O products did not prevent the contact of Ag dendrites with the anodic Ag-Pd wire or the short circuit of the wire couple.

Safety and feasibility of breast lesion localization using magnetic seeds (Magseed): a multi-centre, open-label cohort study

PurposeWire localization has several disadvantages, notably wire migration and difficulty scheduling the procedure close to surgery. Radioactive seed localization overcomes these disadvantages, but implementation is limited due to radiation safety requirements. Magnetic seeds potentially offer the logistical benefits and transcutaneous detection equivalence of a radioactive seed, with easier implementation. This study was designed to evaluate the feasibility and safety of using magnetic seeds for breast lesion localization.MethodsA two-centre open-label cohort study to assess the feasibility and safety of magnetic seed (Magseed) localization of breast lesions. Magseeds were placed under radiological guidance into women having total mastectomy surgery. The primary outcome measure was seed migration distance. Secondary outcome measures included accuracy of placement, ease of transcutaneous detection, seed integrity and safety.ResultsTwenty-nine Magseeds were placed into the breasts of 28 patients under ultrasound guidance. There was no migration of the seeds between placement and surgery. Twenty-seven seeds were placed directly in the target lesion with the other seeds being 2 and 3 mm away. All seeds were detectable transcutaneously in all breast sizes and at all depths. There were no complications or safety issues.ConclusionsMagnetic seeds are a feasible and safe method of breast lesion localization. They can be accurately placed, demonstrate no migration in this feasibility study and are detectable in all sizes and depths of breast tissue. Now that safety and feasibility have been demonstrated, further clinical studies are required to evaluate the seed’s effectiveness in wide local excision surgery.

Needle localization of small pulmonary nodules: Lessons learned

BackgroundLung nodules that are small and deep within lung parenchyma, and have semisolid characteristics are often challenging to localize with video-assisted thoracoscopic surgery (VATS). We describe our cumulative experience using needle localization of small nodules before surgical resection. We report procedural tips, operative results, and lessons learned over time. MethodsA retrospective review of all needle localization cases between July 1, 2006, and December 30, 2016, at a single institution was performed. A total of 253 patients who underwent needle localization of lung nodules ranging from 0.6 to 1.2 cm before operation were enrolled. Nodules were localized by placing two 20-gauge Hawkins III coaxial needles from different trajectories with tips adjacent to the nodule, injection of 0.3 to 0.6 mL of methylene blue, and deployment of 2 hookwires, under computed tomography guidance. Patients then underwent VATS wedge resection for diagnosis, followed by anatomic resection for lung carcinoma. Procedural and perioperative outcomes were assessed. ResultsNeedle localization was successful in 245 patients (96.8%). Failures included both wires falling out of lung parenchyma before operation (5 patients), wire migration (2 patients), and bleeding resulting in hematoma requiring transfusion (1 patient). The most common complication of needle localization was asymptomatic pneumothorax (11/253 total patients; 4.3%) and was higher in patients with bullous emphysema (9/35 patients; 25.7%). Of the 8 individuals who had unsuccessful needle localization, 7 had successful wedge resection in the area of methylene blue injection that included the nodule; 1 required segmentectomy for diagnosis. Completion lobectomy (154 VATS, 2 minithoracotomies) or VATS segmentectomy (18 patients) was performed in 174 individuals with a diagnosis of non–small cell carcinoma or carcinoid. The average length of hospital stay was 1.4 days for wedge resection, 1.9 days for VATS segmentectomy, 3.1 days for VATS lobectomy, and 4.9 days for minithoracotomy. Perioperative survival was 100%. ConclusionsNeedle localization with hookwire deployment and methylene blue injection is a safe and feasible strategy to localize small, deep lung nodules for wedge resection and diagnosis. Multidisciplinary coordination between the thoracic surgeon and the interventional radiologist is key to the success of this procedure.

Accidental Migration of a Guide Wire during Femoral Venous Catheterization for Hemodialysis: A Case Report

Femoral venous catheterization is the most used technic in emergency he-modialysis. Some uncommon mechanical complications can occur during a catheterization. We report the case of an accidental migration of a guide wire during the placement of a hemodialysis femoral catheter. The case of a patient admitted in the nephrology department at Aristide Le Dantec University Hospital for malignant hypertension was investigated. Emergency hemodialysis was indicated. Surgical extraction of the metal guide has been performed and the outcome was favorable.

Thoracoscopic removal of K-wire penetrating lung and mediastinum

Kirschner wire (K-wire) migration into thoracic cavity and organs are uncommon but can have fatal complications. A 60-year-old gentleman had repair of dislocated left acromioclavicular joint with K-wire, which migrated, from the joint into left lung and mediastinum. He was successfully treated by thoracoscopic retrieval of migrated K-wire.

Spinal kirschner wire migration after surgical treatment of clavicular fracture or acromioclavicular joint dislocation: Report of a case and meta-analysis

Abstract Kirschner wire is the most used device for clavicular and acromioclavicular joint dislocation fixation. Although wire migrations have been extensively reported, spinal migrations remain rare. Moreover, the mechanism of migration is still elusive. The aim of the present paper is to describe a single case of cervical spine migration of a K-wire followed by meta-analysis. Twelve cases of spinal K-wire have been reported in the last 20 years, with less than 2 cases per year. Clavicular fixation was the main initial procedure with 66.67% of cases. The average time between surgery and migration was 25.5 months. C7-T1 and T2-T3 were the prominent level of migration with each 33.33% of cases, where the migration was transversal in 72.73% of cases. The neural foramen was the most penetrating site of the K-wire in the spine (75% of cases). In all cases the wire was removed via direct access surgery by gentle pulling out along its axis under view control. The greater range of motion in the shoulder seems to be the main mechanism of all kinds of migrations.

39. First implementation in France of nonpalpable breast lesions localization using an 125I-seed (radioactive)

Introduction For the excision of nonpalpable breast lesions, the surgeon needs a landmark previously placed under radiological or ultrasound imaging control. The current technique consists in implanting a metal wire from the lesion to the skin, which presents some constraints in terms of patient comfort, surgery precision (potential wire migration) and medical organization. Here is presented the implementation of breast lesion localization using an 125I radioactive seed as part of a mononoclinical trial comparing the wire-guided and radioguided techniques. Today, a feedback over 18 patients enables a first report on this technique. Methods In order to insure the feasibility of the iodine seed (IsoSeed® - Eckert & Ziegler) technique, the radiopaque and echogenic seed’s features were checked. In the surgery room, the iodine seed (A Results The seed is visible under X-Ray and ultrasound imaging. Thus this localization technique is possible, as well as the control of the seed presence into the lesion using Faxitron imaging (X-Ray). The 11 mm diameter probe was approved by the surgeons. With a 1.5 cm focalization (FWHM of the radial sensitivity curve), it offers the best compromise sensitivity/focalization. In light of the clinical activities, the scattered radiation of 99mTc does not trouble the 125I seed detection. For a seed implanted at 1, 2 and 3 cm depth, the breast skin dose was respectively evaluated at 2.2, 0.5 and 0.2 mGy/MBq/day. The highest activity and implantation duration being 10 MBq and 10 days, there is no contraindication to this technique due to radioprotection. The simulation using the piece of meat led to validate every step of the protocol with the different operators and thus resolve every major difficulty in relation to this technique. Conclusions The 18 iodine seed localizations (activity: 4.4 ± 1.5 MBq (1 σ ) , presence duration in the breast: 4.6 ± 3 days (1 σ ) ) were successful and enabled to optimize the established protocol. They confirm that this technique brings the solution to the constraints linked to the wire-guided localization: the seed positioning and the surgery gesture are made easier, the patient comfort is unquestionably improved and the medical organization flows better. Today, no seed migration has been observed, which may also promise a gain in precision.

Safe intramedullary fixation of displaced midshaft clavicle fractures with 2.5 mm Kirschner wires – technique description and a two-part versus multifragmentary fracture fixation outcome comparison

IntroductionThe aim of this study was to present a modified Murray and Schwarz 2.5-mm Kirschner wire (K-wire) intramedullary (IM) technique for fixation of displaced midshaft clavicle fractures (DMCF), and to compare the differences in treatment outcome of two-part (Robinson 2B.1) and multifragmentary (Robinson 2B.2) DMCF. MethodsA retrospective analysis of 91 patients who underwent IM fixation with a 2.5-mm K-wire for DMCF and had a 1-year post-operative follow-up between 2000 and 2012 was performed. The patients were allocated into two groups: Robinson 2B.1 (n = 64) and Robinson 2B.2 (n = 27). Assessed outcomes were non-union, reoperation rate, wire migration and infection. ResultsThere was no statistically significant difference in the rate of non-union (2B.1,2B.2; 3.13%, 7.41%; p = 0.365), reoperation (2B.1, 2B.2; 3.13%, 7.41%; p = 0.365), K-wire migration (2B.1, 2B.2; 0.00%, 0.00%; p = 1.00) and clavicle shortening at 12-months (2B.1, 2B.2; 3.13%, 7.41%; p = 0.365). ConclusionIntramedullary clavicle fixation with a 2.5-mm K-wire is a safe surgical technique. 2B.1 injuries treated with 2.5-mm IM K-wire fixation have relatively improved outcome compared with displaced 2B.2 fractures for both non-union and reoperation rates. There were no occurrences of implant migration with either 2B.1 or 2B.2 injuries, and a non-significant difference in implant irritation was documented with IM K-fixation. The non-union rate with K-wire IM fixation of 2B.1 injuries concords with the published results of other IM devices and thus this technique should be added to the surgeon’s armamentarium when considering surgical treatment of such injuries.

P1.16-016 Comparing Safety and Effectiveness of Image-Guided VATS Versus Conventional VATS for Small or Deep Pulmonary Nodules

Video-assisted thoracic surgery (VATS) is currently performed to diagnose and treat solitary pulmonary nodules (SPN). However, the intra-operative identification of small and/or deep nodules can be challenging with VATS as the lung is difficult to palpate. Single-stage image-guided VATS(iVATS) performed in a hybrid operation room has been introduced in recent years for the simultaneous localization and removal of small SPN. However, its efficacy and safety compared with traditional workflow has not been studied. Patients with undiagnosed SPN who required tumor localization prior to surgical resection between 2017/3 to 2017/6 were retrospectively reviewed. Based on the type of tumor localization method, patients were divided into two groups ( Group1 : iVATS ; Group 2: preoperative computed tomography guide tumor localization followed by VATS). The efficacy in localizing the tumor, complications, necessity to convert VATS to thoracotomy and radiation dose were compared. The cohort comprised 24 patients (12 in each group). The median SPN diameter was 7 mm (range: 3 – 11 mm) and the median distance of the lesion from the pleural surface was 13 mm (range: 0 – 47 mm) with no intergroup difference (P>0.05). Tumor localization procedure was successful in all patients with similar procedure time ( group1: 28 mins[range: 16∼41 mins] ; group2: 20 mins[range:14-35 mins] , p>0.05). However, the time interval from completion of localization to surgery was significantly longer in group 2 (median: 159 mins [range:78∼313mins]) than in group1(median:10mins[range:3∼20 mins], p<0.001). In group 2, migration of the hook wire occurred in 1 patients during the waiting period although it did not affect the success of VATS resection (nodule location guided by the lung puncture site). The mean effective radiation dose for group1 was 11.53 mSv and that for group2 was 13.50 mSv, respectively (P>0.05). Compared with the traditional workflow (based on preoperative CT-guided lesion localization followed by its surgical removal), single-stage iVATS for simultaneous localization and removal of small SPN is equally safe and accurate but more efficient.

Stabilization of Proximal Interphalangeal Arthrodesis of Lesser Toes Using K-wires vs. Implants

Category: Lesser Toes Introduction/Purpose: Lesser toe proximal interphalangeal (PIP) joint arthrodesis is one of the most common foot and ankle elective operative procedures. Currently, the most common method for fixation of the PIP joints is utilization of intramedullary Kirschner wires (K-wires). Implantation of K-wires have been shown to be associated with a fair number of complications including hardware failure, loosening, bending, mal-union, non-union, wire migration, and infection. These complications have led to the development of intramedullary devices for fixation. Our hypothesis was that the memo-metal X-fuse PIP joint arthrodesis implant (Stryker, Kalamazoo MI) would provide a stronger and stiffer arthrodesis than Kirschner wire fixation. Methods: Six matched fresh frozen cadaveric second toe pairs were used in the study. Six PIP joints were prepared and fixed with K-wires and the six contralateral PIP joints were prepared and fixed with the X-fuse system. All specimens were then potted and fixed to a custom jig. Specimens were then cyclically loaded with extension bending force of the PIP joint mimicking natural upward bending force in walking using 2 N step increases of force with 10 cycles per step. Failure was defined as 4 mm of actuator displacement. Load to failure was then assessed. Paired t-test was utilized for statistical analysis. Results: The average force at failure (defined as 4 mm of displacement) for the Kirschner wire was 93.3 N (SD 25.8) which was significantly greater than the average for the X-fuse system, 65.0 N (SD 13.8). P-value was 0.0053. Failure of the K-wire resulted from bending of the K-wire itself or breaching of cortical bone. Failure of the X-fuse typically resulted from implant pullout. Conclusion: Contrary to our hypothesis, K-wires provided a stiffer and stronger construct than the X-fuse system. Successful bony fusion is the clinical outcome of interest, and this cadaver study was used to assess stability of the fusion site at time zero after surgery. Limitations of this study include a relatively small sample size.

Management of displaced inferior patellar pole fractures with modified tension band technique combined with cable cerclage using Cable Grip System

IntroductionWe present a modified tension band technique combined with cable cerclage using Cable Grip System for the treatment of displaced inferior patellar pole fractures and report the knee functional outcome. Patients and methodsThe patients who had had operative treatment of a displaced inferior patellar pole fracture (AO/OTA 34-A1) between December 2013 and December 2015 were studied retrospectively. Eleven consecutive patients had had open reduction and internal fixation with the modified technique using Cable Grip System, of whom, five males and six females with an average age of 60.9 years (range, 29–81 years). All fractures occurred from direct fall onto the knee. The average time from injury to surgery was 6.1days (range, 2–12days). The range of motion (ROM) was measured in degrees by goniometry at postoperative intervals of 1, 2, 4, 12, and 48 weeks; Knee function was evaluated using the Rasmussen scores at final follow-up. ResultsNo patients had nonunion, loss of reduction, migration of wire, irritation from the implant and fixation breakage during the follow-up period. Recovery of ROM was achieved at 12 weeks, with the average ROM at 1 week was 72° (range, 65°–78°), 86.4° (range, 78°–92°) at 2 weeks, 115.5° (range, 103°–122°) at 4 weeks, 129.6° (range, 122°–133°) at 12 weeks, 134.5° (range, 129°–139°) at 48 weeks after the operation. Concerning the knee function outcome assessment, all patients showed excellent results at final follow-up. The average Rasmussen scores was 27.9 out of 30 (range, 27–29). ConclusionsThe modified tension band technique combined with cable cerclage using Cable Grip System for displaced inferior patellar pole fractures can provide stable fixation with excellent results in knee function, allows for immediate mobilization and early weight-bearing, which is a simple and valuable technique in routine clinical practice.

Kirschner Wire Migration from Proximal Humerus into the Lung: Brief Report

Although uncommon, migration of wires to solid organs or body cavities has been reported in the literature with potentially lethal complications. Wire migration into the lung is rare.Herein, we report a case of a 26-year-old-woman with Kirschner wire migration from the right shoulder to the thorax, piercing through the upper lobe of the right lung with hemopneumothorax and atelectasis. The wire was later removed through thoracotomy approach. The postoperative course was significant about an acute respiratory distress syndrome (ARDS) managed successfully.

WIRELESS TENSION BAND WIRING FOR OLECRANON FRACTURES. Case Series.

We reviewed retrospectively our WTBW cases done between 2000 and 2015 where we replaced the K-wires by a cerclage wire. In this technique no hardware migration is possible. Patients were evaluated clinically, radiographicaly and a DASH score was measured. Seventeen patients were reviewed with a mean age of 58.5 years. The mean follow-up period was 58.5 months. The mean DASH score was 12 with 7 patients having a DASH score of zero. Joint mobility was near normal compared to the other side with loss of a mean of 4º in elbow extension and a mean of 3º in elbow flexion. In comparison with other series, in addition to good results, hardware removal for medical reasons was the lowest in our technique. It was needed in three patients for pain on elbow contact and in one with ulnar nerve irritation. This represents a rate of 23.5%. Undesirable events related to the use of K-wires in standard tension band wiring, such as wire migration, wire protrusion through the skin and wire impingement, are absent in the wireless tension band wiring. The high rate of patient satisfaction, good clinical results as well as low rate of needed hardware removal make this technique preferable for fixing Mayo Type II A olecranon fractures.

A runaway sternal wire: A rare case and outcome of sternal wire intravascular embolization

We present a case of a 56-year-old man with history of coronary artery disease and prior two coronary bypass surgeries, who presented with chronic chest pain and was found to have a fractured sternal wire that migrated through the right ventricle and embolized to the right lower pulmonary artery without evident hemodynamic consequences. The sternal wire migration process, in part due to patient's poor medical compliance, was captured on serial computed tomography scans over a period of several years.<Learning objective: Recognize potential sternotomy complications on imaging. Identify rare but potentially dangerous complications of sternal wire fractures. Review of the literature on sternal wire embolization.>

Managment Of Fractures Of Patella Olecranon, Malleoli By Tension Band Wiring Method

Fractures of the eccentrically loaded bones like patella, olecranon and medial malleolus are one of the most common fractures encountered by an orthopaedic surgeon, with better operative techniques, internal fixation of these fractures with tension band wiring has become an accepted mode of treatment with its matching outcome results enabling the patient to smoothly resume his work without hampering his day-to-day life. Internal fixation of fractures hastens healing and rehabilitation. It also allows for early mobilization of the joint thereby preventing stiffness of joints and other complications related to immobilization. The aim of the study is to prove tension band wiring is a simple, inexpensive technique and effective means of fixing fracture based on biomechanical principle with minimum complications. Fifty cases of fractures were treated with tension band wiring, which comprised of fracture patella 20 cases, fracture olecranon 15 cases and medial malleolus 15 cases. Operated during period of 2013 to 2015. About 96% of fractures had united after 12 weeks. One case of wire migration was noted and superficial infection in one case who was a diabetic patient. In present study, there were 50% excellent, 32% good, 14% fair and 4% poor results