an unusual case

Almost 15 years ago, this patient had a rod implanted to stabilize his sternum when it fell apart after heart surgery. He came to me complaining of disabling pain in his neck. He pointed to a lump in his neck and when I pushed on it, he had terrible pain. Here is his chest x-ray:

You can see the obvious rod, his old sternal wires, and his pacemaker over on the right.

The rod had apparently migrated up into the base of his right neck and was causing him excruciating pain. This was a unique problem so I talked to his original surgeon, a radiologist, and at least three orthopedic surgeons. After carefully considering their advice and with an appropriate amount of worry, I scheduled him for removal of the hardware. My orthopedic advice and study of the xray and a CT scan led me to believe that I could just cut down on the tip of the pin and pull it out. Apparently it was a Steinman pin, smooth, and untethered.

I took him to the operating room and cut down on the tip of this pin. I used a pair of vice grips as recommended by my orthopedic colleagues, and gave it a good yank. It wouldn't come out.

Turns out it was a "threaded' Steinman pin. So I turned lefty loosey and backed it out. Here it is:

Here is the CXR afterwards;

His pain is gone. My orhopedist Dad can be proud.