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Hidajat NN, Magetsari RMSN, Prasetiyo GT, Respati DRP, Tjandra KC. Buried or exposed Kirschner wire for the management of hand and forearm fractures: A systematic review, meta-analysis, and meta-regression. PLoS One 2024; 19:e0296149. [PMID: 38748687 PMCID: PMC11095696 DOI: 10.1371/journal.pone.0296149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/13/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND The recommendation on whether to bury or expose the Kirschner wire (K-wire) for the management of fractures has still been controversial with inconsistent results in the published studies due to the potential issue associated with exposed K-wire is the heightened risk of infection, as it comes into direct contact with the external environment and air. This study aims to summarize the specific outcomes between buried and exposed K-wire for the management of hand and forearm fractures. METHODS We conducted relevant literature searches on Europe PMC, Medline, Scopus, and Cochrane Library databases using specific keywords. This investigation focuses on individuals of any age diagnosed with hand or forearm fractures who underwent surgery involving Kirschner wire (K-wire) fixation. It examines the comparison between buried and exposed K-wire fixation, emphasizing primary outcome pin infection, along with secondary outcomes such as early pin removal, days to pin removal, and surgical duration. The study includes observational studies (cohort/case-control) or randomized clinical trials (RCTs). The results of continuous variables were pooled into the standardized mean difference (SMD), while dichotomous variables were pooled into odds ratio (OR) along with 95% confidence intervals using random-effect models. The quality of included studies was assessed with Cochrane Collaborations, Risk of Bias version 2 (RoB v2). RESULTS A total of 11 studies were included. Our pooled analysis revealed that buried K-wire was associated with a lower risk of pin site infection [RR 0.49 (95% CI 0.36-0.67), p < 0.00001, I2 = 0%] and 33.85 days longer duration until pin removal [MD 33.85 days (95% CI 18.68-49.02), p < 0.0001, I2 = 99%] when compared with exposed K-wire. However, the duration of surgery was 9.98 minutes significantly longer in the buried K-wire [MD 6.98 minutes (95% CI 2.19-11.76), p = 0.004, I2 = 42%] with no significant difference in the early pin removal rate [RR 0.73 (95% CI 0.36-1.45), p = 0.37, I2 = 0%]. Further regression analysis revealed that sample size, age, sex, and duration of follow-up did not affect those relationships. CONCLUSION Buried K-wire may offer benefits in reducing the infection rate with a longer duration until pin removal. However, further RCTs with larger sample sizes are still needed to confirm the results of our study.
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Affiliation(s)
- Nucki Nursjamsi Hidajat
- Department of Orthopaedics and Traumatology, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia
| | | | - Gregorius Thomas Prasetiyo
- Department of Orthopaedics and Traumatology, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia
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Clutton JM, Kinghorn AF, Trickett RW. Does Dressing Choice Affect Infection Rate in Percutaneous K-Wiring of the Hand and Wrist? - A Systematic Review. J Hand Surg Asian Pac Vol 2024; 29:3-11. [PMID: 38299244 DOI: 10.1142/s2424835524500012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
Background: Percutaneous Kirschner wire (K-wire) fixation of hand and wrist fractures is a common trauma procedure, yet there remains little consensus on the best management of wires postoperatively. If wire's ends are left external to the skin, it remains unknown which dressing regimen best reduces infection risk. We felt that a systematic review was required to assess the current consensus on this question within the published literature. Methods: An electronic search was carried out across multiple databases. Abstracts were screened by two independent reviewers against inclusion criteria and, where necessary, full texts were reviewed. Nine eligible papers were identified, and data regarding type of procedure, dressing choice and infection rate was extracted. Results: The included studies were widely heterogenous, and the standard of the evidence was, in general, poor. In most, dressing choice and infection incidence were not the primary intervention/outcome under study. Conclusions: Based on the available literature, insufficient evidence exists to establish one dressing choice as having a lower infection rate. This highlights the need for further high-quality evidence in this area. Level of Evidence: Level III (Therapeutic).
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Varga M, Józsa G, Hanna D, Tóth M, Hajnal B, Krupa Z, Kassai T. Bioresorbable implants vs. Kirschner-wires in the treatment of severely displaced distal paediatric radius and forearm fractures - a retrospective multicentre study. BMC Musculoskelet Disord 2022; 23:362. [PMID: 35436916 PMCID: PMC9016993 DOI: 10.1186/s12891-022-05305-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 04/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Distal radius fractures are very common in paediatric patients. Severely displaced fractures may require surgical intervention. The gold standard surgical method is percutaneous K-wire osteosynthesis followed by immobilisation. Metal implants can be removed with a second intervention; however, these extra procedures can cause further complications. Several studies confirm the benefits of bioabsorbable implants for paediatric patients. The aim of this retrospective study was to compare the complication rates of displaced distal metaphyseal radius (AO 23r-M/3.1) and forearm (AO 23-M/3.1) fractures in children operated on with K-wires versus a novel technique with bioresorbable implants. METHODS We retrospectively reviewed 94 patients in three paediatric trauma centres who underwent operations due to severely displaced distal forearm or metaphyseal radial fractures between January 2019 and January 2020. The mean age was 8.23 (ranging from 5-12). 30 patients (bioresorbable group, BR-group) were treated with biodegradable PLGA implants (Bioretec®, ActivaPin®), 40 patients with one or two stainless steel Kirschner-wires (K-wires, Sanatmetal®) which were buried under the skin (KW I-group) and 24 children with K-wires left outside the skin. (KWII. Group). We examined the number of minor and major complications as well as the need for repeated interventions. Follow-up was at least one and half year. RESULTS There was no significant difference between the complication rates at the two KW groups (p = 0.241; Cramer's V = 0.211), while the complication rate of the BR group was significantly lower. (p = 0.049; Cramer's V = 0.293 and p = 0.002; Cramer's V = 0.418 respectively). No later than half a year after the injury, no difference was observed between the functional outcomes of the patients in each group. One and a half years after the injury, no signs of growth disturbance were found in any of the children. No second surgical intervention was required in the BR group. CONCLUSIONS Surgeries with bioresorbable intramedullary implants may have fewer complications than K- wire osteosynthesis in the treatment of severely displaced distal forearm fractures. The benefits are most pronounced in the first six weeks after surgery, reducing the number of outpatient visits and increasing the child's sense of comfort. As no second intervention is required, this can lead to significant cost savings. After half a year, there is no difference in the outcomes between the different surgical treatment strategies.
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Affiliation(s)
- Marcell Varga
- Dr. Manninger Jenő Baleseti Központ, Budapest, Hungary.
| | - Gergő Józsa
- University of Pecs Medical School: Pecsi Tudomanyegyetem, Pécs, Hungary
| | - Dániel Hanna
- University of Pecs Medical School: Pecsi Tudomanyegyetem, Pécs, Hungary
| | - Máté Tóth
- Szegedi Tudományegyetem Általános Orvostudományi Kar: Szegedi Tudomanyegyetem Altalanos Orvostudomanyi Kar, Szeged, Hungary
| | | | | | - Tamás Kassai
- Dr. Manninger Jenő Baleseti Központ, Budapest, Hungary
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Khan H, Adil A, Ul Ain N, Qureshi BA, Chishti UF, Malik TS. Outcome of Buried Versus Exposed Kirchner Wires in Terms of Infection in Fractures of Phalanges and Metacarpal Bones of Hand. Cureus 2022; 14:e22515. [PMID: 35345717 PMCID: PMC8956480 DOI: 10.7759/cureus.22515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction and objective The fracture of hand bones is very common among manual hand workers and a fractured hand imparts a great effect on a person’s productivity both socioeconomically and from a body image point of view. The most common method of hand fractures fixation is with the help of Kirschner wires. Kirchner wires can be inserted in exposed or in buried manner. There are a few studies that provide a comparative analysis of rate of infection between these two techniques. This study aimed to assess the rate of infection in buried versus exposed Kirschner (K)-wires for hand fractures. Material and method The study was designed as a randomized controlled trial with consecutive non-random sampling. It was conducted in the Department of Plastic Surgery, Holy Family Hospital, Rawalpindi, Pakistan, and lasted from June to December 2019. Blinding was not possible as both the operating surgeon and patient were aware of the procedure being done; however, the assessor was blinded and was not aware which group got which treatment. Total 122 patients with fractures of metacarpals and phalanges of hand were included in the study and were divided into two groups with 61 patients in each. Group A was treated with buried K-wires and group B with exposed K-wires. The patients were followed for one month for the outcomes in terms of infection in the patients. Results Group A had 24 females (39.3%) and 37 males (60.7%). Group B had 16 females (26.2%) and 45 males (73.8%). In group A, nine (14.8%) patients had ages between 10 and 20 years, 18 (29.5%) patients between 21 and 30 years, 14 (23.0%) patients between 31 and 40 years, 11 (18.0%) patients between 41 and 50 years, and nine (14.8%) were between 51 and 60 years. The mean duration of surgery was 35.16 minutes for group A and 27.30 minutes for group B. Based on modified Oppenheim scoring system for pin site infection, out of 61 patients, seven (11.5%) with buried K-wires while 14 (23%) with exposed K-wires developed pin site infection. Conclusion Rate of infection is low in buried K-wires as compared to exposed K-wires though not statistically significant (p>0.05) for the fractures of metacarpals and phalangeal fractures of hand.
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Levy KH, Sedaghatpour D, Avoricani A, Kurtzman JS, Koehler SM. Outcomes of an aseptic technique for Kirschner wire percutaneous pinning in the hand and wrist. Injury 2021; 52:889-893. [PMID: 33691947 DOI: 10.1016/j.injury.2021.02.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 02/17/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Kirschner wires (K-wires) have been shown to effectively stabilize fractures of the hand and wrist, but are associated with high infection rates, which may limit its use. Previous literature has attributed the risk of infection to many different aspects of a fixation technique. However, we introduce an approach to percutaneous K-wire pinning to mitigate the risk of infection. METHODS Patients undergoing K-wire fixation procedures of the hand and wrist were retrospectively queried. All cases were performed under the same principles of our technique. None of the K-wires were buried, nor bent and were covered with betadine-soaked alcohol pads as pin site dressings. Pins were removed in an outpatient procedure room up to 12 weeks postoperatively and were then assessed for signs of superficial or deep infection. RESULTS 90 patients were included in this study across a variety of K-wire fixation operations in the hand and wrist. No patients presented with any signs of infection or other complications necessitating postoperative antibiotics, early pin removal, or reoperation. DISCUSSION/CONCLUSION The specific guidelines of our technique resulted in no cases of pin site infection, despite a largely underserved patient population. Our low incidence of infection was maintained without the use of prophylactic antibiotics and in patients with long periods of fixation. While the high infection rates in previous literature have often been associated with wires left exposed, the principles of our technique allow for K-wire fixations to be performed percutaneously without burying the wires. This may allow for improved cost and time efficiency, without compromising patient safety.
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Affiliation(s)
- Kenneth H Levy
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY), Downstate Medical Center, Brooklyn, NY, USA
| | - Dillon Sedaghatpour
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY), Downstate Medical Center, Brooklyn, NY, USA
| | - Alba Avoricani
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY), Downstate Medical Center, Brooklyn, NY, USA
| | - Joey S Kurtzman
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY), Downstate Medical Center, Brooklyn, NY, USA
| | - Steven M Koehler
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY), Downstate Medical Center, Brooklyn, NY, USA.
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De La Cruz Monroy MFI, Abdul Z, Khan K, Shariff Z. Is Kirschner Wire (K-wire) Infection Risk Higher when Operated by Junior Surgeons?-Infection Rates of K-wire Fixation in a UK Plastic Surgery Hand Trauma Unit. Indian J Plast Surg 2021; 54:235-236. [PMID: 34239254 PMCID: PMC8257324 DOI: 10.1055/s-0041-1723906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Martha Fatima Irene De La Cruz Monroy
- Plastic Surgery Department, Bradford Royal Infirmary, Bradford Teaching Hospitals Foundation Trust, Bradford, United Kingdom.,Plastic Surgery Department, Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom
| | - Zabihullah Abdul
- Plastic Surgery Department, Bradford Royal Infirmary, Bradford Teaching Hospitals Foundation Trust, Bradford, United Kingdom
| | - Kameel Khan
- Plastic Surgery Department, Bradford Royal Infirmary, Bradford Teaching Hospitals Foundation Trust, Bradford, United Kingdom
| | - Zakir Shariff
- Plastic Surgery Department, Bradford Royal Infirmary, Bradford Teaching Hospitals Foundation Trust, Bradford, United Kingdom
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Maradei-Pereira JAR, Dos Santos AP, Martins JR, Maradei-Pereira MR. Infection after buried or exposed K-wire fixation of distal radial fractures: a randomized clinical trial. J Hand Surg Eur Vol 2021; 46:154-158. [PMID: 32611274 DOI: 10.1177/1753193420936543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We treated 220 extra-articular distal radial fractures with closed reduction and percutaneous K-wire fixation and randomized K-wire placement to buried or exposed. We analysed the incidence and severity of infection and the mobility of the metacarpophalangeal joints. At 6 weeks postoperatively, 12 patients in the exposed group had infections versus two in the buried group, which was a statistically significant difference. Mobility was statistically but not clinically better in the buried group. One patient in each group had wires removed before fracture healing due to infection, which resulted in malunion. From this study we conclude that, in the treatment of distal radial fractures, it is better to bury the K-wires under the skin, especially when geographical conditions make it difficult to control the patients' adherence to hygiene and postoperative care despite the higher costs incurred with removal of buried K-wires.Level of evidence: II.
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Affiliation(s)
- João Alberto R Maradei-Pereira
- Faculdade de Medicina, Universidade Federal do Pará, Belém, PA, Brazil.,Hospital Maradei, Clínica dos Acidentados, Belém, PA, Brazil
| | | | - Juliana R Martins
- Faculdade de Medicina, Universidade Federal do Pará, Belém, PA, Brazil
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Lazarus P, Hidalgo Diaz JJ, Xaxier F, Gouzou S, Facca S, Liverneaux P. Transverse and oblique fractures of the diaphysis of the fifth metacarpal: surgical outcomes for antegrade intramedullary pinning versus combined antegrade and retrograde intramedullary pinning. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 30:425-433. [PMID: 31667582 DOI: 10.1007/s00590-019-02587-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 10/22/2019] [Indexed: 10/25/2022]
Abstract
The purpose of this study was to develop a technique allowing a faster return to previous activities after surgical treatment of short transverse and oblique fractures of the diaphysis of the fifth metacarpal. It consisted of an anterograde and retrograde centromedullary double pinning connected. Our series included 40 patients of average age 25 years including 2 women. In 20 cases (group I), an anterograde centromedullary pinning with a 1.6- or 2-mm pin was performed followed by a 6-week orthosis and then 2-week self-education. In 20 cases (group II), an anterograde and retrograde centromedullary double pinning was performed using 2 1.5-mm pins connected by a connector (MétaHUS®, Arex™). A first pin was introduced into the canal antegrade, then the second retrograde. The 2 externalized pins were connected, and self-rehabilitation was encouraged. Mean tourniquet time was 14.75 min (group I) and 15.8 min (group II), respectively. At the last follow-up, the average pain was 0.35/10 and 0.2/10, the Quick DASH 0.68/100 and 0.57/100, the strength of the hand 94.65% and 94.35%, the active flexion MCP 98.5% and 99%, respectively. MCP active extension was 98.5% and 98.75%; the sick leave was 8.4 and 6.3 weeks. All fractures healed without recovery with 3 complications: 2 infections on pins, in each group, 1 CRPS1 (group I). Our results seem to show that the technique of anterograde and retrograde centromedullary double pinning connected in the treatment of short transverse and oblique fractures of the diaphysis of the fifth metacarpal gives results at least as good as the reference technique with a non-negligible socioeconomic advantage, a less time off work.
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Affiliation(s)
- Priscille Lazarus
- Department of Hand Surgery, SOS hand, University Hospital of Strasbourg, FMTS, Icube CNRS 7357, University of Strasbourg, 1 avenue Molière, 67000, Strasbourg, France
| | - Juan José Hidalgo Diaz
- Department of Hand Surgery, SOS hand, University Hospital of Strasbourg, FMTS, Icube CNRS 7357, University of Strasbourg, 1 avenue Molière, 67000, Strasbourg, France
| | - Fred Xaxier
- Department of Surgery (Spine), Dalhousie University, QEII Health Sciences Centre - Halifax Infirmary, 1796 Summer Street, Halifax, NS, B3H 3A7, Canada
| | - Stéphanie Gouzou
- Department of Hand Surgery, SOS hand, University Hospital of Strasbourg, FMTS, Icube CNRS 7357, University of Strasbourg, 1 avenue Molière, 67000, Strasbourg, France
| | - Sybille Facca
- Department of Hand Surgery, SOS hand, University Hospital of Strasbourg, FMTS, Icube CNRS 7357, University of Strasbourg, 1 avenue Molière, 67000, Strasbourg, France
| | - Philippe Liverneaux
- Department of Hand Surgery, SOS hand, University Hospital of Strasbourg, FMTS, Icube CNRS 7357, University of Strasbourg, 1 avenue Molière, 67000, Strasbourg, France.
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Commentary to accompany the paper: The quality of systematic reviews addressing peripheral nerve repair and reconstruction. J Plast Reconstr Aesthet Surg 2018; 72:457-458. [PMID: 30503819 DOI: 10.1016/j.bjps.2018.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 11/10/2018] [Indexed: 11/20/2022]
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