A 34-year-old Taiwanese man presented to our emergency department with a 3-day history of coughing and chest tightness. He had a history of essential hypertension and congestive heart failure followed up at our cardiovascular department and under medication control. He was an express delivery worker with right hand dominance.\nA chest radiograph on November 16, 2018, revealed metallic internal fixation pins and wire over his right clavicle, and an unidentified object of metallic density at the left side of his upper neck. A further cervical spine radiograph was arranged, which revealed a foreign body of metallic density crossing over the C2–C4 level on the left side of his neck (Fig. ) that indicated a loosened K-wire. He recalled that he had suffered from a right clavicle fracture which was operated on for wire fixation approximately 15 years ago, but had lost follow-up since then. Palpation of his neck revealed no palpable foreign body. His oral cavity was clear, and findings on nasopharyngoscopy were also normal. A series of chest radiographs from 3 years ago showed that the wire had migrated from the right AC joint to the left side of his neck (Fig. ). Computed tomography angiography was performed to evaluate the position of the K-wire regarding the major vessels. The wire was removed by exploratory neck dissection under C-arm fluoroscopy assistance. The wire was found beneath the carotid sheath and removed by gentle traction along its axis (Fig. ). His postoperation recovery was uneventful, and he was discharged 4 days later.
A 60-year-old woman presented to us with pain over medial aspect of right knee joint. The pain was non radiating. The pain was relieved by rest and was exacerbated by squatting and sitting cross legged. The patient had difficulty in climbing stairs. On physical examination there was tenderness along the medial aspect of knee joint and a curved scar mark was present over the anterior aspect of knee joint (). While history taking the patient told us that she had a patella fracture around 4 years back which was treated by open reduction and internal fixation and she subsequently underwent implant removal 2 years back. The patient had full range of motion (ROM) at knee joint (Figs. , ) and moderate pain was observed on medial side while flexing and extending knee joint. There was no history of any recent trauma to knee joint. A provisional diagnosis of osteoarthritis knee joint was made and weight bearing standing antero-posterior and lateral x-rays ofleft knee joint were ordered. On X-rays it was found that multiple pieces of broken circlage wire were present around knee joint and one piece had migrated posteriorly (). On examination patient did not had distal neurovascular deficit and patients pain was not related to these broken pieces, rather it was due to degenerative changes in the knee joint. It is believed that the surgeon who did implant removal removed only the K wires leaving behind the circlage wires which broke into multiple pieces over the passage of time due to the repeated stresses at knee joint. Patient was advised to undergo total knee replacement along with subsequent removal of broken hardware as potential undue complications can occur because ofbroken hardware in the form of damage to neuro vascular structure due to migration of pieces posteriorly. It was also explained to the patient that cases have been reported where broken pieces migrate to heart and sternum and produce life threatening complications. However, patient refused to undergo any type of surgery. she was warned and told to be alert whenever the nature of her pain changes or she experiences new onset of symptoms which is different in character from the pain she is experiencing now and was kept on regular follow up.