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[Migration of the wire after osteosynthesis]
Insights
A Kirschner wire used for sternoclavicular joint dislocation migrated, causing fatal hemopericardium. This rare complication, the wandering wire syndrome, highlights risks associated with osteosynthesis, particularly for sternoclavicular joint injuries.
Area of Science:
- Medical Case Report
- Surgical Complications
- Orthopedic Surgery
Background:
- Osteosynthesis is a common surgical procedure to repair bone fractures or dislocations.
- Kirschner wires are frequently used in orthopedic surgery for fracture fixation.
- Dislocations of the sternoclavicular joint can occur, sometimes requiring surgical intervention.
Observation:
- A 20-year-old woman experienced sudden death due to hemopericardium following osteosynthesis of a dislocated sternoclavicular joint.
- The Kirschner wire migrated from the sternoclavicular joint to the ascending aorta and right auricle.
- This migration resulted in lethal bleeding into the pericardium, a condition known as the wandering wire syndrome.
Findings:
- The pathogenesis of the wandering wire syndrome was discussed, comparing the current case with existing literature.
- Wandering of Kirschner wires after sternoclavicular joint osteosynthesis is identified as particularly dangerous.
- In contrast, wires used for clavicle fractures, acromioclavicular joint dislocations, or hip region injuries typically do not cause serious complications.
Implications:
- Current surgical textbooks inadequately address the risks and clinical phenomena associated with the wandering wire syndrome.
- Increased awareness and detailed reporting of this syndrome are crucial for orthopedic surgeons.
- This case underscores the importance of vigilant monitoring and careful surgical technique to prevent catastrophic complications during osteosynthesis procedures.
Abstract:
In a 20 year old woman, sudden death due to hemopericardium ensued on osteosynthesis with Kirschner wire of a dislocated sternoclavicular joint. The wire moved to the aorta ascendens and to the right auricle thus causing lethal bleeding into the pericardium. The pathogenesis of the wandering wire is discussed and compared with observations in the literature describing causes, history and clinical phenomena. Wandering after osteosynthesis due to dislocation of the sternoclavicular joint is particularly dangerous, whereas in the case of broken clavicle, dislocation of the acromioclavicular joint, fracture of the humereus or in the region of the hips, no serious complications occur as a rule. Present-day text-books on surgery do not make sufficiently detailed reference to the wandering wire syndrome.