Transmediastinale migratie van een Kirschner-pin na fixatie van een proximale humerusfractuur: een casus

Transmediastinal migration of a Kirschner pin after fixation of a proximal humeral fracture: a case report Fractures of the proximal humerus are common lesions in the elderly population. In some cases, they are surgically stabilized via a minimally invasive technique, namely percutaneous osteosynthesis with fixation pins. Intrathoracic migration of these pins or wire is a rare complication after percutaneous osteosynthesis of a proximal humeral fracture. In this article, the authors describe an extremely rare transmediastinal migration of a Kirschner pin from the humeral head. The purpose of this case report is to call for awareness and to open a debate in which appropriate prevention can be freely discussed. The consideration of a conservative management, the choice of alternative osteosynthesis techniques, the use of a sling bandage to restrict the shoulder movement, the use of fixation pins with a threaded tip, bending of the external free end of the pin and an appropriate time to remove the pin are possible recommendations from the literature. Furthermore, it is important to provide additional information and awareness to health care providers in rehabilitation centers, geriatricians and orthopedists concerning the possibility of such a life-threatening postoperative complication. Thus, specific policies for clinical and radiographic monitoring of the position of fixation pins should be developed in hospitals and rehabilitation centers with the aim of prevention, early detection and prompt action when this life-threatening complication is suspected.