There’s a number of different ways that bone can be fixated when performing foot and ankle surgery. We use straight pins called K-wires, screws, plates, absorbable pins and a host of other devices. In the majority of cases, these pins are placed on a temporary basis to hold the bone stable so that it can heal. After healing is completed, the fixation device really has no additional benefit, and if possible, should be removed.
In some cases these fixation devices break prior to removal. Screws can crack in half, pins can break. The image above shows a partial K-wire that was placed during a hammer toe procedure. The pin exited the tip of the second to and was anchored into the second metatarsal. Prior to removing the pin I noticed that the toe was moving more than expected. Once the pin was removed, I noticed that the typical sharp tip of the k-wire was not there. Instead I found a broken end. X-rays were taken that showed the image above.
So, what should we do about the remaining piece of pin? In this particular case, the pin is well buried in the head of the second metatarsal. It’s likely that this remaining piece of pin will never be a problem. We’re hoping that the pin will remain buried in the bone. And if that is the case, the best solution would be to leave it alone. Another, less than optimistic scenario would be that the pin backed out and became lodged in the joint space. In that case, the patient would notice immediate and significant pain. Subsequently, the pin would need to be surgically removed.
It’s important to recognize that a metal pin or screw is non-reactive and typically will never be noticed by the patient. A less-than-honest doc might just not say anything about the remaining fragment of pin. I think most docs would say that you really do need to have the discussion with your patient to be sure they understand what happened, what may happen in the future and what steps would be necessary to fix the problem.
In this particular case, we did just that. The patient realizes that it’s OK to leave the pin in place but that we may need to take it out at some point in the future.
Jeffrey A. Oster, DPM