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Kirschner wire infection rates in hand fractures
Yeliz Cemal, BSc, MBChB, MRCS, MD1; Ioannis Kaloudis, MD1; Akhilesh Pradhan, Bsc2; Kshemendra Senarath-Yapa, MBBS, MRCS1; Ricardo Tejero, MBBS, MRCS1; Andreas Fox, BM BCh DM, FRSC (Plast)1
1Guy's & St Thomas' NHS Trust, London, United Kingdom; 2King's College University, London, United Kingdom

Introduction
Kirschner wires (K-wires) are a commonly used method for fracture fixation. There is little evidence looking specifically at infection rates with their use. Literature ranges between 6-20% have been reported. We aimed to compare infection rates over time between buried and exposed K wires in various hand fractures in our unit.

Materials and methods
Retrospective review of patients with hand fractures treated with K wires from Day Surgery database. We compared two groups; group (A) 104 adult patients (April 2010-March 2011), group (B) 47 patients (October 2015-January 2016). All acute, closed fractures suitable for K-wire fixation were included. Parameters looked at were: location of fracture, digits involved, number of wires, length of time for wire removal, age, gender, smoking, medical history of Diabetes Mellitus. Statistic analysis by paired t-tests, chi-squared and relative risk.

Results
Group A- a total of 202 K wires were used, Male / Female ratio was 82/22. We observed an 8.8% infection rate (3 cases) with buried and 10% (7 cases) with exposed K wires. Total infection rate in group A was 10.4%. Group B- a total of 83 K- wires used, male/female ratio was 40/7 and infection rates were 16.7% (2 cases) with buried and 8.6% (3 cases) with exposed K wires. Total infection rate was 10.6%. The mean age in both groups was 33 and mean time for K-wire removal was 4 weeks. All the infected cases involved a localized skin and percutaneous tissue infection with no osteomyelitis. There was no significant difference in infection rates between buried and exposed K-wires in both group A and group B, and also none when comparing infection rates between the two groups (?2 = 1.05, p= 0.305). Length of time for K-wire removal and smoking history were not significant. There was a significant difference in infection rates with diabetic patients compared to non-diabetics p<0.05 (?2 = 2.03, P= 0.03).

Conclusion
Compared to the literature, in our practice- exposed wires do not increase infection rates compared to buried. We remove wires earlier than that stated in literature (4 weeks mean compared to 6.5 weeks mean). A history of diabetes significantly increased infection rates with K-wire use. We therefore conclude that there is no need to burry K-wires in view of avoiding infections in hand fractures treated with K wires.


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