Abstract
Abstract There is anecdotal evidence suggesting buried K-wires are superior to unburied or exposed K-wires due to lower pin track infection rates, although the evidence remains unclear. We present a closed loop audit looking at a single surgeon’s experience of 111 consecutive cases requiring K-wires in hand surgery. Our pin track infection rates differed between a series of 3 consecutive cohorts. Pin track infection rates were 2% in an initial cohort of buried K-wires, 14.3% in a second cohort of exposed K-wires and 0% in a third cohort when practice was changed back to burying the K-wires. Our experience demonstrates there was a measurable difference in post-procedure infection rates between burying and exposing K-wire ends.
Highlights
Kirschner wires (K-wires) can be used in the fixation of fractures in the hand and for fusion of joints in the hand [1,2,3,4]
Buried K-wires often need removal in theatre and subsequent admission, the burden of which was identified in a recent study examining infection and re-operation rates in K-wire fixation of metacarpal and phalangeal fractures [5]
Unburied k-wires are known to increase the risk of infection, which usually gains entry through the puncture site
Summary
Kirschner wires (K-wires) can be used in the fixation of fractures in the hand (phalanges and metacarpals) and for fusion of joints in the hand [1,2,3,4]. The main advantage of leaving the k-wire exposed is ease of removal. Buried K-wires often need removal in theatre and subsequent admission, the burden of which was identified in a recent study examining infection and re-operation rates in K-wire fixation of metacarpal and phalangeal fractures [5]. Pin track infection appears to be a very common complication of exposed k-wires, with a rate of 13.5% reported in a recent systematic review, compared to 6.1% of buried k-wires [6]. These disadvantages can largely be avoided by cutting the end of the k-wire short to ‘bury’ the end under the skin.
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