Ultrasound scanning helped surgeons to locate the buried metal work: A case series

Removal of metalwork in children can be a challenging procedure, particularly if the metalwork is deeply buried and not palpable. This article proposes a surgical tip to help locate the position of metalwork just before the operation using an ultrasound machine and methylene blue dye. The technique involves using the ultrasound machine to locate the position of metalwork and marking the tract by injection of methylene blue dye just before prepping and draping the skin. This allows the operation to be performed through a smaller wound with less trauma to the soft tissues and avoids radiation exposure to the patient and theatre personnel. Our experience in a case series of 5 patients have found this a useful technique for removing threaded wires following a Salters osteotomy, where the wires can end up being buried beneath the iliac apophysis. It could however, be used to aid removal of any metal work where difficulty finding it is anticipated. Study expanded to include case series of patients rather than just one example. We have tracked a further 4 patients who have had the same technique used to include them in the paper. Reviewer 2 wanted further examples.