Complications of Kirschner-wire Fixation in Distal Radius Fractures

Abstract

Distal radius and ulna fractures are the most common fractures seen in England, occurring at a rate of 22/10,000 person years. Kirschner (K)-wire fixation is a well-accepted method of treating these fractures. There is a surprising paucity of evidence on the subject of prophylactic antibiotics and the duration of K wires can be left in, as these relate to infection rates. We therefore present the results of our protocol for distal radius K-wire fixation for which: no antibiotic prophylaxis was given; we used a percutaneous (not buried) technique, where the K wires were removed after 4 weeks, and the patient has a total of 6 weeks in cast (last 2 wk without wires). The results of the last 100 consecutive patients who were treated with manipulation and K wiring of dorsally displaced distal radial fractures in a standard district general hospital over a 2-year period were analyzed retrospectively. A total of 100 patients had 176 K wires inserted. The mean age was 32.5 years. The mean time to pin removal was 29.4 days. The infection rate was 2%. These results illustrate a safe and clinically effective protocol for K-wire fixation in treating distal radius fractures. On the basis of this study, we do not advocate the use of prophylactic antibiotics, postulating that they do not affect infection rate and thereby eliminating potential antibiotic adverse effects. Furthermore, we do not bury the K wires, which allows for their removal in clinic, thus preventing risks of further operative procedures.

Which modality is the best choice in distal radius fractures treated with two different Kirschner wire fixation and immobilization techniques?

“…However, they have showed 2% infection rate in their study. [33] In the present study, Grip strength was minimally higher in Group I compared to Group II, but this was not statistically significant as previously reported in other studies. [22,24,25] A meta-analysis study has demonstrated that external fixation may lead to greater recovery of grip strength, especially compared to fixation with locking volar plates.…”

Management of Complications of Distal Radius Fractures

“…Subramanian et al conducted a recent study on the use prophylactic antibiotics prior to k-wire fixation for a distal radius fracture, and concluded that they do not advocate the use of prophylactic antibiotics as it does not affect the rate of infection [59]. Further analysis should be done to investigate the benefits of prophylactic antibiotics in order to clarify the use of this prevention measure.…”

Outcome of Open Reduction and Internal Fixation in Lateral Condyle Humeral Fractures in Pediatrics

“…It has been debated whether prophylactic antibiotics should be used for percutaneous wiring of fractures and Subramanian et al [13] advised against it. Bratzler et al [14] agreed that prophylactic antibiotics should be used for open orthopaedic procedures where a foreign material is inserted.…”