Retrieval of broken bone biopsy needle from the sacroiliac j
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A 7-year-old male child was admitted for evaluation of eosinophilia. A bone marrow biopsy from posterior iliac crest was planned for definitive diagnosis. After sedation and left lateral position, an autoclaved reusable 14-gauge trephine biopsy needle of unknown make was inserted percutaneously after all aseptic precautions. The inner stylet was removed and the hollow needle was advanced. Due to the resistance felt, the operating surgeon tilted the needle to change the trajectory while the needle was still in the bone. This led to a needle facture with the distal part being embedded in the bone. The procedure was aborted and the broken needle fragment was left in situ.

Subsequently an Orthopaedic Department consultation was made and X-rays along with a (CT) scan was ordered to locate the broken needle. The radiological investigations showed the presence of 2.7 cm needle fragment traversing the right sacroiliac joint with the needle tip lying just 3 mm posterior to the anterior cortex of the sacrum. As the needle was lying in the joint, after counselling the parents, it was decided to extract the needle fragment.

In the operating room, after induction with general anaesthesia, preoperative antibiotics were administered and the patient was placed in left lateral position. As there were two puncture marks 2 cm apart over the skin, it was decided to visualize the foreign body under fluoroscopy to aid in localization. A skin incision of 2.5 cm was made and after superficial and deep dissection the needle end was localized which was bent and buried in the cortex. The surrounding cortex had to be undermined using a drill bit of 2.5 mm to expose the needle end which was then removed with a plier. Confirmatory C arm shoots were taken.

The needle length was measured and was found to be matching with the CT scan measurement. The core of bone extracted from the broken needle was placed in formalin and sent for histopathological analysis. Post thorough wash the wound was instilled with a local anaesthetic agent and closed in layers. A dressing was applied, and the patient was extubated uneventfully. The patient was allowed to bear weight as tolerated following the procedure as the defect was not deemed a significant fracture risk. The patient had an uneventful 15 month follow up.

Source: https://www.sciencedirect.com/science/article/pii/S2352644020301199?dgcid=rss_sd_all
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