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 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.