Chronic heart perforation with 13.5 cm long Kirschner wire without pericardial tamponade: an unusual sequelae after...

Area of Science:

• Orthopedic surgery
• Cardiology
• Medical device complications

Background:

• Kirschner wires are commonly used in osteosynthesis for fracture fixation.
• Delayed migration of orthopedic implants is a known, albeit infrequent, complication.
• Cardiac embolization by foreign bodies can lead to severe cardiovascular events.

Observation:

• A 13.5 cm Kirschner wire, previously used for right humeroscapular osteosynthesis for 24 months, was found to have migrated to the heart.
• The migrated wire caused a myocardial perforation.
• Despite the perforation, the patient did not develop pericardial tamponade.

Findings:

• This case represents the longest reported duration of an in-situ Kirschner wire preceding cardiac migration.
• The absence of pericardial tamponade despite myocardial perforation is a highly unusual finding in cardiac foreign body migration.
• Autopsy and medical record analysis confirmed the wire's path from the shoulder joint to the cardiac chambers.

Implications:

• Highlights the potential for delayed, extensive migration of Kirschner wires, even after prolonged periods.
• Underscores the importance of vigilance for late implant complications in orthopedic patients.
• Suggests the need for further investigation into factors influencing foreign body migration and associated clinical presentations.