Increased Risk of Time-dependent K-wire and Wound Contamination and the Effect of Covering on K-wire Contamination: A Randomized Controlled Trial

Abstract

Purpose This was a prospective randomized controlled study to evaluate the time-dependent incidence of contamination of K-wires and wounds in patients who underwent osteosynthesis and the effect of covering the K-wires on this incidence rate of infection. Methods The study sample included 90 patients who underwent open reduction and internal fixation between 2018 and 2019. Patients were randomized to two groups: use of covered K-wires during surgery (using a sterile towel) and use of uncovered K-wires. Bacterial samples were obtained from the K-wires and wound at the following time points: 0 (just after opening of the K-wire packages) and at 15, 30, 60, 90, and 120 min after. Samples with bacterial growth at 48 h were considered contaminated. Microscopic, staining, and biochemical properties were used for bacterial typing. Results Bacterial growth was detected at the 30- and 60-min time points for the uncovered and covered groups, respectively. Wound contamination was identified within 15 min for the uncovered group. Wound and K-wire contamination progressed as a function of time, being consistently more significant in the uncovered group (p<0.005). Conclusions Time-dependent K-wire and wound contamination rates may be decreased by covering the K-wires (and other instruments) with a sterile towel. Frequent wound irrigation during surgery and postoperative prophylactic antibiotics targeting the bacteria we identified might further be useful in lowering the incidence rate of infection.