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 69-year-old woman was admitted to the emergency department after an accidental fall. She presented with left shoulder pain and functional impairment. Clinical history included essential hypertension and obesity. Traditional X-ray series and computed tomography (CT) scan with three-dimensional reconstruction were performed. Examinations showed a 3-part fracture of the proximal left humerus, accounting to the Neer's classification (AO/ASIF: 11-B2) [Figure and ]. Two days after patient acceptance to our department, fracture was treated by closed reduction and fixation with two retrograde K-wires and one threaded wire, by mean of a modified “en palmière” technique: The first two wires were retrograde nonthreaded bent wires inserted at the deltoid “V” level, while the latter was an anterograde threaded wire percutaneously introduced to fix the great tuberosity [Figure and ]. Two days after surgery, the patient was discharged from the hospital. One month after surgery, the patient came back for routine clinical and radiographic control, to evaluate the fracture healing and eventually plan the wires removal. In that setting, she referred about global well-being and no pain at the shoulder. X-rays demonstrated the intrathoracic migration of the threaded wire used for tuberosity fixation [Figure and ]. A complementary CT scan was immediately performed to better show the spatial relationship between the wire and intrathoracic vital organs. It revealed the device was migrated through the fifth intercostal space to the left lung parenchyma, without the signs of pneumothorax, nor bleeding [Figure and ]. She was extensively interviewed and investigated for any symptom or sign. She only referred about episodic intercostal mild pain that onset 1 week after surgery and was elicited by a cough. Due to low severity of the symptom, it was completely underestimated by the patient. Physical examination, vital parameters, and blood examination resulted normal. The patient was immediately managed by mean of video-assisted thoracoscopic approach to remove the migrated wire from the lung parenchyma. Intraoperatively, a fibrin-coated spot was identified on the lung surface and excised. This allowed the foreign body to be visualized and easily removed []. Neither parenchymal bleeding nor pneumothorax was observed. A chest drain tube was inserted, and antibiotic prophylaxis was administered. The postoperative outcome was free of complications, and the patient was discharged 3 days after surgery with a normal chest radiogram. One month after surgery, the patient underwent new thoracic and left shoulder X-rays, confirming the healing of the shoulder fracture and the absence of radiographically evident sequelae about the lung. A specialist consultation by thoracic surgeons was performed, assessing the complete recovery of lung function without complications or negative outcomes.