[Spinal migration of a Kirschner wire after surgery for clavicular nonunion. A case report and review of the literature].
Kirschner wires (K-wires) are often used for osteosynthesis particularly in the upper limb. Postoperative K-wire migration through the tissues is a well-recognised and significant complication of surgery of the clavicle, the wire ending up in the lungs, the oesophagus, the aorta, or the subclavian artery. Localisation of a K-wire migration into the spinal cord is very rare. We report the case of a 34-year-old man with K-wire migration into the spinal cord through the intervertebral foramen of T2, two months after surgery for nonunion of a fracture of the lateral clavicle. Apart from acute respiratory failure related to a pneumothorax, the patient initially had no neurological deficit. It was decided to operate on him immediately. Two therapeutic options are possible: simple K-wire removal via a supraclavicular approach, or the same but with direct visual control in the spinal cord after laminectomy. A postoperative check with an MRI scan is desirable after two days. Even if mechanism of K-wire migration is not known, the means of prevention are, namely strict postoperative immobilization, K-wire removal as soon as bone healing is achieved, and bending the external tip of each implanted wire.
Mamane
W
W
Service de chirurgie orthopédique et traumatologique, hôpital Beaujon, 100, boulevard Géréral-Leclerc, 92110 Clichy, France. william.mamane@yahoo.fr
Breitel
D
D
Lenoir
T
T
Guigui
P
P
D000328:Adult; D001864:Bone Wires / Q000009:adverse effects*; D002968:Clavicle / Q000293:injuries*; D005548:Foreign-Body Migration; D005599:Fractures, Ununited / Q000601:surgery*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000209:etiology*; D013115:Spinal Canal