Incidence of Treatment for Infection of Buried Versus Exposed Kirschner Wires in Phalangeal, Metacarpal, and Distal Radial Fractures

Ridley, Taylor J.; Freking, Will; Erickson, Lauren O.; Ward, Christina M.

doi:10.1016/j.jhsa.2017.03.040

Cited by 49 publications

(49 citation statements)

References 7 publications

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“…Recent literature has reported that infections occurred more frequently in exposed k-wire cases than in buried kwire ones [16] but we did not report any case of infections. We observed, however fivecases only of delayed union, most likelydue to the high comminution of the fracture.…”

Section: Complicationscontrasting

confidence: 66%

K-wire fixation vs 23-gauge percutaneous hand- crossed hypodermic needle for the treatment of distal phalangeal fractures

Senesi

Marchesini

Pangrazi

et al. 2020

BMC Musculoskelet Disord

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Background: Distal Phalanx (DP) fractures are the most common hand injuries. Bone fixation associated with soft tissue reconstruction, is often required to ensure more effective outcomes. The aim of the present study is to compare functional outcomes of DP fractures surgically treated with crossed manual drilled 23 Gauge needles vs crossed Kirschner-wires (k-wire). Methods: Clinical data included analysis of patient demographics, range of motion (ROM), and complications. Radiographic assessment considered fracture type, location, fracture displacement, and radiographic union. Functional outcomes analysis was performed.The statistical significance was assessed at the level of probability lower than 5%. Results: A total of 60 patients from 2012 to 2015 were retrospectively enrolled and among them 12 patients suffering from diabetes or current smokers. A total of 60 DP fractures were treated, 32 with needles (group A) and 28 with k-wire fixation (group B). Time to union, showed in different time points, was significantly lower in group A (≤ 40 days, p = 0.023*) compared to group B. ROM of the distal interphalangeal joint at six months follow-up was 60°in group A and 40°in group B. A significant improvement was observed (p = 0.001*) in the 23 G needle treated group. Functional outcome analysis showed that VAS was significantly lower in group A compared to group B (p = 0.023*). Conclusion: Our study showed that the 23 G needle yielded satisfactory results in terms of time to union and range of motion compared to k-wire fixation especially for tuft and shaft DP fractures. Therefore, should be a valid alternative to k-wire fixation in selected patients.

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Section: Complicationscontrasting

confidence: 66%

K-wire fixation vs 23-gauge percutaneous hand- crossed hypodermic needle for the treatment of distal phalangeal fractures

Senesi

Marchesini

Pangrazi

et al. 2020

BMC Musculoskelet Disord

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show abstract

“…Another study about 189 patients undergoing exposed or buried Kirschner wire procedures involving the hand and wrist, identified 19 patients (10%) who developed pin infection [3]. However, the infection rate between exposed and buried Kirschner wire osteosynthesis for hand and wrist fracture was controversial [5][6][7][8][9]. Our meta-analysis exhibited that exposed Kirschner wire osteosynthesis resulted in a significantly higher infection rate than buried Kirschner wire osteosynthesis.…”

Section: Discussionmentioning

confidence: 96%

Effect of buried vs. exposed Kirschner wire osteosynthesis on phalangeal, metacarpal and distal radial fractures: A systematic review and meta-analysis

Chen

Wang

et al. 2020

Arthroplasty

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Background: During Kirschner wire osteosynthesis for phalangeal, metacarpal and distal radial fractures, a key clinical decision is whether to leave a Kirschner wire exposed or bury it beneath the skin. Therefore, we conducted a meta-analysis to evaluate the clinical effect of buried and exposed Kirschner wire osteosynthesis on phalangeal, metacarpal and distal radial fractures. Methods: PubMed, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched and clinical trials that evaluated buried and exposed Kirschner wire osteosynthesis for phalangeal, metacarpal and distal radial fractures were identified. Methodological qualities of studies were assessed by using the Cochrane Collaboration tool and Newcastle-Ottawa Scale. Publication bias was detected using Begg's test and Egger's test. Sensitivity analyses were performed by excluding one study at a time to determine whether overall results were reliable. Results: Two randomized controlled trials (RCT) and five case-controlled studies involving 1446 patients were included in the analysis. Sensitivity analyses indicated that the results of each study were statistically robust. Begg's test or Egger's test revealed no significant publication bias. Our meta-analysis indicated that exposed Kirschner wire osteosynthesis had a significantly higher infection rate than its buried counterpart. Additionally, buried Kirschner wire osteosynthesis resulted in a significantly higher rate of Kirschner wire removal in operating room than the exposed one. Our meta-analysis exhibited no statistical differences between the two procedures in the rate of early pin removal.Conclusions: Meta-analysis of available RCTs and case-controlled studies demonstrated that buried Kirschner wire osteosynthesis had a lower infection rate but tended to lead to more frequent Kirschner wire removal in the operating room as compared to its exposed counterpart.Trial registration: PROSPERO (CRD42018105249).

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“…15 Ridley et al found that buried K-wires were less likely to develop pin tract infection. 25 Most studies have not evaluated metacarpal fractures specifically in the elderly. This is likely due to the consideration that these are not fragility fractures.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Age on Fracture Healing Time in Metacarpal Fractures

Wollstein

Trouw

Carlson

et al. 2018

Hand (New York, N,Y.)

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Background: Older patients are treated for fracture with increasing frequency. Although studies on animals suggest that older mice and rats heal fractures more slowly, the clinical implications remain unclear. A better understanding of differences in healing with age can help customize fracture treatment. Our purpose was to retrospectively evaluate metacarpal fractures for healing time looking specifically at age-related differences. Methods: A retrospective review of patients treated for metacarpal fractures was conducted. Patients with incomplete charts or inadequate follow-up were excluded. One hundred ninety-eight charts were analyzed. Demographic and other patient factors were documented. Fracture characteristics and treatment type were documented. Fracture healing was determined clinically. Plain radiographs and examination were used in decision making. Results: Age was not associated with fracture healing time as a continuous variable ( P = .09). Patients above 75 years were not associated with increased healing time ( P = .58). Fracture characteristics were related to healing time: minimally displaced and comminuted fractures healed faster than oblique fractures, spiral fractures, or transverse fractures ( P = .048). Patients undergoing surgery healed faster than those without surgery ( P = .046). Renal failure negatively affected fracture healing time ( P = .03). Diabetes, hypothyroidism, and gender were not associated with healing time. Complications were not associated with age or other patient or fracture-related factors. Conclusions: Age does not affect clinical fracture healing time in adult. Therefore, older patients do not require disparate treatment. Other fracture-related factors and considerations such as functional demand and support systems might influence treatment decisions in fracture care.

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Incidence of Treatment for Infection of Buried Versus Exposed Kirschner Wires in Phalangeal, Metacarpal, and Distal Radial Fractures

Cited by 49 publications

References 7 publications

K-wire fixation vs 23-gauge percutaneous hand- crossed hypodermic needle for the treatment of distal phalangeal fractures

K-wire fixation vs 23-gauge percutaneous hand- crossed hypodermic needle for the treatment of distal phalangeal fractures

Effect of buried vs. exposed Kirschner wire osteosynthesis on phalangeal, metacarpal and distal radial fractures: A systematic review and meta-analysis

The Effect of Age on Fracture Healing Time in Metacarpal Fractures

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