Unusual migration of a Kirschner wire in a patient with Osteogenesis Imperfecta

Abstract

Rationale:Kirschner wires (K-wires) are the most commonly used implants in orthopedic surgery. Although complications are not uncommon, they are mostly benign in nature and easily managed. While migration of K-wires is a rare complication, fatal outcomes have been reported. A review of the literature showed that only 7 cases of wire migration in the hip and pelvic region have been reported. Only 2 occurred in the pediatric population. Although K-wires are routinely used in osteogenesis imperfecta (OI) patients, there has been no report of complications in this vulnerable patient population.Patient concerns:A 10-year-old girl with OI, presenting with gastrointestinal symptoms 1 year after operative fixation of a subtrochanteric femoral fracture. Pelvic x-ray showed a missing K-wire.Diagnosis:The patient was diagnosed with migration of a K-wire from the left femoral neck to the right retroperitoneal space.Interventions:The patient underwent surgery. During the operation, the migrated K-wire was extracted from just below the 12th rib on the right side.Outcomes:The patient had an uneventful rehabilitation, recovered completely, and was asymptomatic at 2-year follow-up.Lessons:There has been no prior report of migrated K-wires in the OI population. This is also the first report of a K-wire migrating from the femoral neck to the contralateral retroperitoneal region. Proper intraoperative bending of K-wires, timely removal of temporary K-wires, and considering K-wire migration in patients with retained hardware complaining of respiratory or gastrointestinal symptoms will prevent potentially life-threatening complications.

Retroperitoneal Kirschner wire migration after surgical treatment in a patient with cerebral palsy

“…In the second case presented by Marya et al, [5] a transarticular K-wire was used for the five-year-old patient in the same technique as in Yurtçu et al's study [4] The K-wire was migrated to the liver asymptomatically after the plaster cast was removed. [5] The last cases are the symptomatic late term K-wire migration pediatric cases presented by Baghdadi et al [3] and Şahin and Karakaş. [6] In the case report by Bagdadi et al, [3] they stated that a 10-year-old patient with osteogenesis imperfecta was fixed in the subtrochanteric region fracture using tension band technique with two K-wires and one Cerclage wire.…”

“…[5] The last cases are the symptomatic late term K-wire migration pediatric cases presented by Baghdadi et al [3] and Şahin and Karakaş. [6] In the case report by Bagdadi et al, [3] they stated that a 10-year-old patient with osteogenesis imperfecta was fixed in the subtrochanteric region fracture using tension band technique with two K-wires and one Cerclage wire. One year after the surgery, they reported the detection of the K-wire migration to the retroperitoneal region in the patient who presented with chest pain and back pain.…”

“…One year after the surgery, they reported the detection of the K-wire migration to the retroperitoneal region in the patient who presented with chest pain and back pain. [3] In the last case report study about K-wire migration, Şahin and Karakaş [6] reported that they found K-wire migration in three cases after pelvic osteotomy surgery in pediatric patients. Yurtcu et al [4] and Marya et al [5] reported that this complication can be prevented by tilting the K-wire outside the skin.…”

“…[ 2 ] On the other hand, K-wire migration is the critical complication which may even result in possible mortality. [ 3 ] To the best of our knowledge, there have been only a few reports in the pediatric population with late-term migration of pelvic K-wire. [ 3 - 6 ]…”

“…[2] On the other hand, K-wire migration is the critical complication which may even result in possible mortality. [3] To the best of our knowledge, there have been only a few reports in the pediatric population with late-term migration of pelvic K-wire. [3][4][5][6] In this case report of a patient with spastic type cerebral palsy sequel, following surgical treatment of developmental hip dysplasia, we presented the migration of the K-wire used in the stabilization of pelvic osteotomy, in the psoas muscle at the retroperitoneal region.…”