Case Connector “Watch”—Beware Wayward Wires in the Shoulder Girdle

A substantial number of patients, old and young, who sustain a proximal humeral fracture are managed with Kirschner wires (K-wires). Surgeons are especially likely to opt for wires over other forms of fixation when they need to protect the repair of a concomitant neurovascular injury, or in cases in which the patient cannot tolerate a more invasive surgery.

However, there is a somewhat frequent and potentially lethal drawback to using wires about the shoulder girdle. This latest JBJS Case Connector “Watch” looks at several cases in which wires were adequately placed in the shoulder but subsequently moved to other parts of the body. It also identifies apparent risk factors for wire migration and provides some guidance for minimizing that risk. Finally, it encourages orthopaedists to seriously consider alternate fixation options, whenever feasible, to eliminate the risk of wire migration altogether.