Neck migration of a K-wire following fixation of clavicle fracture: a case report

Background: Kirschner wires (K-wires) remain a simple and cost-effective option for clavicle fixation, especially in resource-limited settings. However, migration of K-wires is a rare but potentially fatal complication that can involve critical structures in the thorax, mediastinum, or neck. Preventive measures such as bending, burying, and early removal are essential but often overlooked. Case presentation: A 35-year-old male underwent K-wire fixation for a displaced left clavicle fracture. Three months postoperatively, he presented with progressive shoulder pain and restricted motion. Imaging revealed migration of a 10 cm K-wire traversing the thoracic inlet into the lower cervical region, closely abutting the trachea and left subclavian vein. The wire was successfully removed through a low cervical-suprasternal approach under fluoroscopic guidance without neurovascular or airway injury. The patient recovered uneventfully, regaining full shoulder function by six weeks and remained asymptomatic at six months follow-up. Discussion: K-wire migration can occur silently within weeks to years after fixation due to muscle activity, respiratory motion, and unanchored wire ends. Neck migration is exceptionally uncommon but can endanger major cervical vessels and the airway. Vigilant radiographic surveillance and timely removal of migrated hardware are critical once migration is detected. This scenario is particularly relevant for orthopedic practice in resource-limited settings where rapid revision fixation is common and wire-end stabilization may be overlooked. Conclusion: K-wire migration after clavicular fixation, though rare, carries significant morbidity. Secure fixation, bending or burying of wire ends, regular follow-up imaging, and prompt surgical retrieval of migrated wires are vital to prevent life-threatening complications.