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.
A 28-year-old male patient from Turkey presented to our clinic with complaints of palpable foreign bodies under the skin in the dorsolateral side of his right foot (Fig. ). Except for the palpable and moving body of about 6 cm length under the skin in his foot, he had no functional complaints. An X-ray demonstrated the presence of a K-wire of about 6 cm length in front of the lateral malleolus in the dorsolateral side of his foot (Fig. ). There was a cerclage wire from the tension band fixation of his patella in the ipsilateral knee (Fig. ). There was no diagnostic challenge. Our patient explained that he was operated on by another orthopedic surgeon in the same hospital after a patellar fracture in 2007 and he had not attended regular checks. He also reported that a wire similar to the one in the X-ray had protruded through his skin in 2009 and he had removed the wire by pulling it out. This statement explained why the K-wire was not in place.\nOn physical examination, our patient showed no restriction in his knee movement. Routine blood test results showed no abnormalities. Palpation of the K-wire showed that the wire was mobile under his skin (Fig. ). Our patient reported that, after removing the first wire, he had not felt any serious discomfort during the migration of the other wire over a period of 5 years.\nOur patient was taken to the operating room. After staining, a 3-mm skin incision was made that coincided with the proximal end of the K-wire, and the K-wire was pulled out with the help of clamp (Fig. ). Our patient was discharged on the same day. The cerclage wire in his patella was not removed to avoid creating complications and because of our patient’s unwillingness to have it removed.