Subcostal wire migration from the left clavicle internal fixation: A case report.

Background: Kirschner wire is a widely used implant in orthopedics, with migration being a typical problem following internal fixation. Subcostal wire migration might result in catastrophic problems such as penetration of the heart, lungs, trachea, big blood vessels, or abdominal cavity. Every orthopedic surgeon must be vigilant and mindful of the potential hazards of wire migration.

Case Report: a 45-year-old Indonesian male was referred from another hospital. 1 year prior, the patient underwent internal fixation of the left clavicle. 2 weeks before admission, the patient complained of stabbing pain in the left shoulder area. An X-ray examination revealed a broken end wire in the left infraclavicular area. Immediate wire-extraction surgery was planned. An X-ray and CT scan showed that the wire had migrated into the left lateral side of the 9th subcostal space and was heading inferiorly. The Thoracic and Cardiovascular Surgery Department carried out the wire evacuation. The wire was successfully removed without any concern.

Discussion: Previous studies have suggested that wire migration can occur due to muscular activity, respiratory motion, gravity, and upper-extremity movement. Wire migration is a condition that can occur following shoulder fixation, especially in comminuted fractures that typically use K-wires to stabilize the fragments. Upon the detection of wire migration, prompt evacuation should be conducted to mitigate the severity.

Conclusion: In cases of wire migration, orthopedic surgeons should pay special attention. Actions that can be taken to prevent wire migration are to: bend the wire, use a threaded wire, and remove it quickly after callus formation.