Unusual clinical course, Challenging differential diagnosis, Unusual or unexpected effect of treatment, Diagnostic / therapeutic accidents, Clinical situation which can not be reproduced for ethical reasons
Érica Lofrano Reghine, Caio César Inaco Cirino, André Amate Neto, Fabiana Rossi Varallo, Paulo Roberto Barbosa Évora, Tales Rubens de Nadai
(Américo Brasiliense State Hospital, São Paulo, SP, Brazil)
Am J Case Rep 2018; 19:325-328
Kirschner wires are often used to perform osteosynthesis. Migration through tissue of these wires is a rare but well-known occurrence.
CASE REPORT: A 65-year-old female presented with light intensity pain complaints in the upper left chest area; personal history included left clavicle fracture 20 years ago that was treated surgically with fixation using a K-wire. Chest radiography showed the presence of metallic foreign body in the left pulmonary apex. An exploratory axillary thoracotomy was performed, and the foreign body was extracted by a pneumotomy.
CONCLUSIONS: To obtain satisfactory results with a K-wire, some peculiarities in their application should be respected. The time from orthopedic surgery of the collarbone to migration into the chest of the metal rod used can vary from one day to nearly 20 years. Although the migration mechanism remains unclear, it is likely that it involves shoulder movements, breathing movements, negative intrathoracic pressure, gravitational force, or local bone resorption. Caution should be exercised when orthopedic pins and wires are used for the fixation of fractures and dislocations of the shoulder girdle. If there is migration of the wire, it should be removed immediately to avoid sudden and fatal complications.
Keywords: Clavicle, Device Removal, Lung, Risk Management, Thoracic Surgery