A 75-year-old man underwent tension band wiring with cerclage wiring for treatment of a transverse patellar fracture of the right knee (). At 10 weeks postoperatively, radiographs demonstrated breakage of the superior portion of the cerclage wire (). Although he was advised to have all fixation devices removed after fracture healing and continuous follow-up, the patient was lost to follow-up after a clinical examination and plain radiography at 16 weeks postoperatively because he had no symptoms such as irritation due to the wire or limitation of range of motion. At 16 weeks, the wire was still radiographically at the superior part of the right patella.\nThe patient returned to our outpatient clinic 2 years after the surgery because the wire had perforated the skin anteriorly. He did not recall any trauma to the knee since the last follow-up. Radiographs of the right knee demonstrated that the cerclage wire was broken into pieces, and a fragment had migrated into the posterior compartment (). We could not decide from plain radiographs or three-dimensional computed tomography (3D CT) whether the wire fragment was in the posterior compartment of the knee joint or the popliteal fossa (). Because there was a risk of chondral damage if it was inside the joint or neurovascular damage if it was in the popliteal fossa, the patient agreed to surgery to remove the hardware.\nA skin incision was made anteriorly over the previous incision and all the wires were removed. An arthroscopic examination was then performed; before scoping the posterior compartment, we performed the routine arthroscopic assessment through the standard anteromedial portal. Any structural damage including chondral lesion due to the wire migration was not found. Then, we examined the posterior compartment through the posteromedial or posterolateral portal. However, we could not find the wire fragment by palpating with a probe. However, we could not find the wire fragment by palpating the posterior structures with a probe introduced through the posteromedial or posterolateral portal. Before finishing the arthroscopic examination and approaching the popliteal fossa from the posterior aspect of the knee, we used intraoperative fluoroscopy, which demonstrated that the wire fragment had moved when we palpated the upper part of the posterior septum with the arthroscopic probe. This suggested that the wire was embedded in the posterior septum. We therefore made a posterior transseptal portal according to the procedure of Ahn and Ha and enlarged the portal upwards with a radiofrequency probe []. We eventually found the fragment embedded in the septum and were able to remove it safely through the posteromedial portal (Figures and ).\nAfter surgery, the patient could walk without pain and showed full range of motion at final follow-up.
A 27-year-old female patients with Grade II avascular necrosis of the head of femur secondary to sickle cell disease were taken to operating room for drilling and injection of autologous bone marrow derived osteoblasts and are recommended to use a smaller diameter K-wire for instillation of the cells. During the procedure, two guidewires were passed to centralize the area of injection. A 3.2 mm cannulated drill was used to drill on top of the guidewires. During drilling, 2 cm of the proximal guide wire broke () and we believe that this happened due to metal fatigue as the wire was used before couple of time. A discussion arose whether to leave the broken wire in situ. The risk of migration was always on the cards, hence, the guidewire was pushed back to the edge of the broken part. A 4.0 mm cannulated drill was used to drill over the broken wire (). The drill was pushed till the subchondral bone and slowly the cannulated drill was withdrawn and with it the broken part came out (). The rest of the procedure was carried out as per our protocol. shows the X-ray the right hip after 16 months of the surgery.