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Intrathoracic migration of large-fragment screws after failed shoulder arthrodesis: a case report.

Orthopaedic implants used during upper-extremity surgery have been discovered in many locations. Kirschner wires and Steinmann pins have migrated into the thorax or mediastinum from local sites1-5 and from distant sites such as the phalanx6, patella7, and hip8. Although there are well-documented case reports on the migration of smooth and threaded Kirschner wires and Steinmann pins from the sternoclavicular and acromioclavicular joints into the thorax, the migration of large-fragment screws from the shoulder into the thorax has not been reported, to our knowledge. Screws are less likely to migrate because of their larger size and irregular shape. We present a case of intrathoracic migration of large-fragment screws after a failed shoulder arthrodesis. In accordance with the medical center institutional review board policy, the patient was informed about, and consented to, case publication.

A sixty-three-year-old woman with oxygen-dependent obstructive pulmonary disease presented with right-sided pleuritic chest pain. Her surgical history included multiple surgical procedures in the right shoulder due to instability and rotator cuff arthropathy. An arthroscopic rotator cuff repair in the right shoulder, done in 1989, had failed, and a shoulder arthrodesis was subsequently attempted. Shoulder implants were removed in 1992. Although the patient was asymptomatic, she was noted to have a fibrous nonunion of the right shoulder and had a revision arthrodesis in May 1996. This arthrodesis was unsuccessful, and there was subsequent failure of the implants. The patient was not a candidate for repeat revision arthrodesis because of inadequate bone stock and medical comorbidities.

A routine chest radiograph made in 2003 showed a broken plate with screws remaining in the right shoulder region as well as a large-fragment screw on the left side of the thorax, which was from a failed left glenoid reconstruction performed in 1995 at the …