Open Access Peer-reviewed

Migration of A K Wire in A Pediatric Floating Elbow Managed by Percutaneous Pinning-A Case Report

Imtiaz Hussain Dar1, Mohammad Moosa1,, Nasir Muzaffar1

1Department of Orthopaedics, Hospital for Bone and Joint Surgery, Srinagar, Kashmir, India

Global Journal of Surgery. 2013, 1(3), 19-21. DOI: 10.12691/js-1-3-3
Published online: August 25, 2017

Abstract

Simultaneous ipsilateral fracture of the elbow and forearm is an uncommon injury. In such injuries, the elbow is effectively dissociated from the rest of the limb. Hence this injury is also called ‘the floating elbow’. It is an indicator of a high energy injury and requires aggressive operative management. We present a unique case of a pediatric floating elbow in a nine year old boy. The supracondylar fracture was reduced under general anesthesia and fixed by percutaneous pinning with two crossed Kirshner (K) wires and the forearm fracture post reduction was managed conservatively by a Plaster of Paris long arm back slab. At 4 weeks post op, the slab was removed but only the lateral K wire could be visualized and removed. The child subsequently complained of pain in the upper arm and a prickly feeling in the skin. On examination, a sharp tip could be palpated in the upper arm and radiographs confirmed that the medial K wire had migrated into the upper arm. The K wire was removed under anesthesia and the patient started on range of motion exercises. He made an uneventful recovery with no residual side effects.

Keywords:

floating elbow, percutaneous pinning, K wire, migration
[1]  Stanitski CL, Micheli LJ. Simultaneous ipsilateral fractures of the arm and forearm in children. Clin Orthop Relat Res 1980; 153:218-222. PubMed
 
[2]  Palmer EE, Niemann KM, Vesely D, Armstrong JH. Supracondylar fracture of the humerus in children. J Bone Joint Surg Am 1978; 60: 653-656. PubMed
 
[3]  Templeton PA, Graham HK. The 'Floating elbow' in children- Simultaneous supracondylar fractures of the humerus and of the forearm in the upper limb. J Bone Joint Surg Br 1995; 77: 791-796. PubMed
 
[4]  Flynn JC, Mathews JG, Benoit RL. Blind pinning of displaced supracondylar fractures of the humerus in children. Sixteen year's experience with long term follow-up. J Bone Joint Surg Am 1974; 56: 263-72. PubMed
 
[5]  Reed FE Jr, Apple DF Jr. Ipsilateral fractures of the elbow and forearm. South Med J 1976; 69: 149-51.View Article  PubMed
 
[6]  Williamson DM, Cole WG. Treatment of ipsilateral supracondylar and forearm fractures in children. Injury 1992; 23: 159-61.View Article
 
[7]  Fowles JV, Kassab MT. Displaced supracondylar fractures of the elbow in children. A report on the fixation of extension and flexion fractures by two lateral percutaneous pins. J Bone Joint Surg Br 1974; 56: 490-500.
 
[8]  Lyons FA, Rockwood CA., Jr Migration of pins used in operations on the shoulder. J Bone Joint Surg Am. 1990; 72: 1262-7. PubMed
 
[9]  Fowler AW. Migration of a wire from the sternoclavicular joint to the pericardial cavity. Injury.1981; 13: 261-2.View Article
 
[10]  Loncan LI, Sempere DF, Ajuria JE. Brown-Sequard syndrome caused by a Kirschner wire as a complication of clavicular osteosynthesis. Spinal Cord. 1998; 36: 797-9.View Article  PubMed
 
[11]  Asavamongkolkul A, Ruangsetakit C. False aneurysm of the brachial artery in supracondylar fracture treated with Kirschner wire fixation: a case report. Injury. 2001; 32: 256-7.View Article
 
[12]  Fang RH, Chang TL. Watch out for the K-wire: painful experiences in two cases. Br J Plast Surg.2002; 55: 698-9.View Article
 
[13]  H Sharma, GR Taylor, NMP Clarke. A Review of K-wire Related Complications in the Emergency Management of Paediatric Upper Extremity Trauma. Ann R Coll Surg Engl. 2007 April; 89(3): 252-258.View Article  PubMed