Spinal migration of a Kirschner wire after surgery for clavicular nonunion. A case report and review of the literature

Kirschner wires (K-wires) are often used for osteosynthesis, particularly in the upper limb. Postoperative K-wire migration through the tissues is a well-recognised and significant complication of surgery of the clavicle, the wire ending Lip in the lungs, the oesophagus, the aorta, or the subclavian artery. Localisation of a K-wire migration into the spinal cord is very rare. We report the case of a 34-year-old mail with K-wire migration into the spinal cord through the intervertebral foramen of T2, two months after surgery for nonunion of a fracture of the lateral clavicle. Apart from acute respiratory failure related to a pneumothorax, the patient initially had no neurological deficit. It was decided to operate on him immediately. Two therapeutic options are possible: simple K-wire removal via a supraclavicular approach, or the same but with direct visual control in the spinal cord after laminectomy. A postoperative check with an MRI scan is desirable after two days. Even if mechanism of K-wire migration is not known, the means of prevention are, namely strict postoperative immobilization, K-wire removal as soon as bone healing is achieved, and bending the external tip of each implanted wire. (C) 2009 Elsevier Masson SAS. All rights reserved.