A 51-year-old man reported with complaints of recent onset of left knee pain. He had sustained a displaced comminuted fracture of his left patella following a fall 15 months ago. Modified tension band wiring with cerclage wiring was successfully performed, and the patient was recovering well. He was well for the last 14 months and returned to his job without any pain or functional disability. However, he started experiencing deep-seated pain within the left knee with restriction of movements for the last 4 weeks. There was no recent history of any fall or trauma to the left knee. Clinical examination of the left knee revealed no patella or joint line tenderness but pieces of wires were palpable percutaneously. There was no effusion and the cruciate and collateral ligaments were intact; there was no neurovascular deficit. There was no extensor lag and knee extension power was normal. The range of motion of the knee was painfully restricted.\nRadiographs of the left knee revealed a united fracture patella with broken cerclage wire (). The inferio-medial segment of the broken cerclage wire was found to have migrated into the posterior compartment of the knee joint and hooked anteriorly at the base of anterior cruciate ligament.\nThe patient underwent surgery for removal of the patella wires. Fluoroscopic examination before surgery revealed the posterior part of wire had shifted its position with anterior part of it still hooked with anterior cruciate ligament. An arthroscopic examination of the knee was done through the standard anteromedial and anterolateral portal. Any structural damage including chondral lesion due to wire migration was not found, a migrated piece of wire was found embedded at the base of anterior cruciate ligament, going toward posterior compartment of knee through medial side of notch, which was removed (). We used intraoperative fluoroscopy (), before finishing the arthroscopic examination of knee, which demonstrated that, there was no remaining piece of wire in posterior compartment of knee. The rest of the broken wires were removed via a midline anterior knee incision along the old scar. The patella was stable after complete removal of the wires, indicating union of the rest of the fragments.\nThe patient was discharged the next morning and his wounds healed at 2 weeks. Complaints of knee pain resolved completely following the surgery, and the patient was able to resume work at 2 weeks.
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.