Laparoscopic extraction of fractured Kirschner wire from the pelvis
A 25-year-old male presented to the Accident and Emergency Department with an alleged history of a road traffic accident. On examination, he had a painful right hip with no other injury. On plain radiograph of both hip, he was diagnosed as having a sub-trochanteric fracture of right femur. The patient was posted for percutaneous femoral nailing. During surgery, after threading over the nail when the K wire was to be removed, it fractured and during an attempt at retrieval by the orthopaedician through the same hole, it was further pushed into the pelvis through the acetabulum plate []. The orthopaedic procedure was completed, and the patient was referred to the surgical unit for retrieval of the fractured segment of the K wire.\nAs the patient was stable, we conducted a contrast enhanced computed tomography (CT) scan of the abdomen and pelvis [], in which the broken fragment of the K wire was seen protruding through the acetabulum into the right hemi-pelvis between the bladder and rectum, without any obvious injury to surrounding structures. The patient was planned for laparoscopic retrieval under general anaesthesia with C-arm guidance, if required.\nA midline infra-umbilical 10 mm camera port was placed, and two 5 mm ports were further placed, both in the left mid-clavicular line, one at the level of umbilicus, and the other at the level of the Anterior Superior Iliac Spine. On inspection, there was no free fluid in the abdomen and no evidence of any bowel or vascular injury. The tip of the K wire was not visible either. In the pelvis, just lateral to the bladder and approximately at the level of the right Cooper's ligament, a blunt protrusion of the peritoneum was identified. The peritoneal flap was raised, and with sharp dissection, of superficial tissues, the pointed metallic K wire was seen [], and retrieved with the help of a needle holder. No bleeding was seen, and the peritoneal flap was closed. Post-operatively, the patient recovered uneventfully.