migration of a kirschnerwirelead to brachialartery injury after fixation for proximal humerus fracture

K-wiresare generally used in orthopedic fracture surgery. pinning with metal wires is a reasonable option for proximal humeral fractures treatment. one 91yearold man received multiple kwire fixation for left proximal humeral fractures. later in postoperative followup at the outpatient department, he illustrated symptoms of tenderness, swelling, coinsized bullae formation and ecchymosis over left axillary region.kwire migration was noted, which lead to brachial artery injury with traumatic pseudoaneurysmformation. the patient underwent emergent surgery wherepreviously placed kpins were removed and then received revascularization surgery afterward. functional shoulder brace was adopted for his postoperative immobilization of left shoulder and fracture site bony :union: was noted an year later. he lead independent activity of daily life as previously before the accident.previous documents had reported potentially dramatic complications related to wires migration and most of them were intrathoracic migration cases. we present the uncommon case of brachial artery injury with traumatic pseudoaneurysm. while it may not be as detrimental injury as intrathoracic migration of kpins, brachial artery penetration could lead to more undetected clinical symptoms and result in irreversible damage. orthopedic surgeons should consider related risks when using kwire fixation over proximal humerus,especially in cases of elder patients with possible lowcompliance to immobilization and low bone quality. most important of all, doctors must alert patients about the importance of returning for followup evaluation postoperatively,and for the removal of k-wires.

Migration of a KirschnerWireLead to BrachialArtery Injury after Fixation for Proximal Humerus Fracture

AbstractK-wiresare generally used in orthopedic fracture surgery. Pinning with metal wires is a reasonable option for proximal humeral fractures treatment. One 91yearold man received multiple Kwire fixation for left proximal humeral fractures. Later in postoperative followup at the outpatient department, he illustrated symptoms of tenderness, swelling, coinsized bullae formation and ecchymosis over left axillary region.Kwire migration was noted, which lead to brachial artery injury with traumatic pseudoaneurysmformation. The patient underwent emergent surgery wherepreviously placed Kpins were removed and then received revascularization surgery afterward. Functional shoulder brace was adopted for his postoperative immobilization of left shoulder and fracture site bony :union: was noted an year later. He lead independent activity of daily life as previously before the accident.Previous documents had reported potentially dramatic complications related to wires migration and most of them were intrathoracic migration cases. We present the uncommon case of brachial artery injury with traumatic pseudoaneurysm. While it may not be as detrimental injury as intrathoracic migration of Kpins, brachial artery penetration could lead to more undetected clinical symptoms and result in irreversible damage. Orthopedic surgeons should consider related risks when using Kwire fixation over proximal humerus,especially in cases of elder patients with possible lowcompliance to immobilization and low bone quality. Most important of all, doctors must alert patients about the importance of returning for followup evaluation postoperatively,and for the removal of K-wires.