title: Intraspinal migration of a clavicular Steinmann pin: case report and management strategy.
abstract: Spine injury resulting from migration of previously implanted appendicular skeleton fixation hardware is rare. We present a 41-year-old man who had Steinmann fixation pins placed for a left clavicular fracture 2 years prior. He presented with a burning sensation over his biceps bilaterally and numbness over the left anterior chest and abdomen following a significant blunt traumatic injury. A CT scan revealed migration of a fractured Steinmann pin entering the left C8 neural foramen, traversing anterior to the spinal cord. The patient underwent a left C7 hemilaminectomy, foraminal decompression, and first rib resection to identify the extraforaminal portion of the pin and remove it under direct vision. He recovered uneventfully. We conclude that a principle of safe surgical removal includes adequate exposure to allow for direct visualization of the pin and neural structures. We review the evaluation and management strategies of this unusual condition.
authors.affiliation: Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit Street, White Building 502, Boston, Massachusetts 02114, USA.
authors.forename: Matthew K
authors.initials: MK
authors.lastname: Mian
authors.forename: Brian V
authors.initials: BV
authors.lastname: Nahed
authors.forename: Brian P
authors.initials: BP
authors.lastname: Walcott
authors.forename: Jean-Valery
authors.initials: JV
authors.lastname: Coumans
mesh_terms: D000328:Adult; D001858:Bone Nails / Q000009:adverse effects*; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000601:surgery; D005548:Foreign-Body Migration / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D016268:Internal Fixators / Q000009:adverse effects; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods; D011859:Radiography; D013116:Spinal Cord / Q000000981:diagnostic imaging* / Q000601:surgery