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Drill bit and guide wire left in during ankle surgery

by Rayleen
(Illinois )

I had a ankle fusion. Dr came out after 2 hrs and told my husband everything went well except. His drill bit and guide wire broke off during surgery so he left them in my foot. Said drill bit was in talus bone and would not cause any problem. After 6 months of pain Doctor ordered MRI and found I had non Union of both joints, loose screw, one screw not in bone but in soft tissue and yes guide wired and fragmented drill bit in my foot. 3 months after MRI had. Another surgery with different Doctor to fix foot. When he got into surgery which took 4 hours he found the drill bit was shattered in 3 pieces and was in my joint and I had non viable dis colored bone and ended up with bone graft. My question is if the drill bit was embedded in the talus bone could it have migrated into my joint where the fragmented pieces were found? Also if original cartilage was removed during first surgery for ankle fusion could the cartilage grown back?


RESPONSE

Hi Rayleen,

I can only talk in generalities here since I am not privy to seeing the x-rays or MRI.

In answer to your first question, yes the drill bit could have migrated backwards and ended up in the joint, in the same manner that screws used in screw fixation can also "back out". Since the drill bit was embedded, but not fixated in the bone, there was always the possibility that it would move.

The decision your first surgeon had to make was to either leave it there and hope there would be no problem going forward, or try to remove it. Depending where it was located and how deep it was in the talus bone, removing it might not have been a logical answer as he or she would have had to open up too much of the bone to get it out and might have ended up either weakening or fracturing the talus bone.

In answer to your second question although some cartilage might grow back, it would not have happened in the nine months that passed since the original surgery. In general, the consensus is that cartilage does not grow back.

What I am guessing happened here is the reason the fusion did not "take" is simply because it was poorly fixated with the screws as evidenced by MRI which revealed a "loose screw and another screw not in bone".

Now, the screws may have been improperly placed or the "discolored bone" that you mention might have been poorly mineralized bone which would have not held a screw under any circumstance. This is conjecture on my part since I have nothing else to go by, except your narrative.

Ankle fusions are salvage procedures meaning they are usually done as a last resort for either trauma or a long history of pain in the ankle and subtalar joints with all conservative options having failed. By fusing a joint, you hope to overcome the pain that the patient is experiencing with knowledge that there will still be stress where the bones have been fused and because of this, there can be complications.

Hopefully, after your second surgery you will do much better and move forward with your life.

Marc Mitnick DPM
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