Kirschner Wire Migration into SpinaL Canal after Acromioclavicular Joint Fixation (Literature Review and Clinical Case)

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Abstract

Fracture and migration of metal implants is a well-known issue which is especially relevant for actively loaded zones with a high amplitude of physiological movements. The authors analyzed 17 publications dedicated to Kirschner wire migration into the spinal canal after fixation of acromioclavicular joint (ACJ) injury. The present paper contains literature review and own clinical case of the authors. The authors generalize the conceptions of migration causes, surgical tactics and prevention recommendations. The key reason of fracture and migration of Kirschner wires during fixation of ACJ injury is the instability of implants, trans-articular wire insertion during fixation of reduced dislocation of acromial end of the clavicle, insufficient immobilization and untimely implants removal after removal of immobilization. Implants migration into the spinal canal is the indication for their surgical removal irrespective of clinical signs. In the majority of studied publications authors described posterior approach or lateral approach aligned with the migration direction. No grafting techniques for dura mater defects were present in the studied literature. The authors of the current paper justify a surgical procedure for removal of migrated implant using a combined posterior and lateral approach on the own clinical case. The choice of procedure algorithm results from the need for prophylaxis of secondary spinal cord lesion and liquorrhea during removal of migrated implants from spinal canal.

About the authors

D. A. Gulyaev

Almazov National Medical Research Centre

Email: fake@neicon.ru

Dmitry A. Gulyaev — Dr. Sci. (Med.), professor, chief of the Department of Neurosurgery N 5

St. Petersburg

Russian Federation

D. S. Godanyuk

Almazov National Medical Research Centre

Author for correspondence.
Email: godanyuk@gmail.com

Denis S. Godanyuk — neurosurgeon. Department of Neurosurgery N 5

St. Petersburg

Russian Federation

T. A. Kaurova

Almazov National Medical Research Centre

Email: fake@neicon.ru

Tatiana A. Kaurova — Cand. Sci. (Med.), neurosurgeon. Department of Neurosurgery N 5

St. Petersburg

Russian Federation

P. V. Krasnoshlyk

Almazov National Medical Research Centre

Email: fake@neicon.ru

Pavel V. Krasnoshlyk cand. Sci. (Med.), head of the Department of Neurosurgery N 5

St. Petersburg

Russian Federation

S. V. Maikov

Vreden Russian Research Institute of Traumatology and Orthopedics

Email: fake@neicon.ru

Sergey V. Maikov — cand. Sci. (Med.), researcher, department of Sports Traumatology and Rehabilitation

St. Petersburg

 

Russian Federation

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