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Mr Kumar and his colleagues (April 2002 JRSM1) should be commended for stressing the potentially fatal consequences if Kirschner wires migrate from the sternoclavicular joint. Sternoclavicular dislocations are uncommon but serious injuries2. Closed reduction if attempted within 48 hours of injury is usually successful, although anterior dislocations are frequently unstable3. As the risks of open surgical stabilization are high, unstable anterior dislocations post-reduction are often best left untreated, whereas unstable posterior dislocations do require intervention because of the proximity of the medial end of the clavicle to the great vessels, oesophagus and trachea3.
If operative stabilization of the sternoclavicular joint is required, many techniques have been described, including Kirschner wire fixation, repair of the sternoclavicular and costoclavicular ligaments4, reconstruction of the joint with a tendon or fascial graff4, and resection of the clavicle medial to the costoclavicular ligament5.
Kumar and colleagues state that the most important step in preventing wire migration is to bend the exposed part of the wire after fixation. However, in view of the dangers of Kirschner wire fixation and the excellent outcomes from the other sternoclavicular joint reconstruction procedures mentioned above, it should be emphasized that if joint reconstruction is required, soft tissue techniques should be utilized, and fixation with metal should be avoided altogether.