Should we bury K-wires after metacarpal and phalangeal fracture osteosynthesis?

Publication date: Available online 22 March 2018
Source:Injury
Author(s): Mads Terndrup, Thomas Jensen, Søren Kring, Martin Lindberg-Larsen
BackgroundBurying Kirschner wires (K-wires) under the skin after metacarpal and phalangeal fracture osteosynthesis may reduce risk of infection, but it might also complicate later removal.Purpose/Aim of StudyTo examine infection and reoperation rates after metacarpal and phalangeal fracture osteosynthesis with buried versus exposed K-wires.Materials and MethodsMetacarpal and phalangeal fractures treated with K-wire osteosynthesis at our institution from 1 st of January 2009 to 1 st of February 2015 were identified retrospectively. The final study population included 444 patients, 331 with metacarpal, 109 phalangeal and 4 with mixed fractures. Surgical and patient records were examined 90 days postoperatively.Findings/Results337 patients (75.9%) were treated with buried K-wires and 107 patients (24.1%) with exposed (non-buried) K-wires. 14 patients (4.1%) treated with buried K-wires presented with postoperative infection, opposed to 7 patients (6,5%) treated with non-buried K-wires (p = 0.311). None of the postoperative infections caused re-operation. Only one case of deep/severe infection was recorded in a patient treated with buried K-wires requiring intravenous antibiotic treatment. In 58 of 337 patients (17.2%) treated with buried K-wires, removal was not possible in the outpatient clinic and required readmission for removal in the operation theatre. All exposed K-wires could be removed in the out-patient clinic without re-operation.ConclusionsWe found no difference in postoperative infection rate between metacarpal and phalangeal fracture osteosynthesis with buried versus exposed K-wires. However, the high readmission and reoperation rate (17.2%) after burying K-wires should call for reconsideration of surgical strategies.



http://ift.tt/2py83a0