Kirschner wire migration causing spinal cord injury one year after internal fixation of a clavicle fracture.
K-wire migration after internal fixation of the clavicle has rarely been reported to cause spinal cord injuries. A 30-year-old man presented with progressive paraparesis, hypaesthesia under a Th4 level and electric pain in the neck and arms. CT of the spine revealed a migrated K-wire from a one-year-old clavicle osteosynthesis, penetrating the spinal canal through the Th2 nerve root foramen, and perforating the spinal cord with a transversal trajectory. Surgical removal of the K-wire was performed after exposing both ends. Laminectomy allowed visual control of the entry point and correction of cerebrospinal fluid leakage. The pain disappeared and the patient recovered a normal gait after 6 weeks. The use of two incisions is advocated in such cases: one lateral to allow wire removal, and one medial for dural repair and early intradural bleeding control. Regular follow ups, K-wire removal after fracture healing as well as bending the wire end in a walking stick shape should minimise the risk of migration.
Fransen
Patrick
P
Department of Neurosurgery, Clinique du Parc Léopold, Brussels, Belgium. p.fransen@neurobrussels.be
Bourgeois
Sylvie
S
Rommens
Jacques
J
D000328:Adult; D001864:Bone Wires; D002968:Clavicle / Q000293:injuries*; D005548:Foreign-Body Migration / Q000150:complications*; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D008297:Male; D013119:Spinal Cord Injuries / Q000209:etiology*; D013997:Time Factors