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Infection Rates of Buried vs. Exposed Kirschner Wires in Phalangeal, Metacarpal, and Distal Radius Fractures
TJ Ridley, MD1; Christina Ward, MD2, Will Freking, BS1; Lauren Erickson, MS3
1University of Minnesota, St Paul, MN; 2Regions Hospital, St Paul, MN; 3HealthPartners Institute, Bloomington, MN

Introduction: Kirschner wires (K-wires) are commonly used by hand surgeons for temporary fixation of unstable fractures. To decrease risk of infection, some surgeons bury K-wires subcutaneously rather than leaving them exposed through the skin. However, studies comparing these two techniques have shown conflicting results. Our goal was to determine if there is a difference in infection rates between exposed and buried K-wires when used to treat phalanx, metacarpal, and distal radius fractures.

Methods: We conducted a retrospective review identifying all patients over 16 years of age at our institution who underwent fixation of phalanx, metacarpal or distal radius fractures with K-wires between 2007 and 2015. We recorded patient demographic data as well as location of fracture, number of K-wires used, whether K-wires were buried or left exposed, and duration of K-wire placement. Infectious complications were separated into five groups based on treatment: 1) oral antibiotics, 2) oral antibiotics + early pin removal, 3) IV antibiotics without early pin removal, 4) IV antibiotics with early pin removal and 5) IV antibiotics + surgical debridement. Data was analyzed using equal variance t-test, chi-square test, Fisher's exact test, or unequal variance t-test, as appropriate.

Results: Six hundred and ninety five patients met the inclusion criteria. Surgeons buried K-wires in 207 (29.78%) patients, and left K-wires exposed in the remaining 488 (70.22%) patients. Infections occurred in 80 exposed K wire cases (16.4%) and 19 buried K wire cases (9.2%) resulting in a statistically significant relative risk of infection for patients with exposed K-wires of 1.79 (95% CI: 1.11-2.87; p=0.01). Subgroup analysis based on fracture location revealed a statistically significant increased risk of infection for exposed pins when used in metacarpal fractures (RR= 2.25; 95% CI: 1.13-4.49; p=0.02).

Conclusion: Patients with exposed K-wires for fixation of phalanx, metacarpal, or distal radius fractures were more likely to be treated for a pin site infection than those with K-wires buried beneath the skin. Metacarpal fractures treated with exposed K-wires were 2.25 times as likely to get a post-operative infection. To decrease infection rates when pinning hand and wrist fractures, particularly metacarpal fractures, surgeons should consider burying K-wires beneath the skin subcutaneously.

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