577201 research-article2015
JHS0010.1177/1753193415577201The Journal of Hand Surgery (Eur)Short report letter
JHS(E)
Short report letter
The Journal of Hand Surgery (European Volume) XXE(X) 1–2 jhs.sagepub.com
A valuable surgical technique to remove a loose fragment Kirschner wire from the carpal bones Dear Sir, Breakage, infection, osteomyelitis, and pin migration of Kirschner wires (K-wires) have been described (Botte et al., 1992; Stahi and Schwartz, 2001). We report a case of a broken K-wire in the hand of a 39-year-old man. He presented with radiographic evidence of scapholunate (SL) dissociation, probably from previous trauma. Wrist arthroscopy showed post-traumatic SL instability (Grade 4). A modified Brunelli procedure was performed to reconstruct the SL interosseous ligament. Two K-wires were positioned through the SL joint and the scaphocapitate (SC) joint to stabilize the reduced SL joint. The Kwires were due to remain in place for 6–8 weeks. Unfortunately 5 weeks after surgery the follow-up radiographs showed that the K-wire stabilizing the SC joint had broken and a fragment of this K-wire remained in the capitate (Figure 1). Since leaving the loose K-wire fragment in place may pose a risk of complications due to possible migration of the fragment (Cebesoy et al., 2007; Dhillon et al., 2009), we decided to remove the remaining part of the broken K-wire. In the medical literature, we found one case that was similar to ours
except for the location, namely in the midfoot (Roy et al., 2014); we decided to adopt this method to our case. Under regional anaesthesia, a 1-cm incision was made in the anatomical snuffbox. A 1.6 mm K-wire was positioned to stabilize the SC joint and prevent the bones and broken K-wire from moving. After slight overdrilling of the tunnel in the scaphoid, the distal part of the drill bit gained sufficient mobility to catch the remaining part of the broken K-wire in the capitate bone (Figure 2(A)). Under fluoroscopic guidance, we targeted the distal part of the broken K-wire in the capitate and the K-wire was removed together
Figure 1. Radiographs 5 weeks after modified Brunelli procedure: (A) posterior-anterior view; (B) lateral view.
Figure 2. Per-operative fluoroscopy images.
(A) After slight overdrilling of the tunnel in the scaphoid, the distal part of the drill bit gained sufficient mobility to catch the remaining part of the broken K-wire in the capitate. (B) Targeting the distal part of the broken K-wire in the capitate bone and removal of the broken K-wire. (C) Confirmation of removal of the K-wire without evident scapholunate dissociation. Downloaded from jhs.sagepub.com at UNIV MASSACHUSETTS BOSTON on September 27, 2015
2
The Journal of Hand Surgery (Eur)
with the drill while withdrawing it carefully (Figure 2(B)). Fluoroscopy confirmed complete removal of the K-wires without causing scapholunate dissociation (Figure 2(C)). This technique has not previously been described in hand surgery. We recommend this technique in these difficult cases. Acknowledgements Special thanks to Dr A. D. Verburg for sharing his professional expertise.
Dhillon R, Williams K, Alhadhi K. Transcarpal migration of a broken Kirschner wire causing ulnar neuropraxia. J Hand Surg Am. 2009, 34: 522–4. Stahl S, Schwartz O. Complications of K-wire fixation of fractures and dislocations in the hand and wrist. Arch Orthop Trauma Surg. 2001, 121: 527–30. Roy SP, Lim CT, Tan KJ. A useful surgical technique for retrieval of a broken guide pin in the midfoot. J Foot Ankle Surg. 2014, 53: 120–123.
K. E. M. Cox-Limpens1, L. K. Hoevenaars1 and T. J. M. v Mulken1,2 1Department
Conflict of interests None declared.
References Botte MJ, Davis JL, Rose BA et al. Complications of smooth pin fixation of fractures and dislocations in the hand and wrist. Clin Orthop Relat Res. 1992, 276: 194–201. Cebesoy O, Subasi M, Arpacioglu O et al. A rare complication in scaphoid pseudoarthrosis: intra-articular migration and breaking of Kirschner wire. Injury. 2007, 38: 988–9.
of Plastic Surgery, Orbis Medical Center, Sittard, The Netherlands 2Department of Plastic Surgery, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands Corresponding author: [email protected]
© The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav doi: 10.1177/1753193415577201 available online at http://jhs.sagepub.com
Downloaded from jhs.sagepub.com at UNIV MASSACHUSETTS BOSTON on September 27, 2015
JHS0010.1177/1753193415577201The Journal of Hand Surgery (Eur)Short report letter
JHS(E)
Short report letter
The Journal of Hand Surgery (European Volume) XXE(X) 1–2 jhs.sagepub.com
A valuable surgical technique to remove a loose fragment Kirschner wire from the carpal bones Dear Sir, Breakage, infection, osteomyelitis, and pin migration of Kirschner wires (K-wires) have been described (Botte et al., 1992; Stahi and Schwartz, 2001). We report a case of a broken K-wire in the hand of a 39-year-old man. He presented with radiographic evidence of scapholunate (SL) dissociation, probably from previous trauma. Wrist arthroscopy showed post-traumatic SL instability (Grade 4). A modified Brunelli procedure was performed to reconstruct the SL interosseous ligament. Two K-wires were positioned through the SL joint and the scaphocapitate (SC) joint to stabilize the reduced SL joint. The Kwires were due to remain in place for 6–8 weeks. Unfortunately 5 weeks after surgery the follow-up radiographs showed that the K-wire stabilizing the SC joint had broken and a fragment of this K-wire remained in the capitate (Figure 1). Since leaving the loose K-wire fragment in place may pose a risk of complications due to possible migration of the fragment (Cebesoy et al., 2007; Dhillon et al., 2009), we decided to remove the remaining part of the broken K-wire. In the medical literature, we found one case that was similar to ours
except for the location, namely in the midfoot (Roy et al., 2014); we decided to adopt this method to our case. Under regional anaesthesia, a 1-cm incision was made in the anatomical snuffbox. A 1.6 mm K-wire was positioned to stabilize the SC joint and prevent the bones and broken K-wire from moving. After slight overdrilling of the tunnel in the scaphoid, the distal part of the drill bit gained sufficient mobility to catch the remaining part of the broken K-wire in the capitate bone (Figure 2(A)). Under fluoroscopic guidance, we targeted the distal part of the broken K-wire in the capitate and the K-wire was removed together
Figure 1. Radiographs 5 weeks after modified Brunelli procedure: (A) posterior-anterior view; (B) lateral view.
Figure 2. Per-operative fluoroscopy images.
(A) After slight overdrilling of the tunnel in the scaphoid, the distal part of the drill bit gained sufficient mobility to catch the remaining part of the broken K-wire in the capitate. (B) Targeting the distal part of the broken K-wire in the capitate bone and removal of the broken K-wire. (C) Confirmation of removal of the K-wire without evident scapholunate dissociation. Downloaded from jhs.sagepub.com at UNIV MASSACHUSETTS BOSTON on September 27, 2015
2
The Journal of Hand Surgery (Eur)
with the drill while withdrawing it carefully (Figure 2(B)). Fluoroscopy confirmed complete removal of the K-wires without causing scapholunate dissociation (Figure 2(C)). This technique has not previously been described in hand surgery. We recommend this technique in these difficult cases. Acknowledgements Special thanks to Dr A. D. Verburg for sharing his professional expertise.
Dhillon R, Williams K, Alhadhi K. Transcarpal migration of a broken Kirschner wire causing ulnar neuropraxia. J Hand Surg Am. 2009, 34: 522–4. Stahl S, Schwartz O. Complications of K-wire fixation of fractures and dislocations in the hand and wrist. Arch Orthop Trauma Surg. 2001, 121: 527–30. Roy SP, Lim CT, Tan KJ. A useful surgical technique for retrieval of a broken guide pin in the midfoot. J Foot Ankle Surg. 2014, 53: 120–123.
K. E. M. Cox-Limpens1, L. K. Hoevenaars1 and T. J. M. v Mulken1,2 1Department
Conflict of interests None declared.
References Botte MJ, Davis JL, Rose BA et al. Complications of smooth pin fixation of fractures and dislocations in the hand and wrist. Clin Orthop Relat Res. 1992, 276: 194–201. Cebesoy O, Subasi M, Arpacioglu O et al. A rare complication in scaphoid pseudoarthrosis: intra-articular migration and breaking of Kirschner wire. Injury. 2007, 38: 988–9.
of Plastic Surgery, Orbis Medical Center, Sittard, The Netherlands 2Department of Plastic Surgery, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands Corresponding author: [email protected]
© The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav doi: 10.1177/1753193415577201 available online at http://jhs.sagepub.com
Downloaded from jhs.sagepub.com at UNIV MASSACHUSETTS BOSTON on September 27, 2015
