Cerruti Paola, Mangano Tony, Giovale Marcello, Repetto Ilaria
Department of Orthopaedics and Traumatology, University of Genova, School of Medicine, Padiglione 40, Largo Rosanna Benzi 10, Genova, Italy.
GSL, Albenga Orthopedic Center, Santa Maria di Misericordia Hospital, Viale Martiri Della Foce, Albenga, Italy.
Int J Shoulder Surg. 2016 Jan-Mar;10(1):41-3. doi: 10.4103/0973-6042.174520.
Pinning with metallic wires is a suitable therapeutic option for proximal humeral fractures. Loosening and migration of such devices from this site is uncommon. Despite infrequently occurring, however, the literature reports dramatic and potentially lethal complications related to wires dislocation. A 69-year-old woman underwent closed reduction and fixation of a proximal 3-part humeral fracture by mean of two retrograde Kirschner wires and one anterograde threaded pin. One month after surgery, during a routine follow-up control, it was diagnosed the migration of the threaded pin in the left lung parenchyma. In the meantime, the only symptom the patient complained was an episodic intercostal pain of mild intensity, with referred onset 1 week after surgery. The migrated pin was removed through thoracoscopic approach in the emergency setting, without intra- or post-operative complications. Only a few authors reported similar complications after fixation of proximal humeral fractures. Immediate surgical removal of the device is always mandatory. When considering pinning fixation for shoulder girdle's fractures, orthopedic surgeons should take into account the risk for wire dislocation, and take up adequate precautions during surgery and follow-up control visits.
金属丝内固定是治疗肱骨近端骨折的一种合适方法。此类装置在此部位松动和移位并不常见。然而，尽管这种情况很少发生，但文献报道了与金属丝移位相关的严重且可能致命的并发症。一名69岁女性通过两根逆行克氏针和一根顺行螺纹针进行了肱骨近端三部分骨折的闭合复位和固定。术后1个月，在常规随访检查时，诊断出螺纹针移位至左肺实质。与此同时，患者唯一抱怨的症状是轻度间歇性肋间疼痛，术后1周开始出现。在紧急情况下，通过胸腔镜手术取出了移位的针，未出现术中或术后并发症。只有少数作者报道过肱骨近端骨折固定后出现类似并发症。必须立即手术取出该装置。在考虑对肩胛带骨折进行内固定时，骨科医生应考虑金属丝移位的风险，并在手术和随访检查期间采取适当的预防措施。
