The K Wire Project: removal of percutaneous kirschner wires from children without general anaesthetic

Abstract

Percutaneous Kirschner (K) wires are used to hold the position of a fracture of a bone following manipulation under anaesthetic. The K wire is left protruding through the skin so that the wire can be removed as the fracture heals. This audit reviews a change in practice in the removal of K wires without a general anaesthetic (GA), which resulted in ‘The K Wire Project’, which set a standard of treatment and a clinical pathway for these children. The change in practice proposal offered a less invasive procedure for the children and their families and reduced the time the child had to spend in hospital. This was a collaborative project which involved developing the skills of the paediatric orthopaedic practitioner combined with preparation and distraction techniques facilitated by the hospital play specialist. The project set a standard of treatment and a clinical pathway for these children. Before June 2001 children attending the Royal Hospital for Sick Children in Edinburgh (RHSC), who required having K wires removed, were admitted to the Day Care Unit (DCU) to have the procedure carried out under GA. Occasionally, the orthopaedic surgeon would consider the child ‘old enough’ to have the wire removed in the Fracture Clinic. This was not usually planned and children who had the procedure carried out in the fracture clinic received very little, if any, preparation and distraction for the procedure. However, orthopaedic surgeons and anaesthetists felt that in many cases this short procedure could be undertaken in a controlled environment, with the child awake.