Abstract
Kirschner's wires are widely used for fixation of bone fractures, with cause serious complications only very rarely. A rare case of K-wire migration through the trachea is reported. A 28-year-old male was admitted to our hospital with complaints of cough and bloody sputum. Chest X-ray film showed a metallic needle approximately 5cm. in length in the upper mediastinum above the sternum. There was no evidence of pneumothorax, pleural effusion or mediastinal emphysema. Chest CT scan revealed a metallic needle passing completely through the trachea. Bronchoscopic examination revealed a metallic needle passing through the upper trachea from the right posterolateral 3rd cartilage to the left anterolateral 5th cartilage. Migration of a K-wire into the trachea was diagnosed, because of his history of right clavicular-osteosynthesis 6 months previously. Two months after osteosynthesis using 3 K-wires, two of the wires were extracted and 4 weeks roentgenological examination revealed a broken K-wire. The distal half of the K-wire was extracted. 2 days after admission, operation was performed with a collar skin incision under local anesthesia. Separating the trachea and the left sternothyroid muscle the surface of the metallic needle was seen covered with thin fibrous tissue and granulation. The metallic needle was extracted without tracheotomy. Intubation with a cuffed endotracheal tube was performed after needle extraction because air leaks could be seen at both puncture sites in the trachea. The tracheal puncture sites were not sutured. Drainage was performed at both sides of the trachea and the wound was closed. The patient was discharged no the 12th day after operation without complications. In this patient, there were no symptoms during the interval of 3 months between extraction of half of the remaining needle and the subsequent examination demonstrating the needle in the trachea. Shoulder joint mobility is extensive therefore if a broken K-wire is found after claviclar osteosynthesis on X-ray examination, surgical operation should be performed soon to extract it because of the possibility of migration.
