Resistant K-Wire

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Had a patient who had a bit of pain at the site of a K-wire used for a distal bunionectomy 8 months before. No symptoms otherwise except at area of pin that was above cortex. Tried to remove same with stats, stout needle holders, decent pin pliers, sterilized vice grips, nipping cortex around pin with a rongeur, and even took a small bit of cortex away circumferentially around pin with a 6mm osteotome without budging stubborn threaded pin. It was like it was welded in place. Used to have a small trephine to remove resistant pins, but some delightful person at the hospital decided we really didn't need that piece of equipment any more and threw it out.

Solution? Got wire driver and a smooth 0.062 K-wire and drilled 5 new pin holes parallel to existing wire around pin and finally the pin moved and was freed. Tried to cheat and do the same as the deceased trephine would have by creating a channel around the cortex. It was getting to be fairly aggravating because I was literally leaving metal dust where I was spinning around the pin and seeing the jaws of all the instruments twisting sideways as I gripped them in a manly fashion and turned around the pin while it mockingly laughed at me.

Anyone else have any other solutions to same issue that may have come up over the years? I think I have seen 2-3 over 30 years that just would not move. Used that little trephine twice before with good results, but not since it went swimming with the fishes.

 

Some of the cannulated screw sets have cannulated countersinks and cannulated drills that may be able to be used around a smaller diameter threaded K-wire to help free it from the bone.

I have learned over my 25 years of dong surgery that, before I try to do something out of the ordinary at the surgery center or hospital, I always check with the supply nurse before-hand to make sure they have the right tool for the job. It's frustrating to find out during the case that they don't have what I need to get the job done properly in a time-efficient fashion.

 

Thanks for the reply. This still took about 25 minutes, so it was not like hours, but it was frustrating to know you had as good a grip on that pin as humanly possible and it still wouldn't move. I knew the hospital had some heavier pin pliers and a broken screw set, but that set was so huge as to be useless for this. I was amazed that even with leaving a decent concavity in the cortex around the pin exit , it still would not break free.

Hope you have not been up in the mountains getting hammered with all that snow. My niece is a ranger at Yosemite and I was supposed to go there and snow shoe out 10 miles to a cabin when y'all were getting 7 feet of snow over the week before. Glad that didn't work out or it may have me found dead in the middle of Yosemite trying to photograph Falling Fire and other parts of the park.

 

Dear Rick,

I have enjoyed similar experiences over the years where I have employed the same technique you utilised. I have also had a similar exerience recently when the screw head broke off and the screw shaft was solidly fixed to the surrounding bone. Once released from the surrounding cortex, the screw came out with pliers (albeit with plenty of sweat and arm fatigue).

Thanks for sharing your experience.

Andrew.

 

thanks everyone...this is something I know nothing about...Ive learned alot from these few posts ..
kind regards

FDCB

 

Can't you just stick a Jürgen ball on the end of it and suture it up? J/K.

Good work drilling out around the pin. Fortunately I have not needed to do that. Deep hardware removals can be very tricky. Sometimes on the x-ray I will see a screw that looks as if it is ready to jump right out of the patient, but I have done enough hardware removals to know that it is not always as easy as it seems. Patients sometimes ask me to do hardware removals in the office. "Just poke a little hole in there and pull it out!" That's when I review Murphy's Law with them.

 

I actually tried getting it in office first and most times, that works great with a 1cm or less incision and minimal use of medical and insurance resources. I thought I was simply not getting a sufficient purchase on the pin, so I changed venue to open it up a bit further and add more equipment and some added hands.

But, this is nothing compared to taking wedding photos for a niece. God bless the poor people who do that for a living. I would rather have my toenails avulsed without anesthesia than to do that, again.

 

Hi Rick:
I'm curious - who put in the threaded K wire for the distal osteotomy?
Perhaps there are better fixation options available. (actually, I'm sure there are!)

Steve

 

I sometimes will do a deep hardware removal in the office if and only if the patient seems emotionally and constitutionally able to tolerate a difficult removal. I make sure to tell them that if it only gets half way out they may have to go home with the hardware sticking halfway out of their foot until we can get operating room time, then gauge their reaction.

Even if I had the skills, no way would I take on the duties of a wedding photographer. No way. Talk about high expectations!

 

Back in residency I had a couple of Attendings who used the threaded K-wire technique. I think part of it was HMO-fueled cost-containment.

 

I have done wedding photography for quite a few friends and relatives over the years, have never accepted money for the service and had lots of fun doing it. However, I only volunteered to do it on the condition that these friends and/or relatives understand that if they want professional photos, then they will have to pay for one, since even though I am a good amateur photographer, I am not a professional photographer.

If you love photography and are good at it, there is no better wedding gift that you can give than some beautiful photos of the event and the people involved in the event. However if you don't love photography, aren't good at it and promise the wedding couple something more than you can reasonably produce, then this isn't a good idea for anyone involved.