Sharma Satish Kumar, Sharma Sonendra Kumar, Aslam Mohammed, Chadha Gagan Naresh
Department of Orthopaedics, Sir Ganga Ram Hospital, New Delhi, India.
J Orthop Case Rep. 2016 Nov-Dec;6(5):41-43. doi: 10.13107/jocr.2250-0685.622.
Comminuted fracture of patella is most commonly treated by tension band wiring with cerclage wiring. Broken cerclage wiring after such surgery is not uncommon but intra-articular migration of broken cerclage wire is rarely known and described complication.
A 51-year-old male patient of Indian origin which was treated, 15 months back for fracture patella with tension band wiring with cerclage wiring, presented with painful restriction of knee movements for the last 4 weeks. X-ray showed cerclage wire had broken at multiple sites with one broken piece migrated intra-articular. This case is unique due to the size of migrated broken cerclage wire which was about 4.5 cm long, second the anterior part of broken wire was hooked around anterior cruciate ligament, which prevented its further migration otherwise neurovascular structures could have been damaged. This intra-articular piece of wire was removed arthroscopically.
We recommend that all patients receiving bone fixation with wires should be counseled about the risks of hardware failure and possible migration, with the option of elective hardware removal discussed. In addition, when wire breakage is detected radiologically, the patient should be strongly advised to have the wires removed as soon as possible.
髌骨粉碎性骨折最常用张力带钢丝环扎术治疗。此类手术后钢丝环扎断裂并不罕见，但钢丝环扎断裂后在关节内移位是鲜为人知且鲜有描述的并发症。
一名51岁的印度裔男性患者，15个月前因髌骨骨折接受张力带钢丝环扎术治疗，在过去4周出现膝关节活动疼痛受限。X线显示钢丝环扎在多处断裂，其中一块断端移入关节内。该病例独特之处在于，移入关节内的断裂钢丝环扎长度约为4.5厘米，其次，断裂钢丝的前部钩在前交叉韧带上，否则会进一步移位，可能损伤神经血管结构。通过关节镜取出了关节内的钢丝碎片。
我们建议，对于所有接受钢丝内固定的患者，应告知其内固定失败和可能移位的风险，并讨论择期取出内固定的选择。此外，当影像学检查发现钢丝断裂时，应强烈建议患者尽快取出钢丝。
