title: Intraoperative pulmonary embolism of Harrington rod during spinal surgery: the potential dangers of rod cutting.
abstract: This is a case report and laboratory-based biomechanics study. The objective is to report the first case of Titanium rod embolisation during scoliosis surgery into the Pulmonary artery. To investigate the potential of an unconstrained cut Titanium rod fragment to cause wounding with reference to recognised weapons. Embolisation of a foreign body to the heart is rare. Bullet embolisation to the heart and lungs is infrequently reported in the last 80 years. Iatrogenic cases of foreign body embolisation are very rare. Fifty 1-2 cm segments of Titanium rod were cut in an unconstrained manner and a novel method was used to calculate velocity. A high-speed camera (6,000 frames/s) was used to further measure velocity and study projectile motion. The wounding potential was investigated using lambs liver, high-speed photography and local dissection. Rod velocities were measured in excess of 23 m s(-1). Rods were seen to tumble end-over-end with a maximum speed of 560 revolutions/s. The maximum kinetic energy was 0.61 J which is approximately 2% that of a crossbow. This is sufficient to cause significant liver damage. The degree of surface damage and internal disruption was influenced by the orientation of the rod fragment at impact. An unconstrained cut segment of a Titanium rod has a significant potential to wound. Precautions should be taken to avoid this potentially disastrous but preventable complication.
authors.affiliation: Bristol Royal Infirmary, 2 Grove Road, Coombe Dingle, Bristol, UK. caspar@doctors.net.uk
authors.forename: Caspar E W
authors.initials: CE
authors.lastname: Aylott
authors.forename: Kamran
authors.initials: K
authors.lastname: Hassan
authors.forename: Donal
authors.initials: D
authors.lastname: McNally
authors.forename: John K
authors.initials: JK
authors.lastname: Webb
mesh_terms: D000328:Adult; D000818:Animals; D001696:Biomechanical Phenomena; D001858:Bone Nails / Q000009:adverse effects*; D005260:Female; D005548:Foreign-Body Migration / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology* / Q000503:physiopathology; D008099:Liver / Q000293:injuries; D008962:Models, Theoretical; D010781:Photography / Q000379:methods; D011651:Pulmonary Artery; D011655:Pulmonary Embolism / Q000209:etiology* / Q000503:physiopathology; D012600:Scoliosis / Q000601:surgery*; D012756:Sheep; D013123:Spinal Fusion / Q000295:instrumentation; D014025:Titanium; D014947:Wounds and Injuries / Q000209:etiology / Q000503:physiopathology
chemical_list: D014025:Titanium