From case to context: A case-driven comprehensive review on Kirschner wire migration to the cervical spine and neck

Abstract

Osteosynthesis using Kirschner wires constitutes a fundamental technique within the realms of traumatology and orthopaedics. Despite its widespread application and popularity, it is susceptible to migration of the wires. A 36-year-old patient presented with neck pain; subsequent radiographic imaging identified two Kirschner wires that had migrated to the cervical spine following failed removal after K-wiring of a fractured left clavicle 16 years previously. Surgical removal was undertaken complicated by a parapharyngeal abscess that needed surgical drainage and neurological symptoms in terms of left shoulder weakness and left arm/hand paraesthesia. All neurological symptoms resolved after many months of rehabilitation excepting some residual paraesthesia on the ulnar border of the left hand. A thorough literature review reveals 30 other cases of K-wire migration to the cervical spine. Vague symptoms are the norm with <25% presenting focal neurological symptoms, with only 6 penetrating the spinal cord, two of which were left with severe deficits. The other 28 patients had no long-term significant deficits. The migration of K-wires into the spinal canal, is a rare but recognised complication. Functional outcomes are contingent on spinal cord injuries arising from the implantation. In the absence of spinal cord injury, a high probability of complete functional restoration and symptom resolution exists.