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Introduction: Fractures of the hand and wrist are common injuries that account for 10-12 % of all fractures. K-wire fixation is a common, inexpensive, and cost-effective treatment option for a many of these fractures. Despite the frequency of K-wire use in hand and wrist fractures, there is lack of consensus regarding optimal technique to prevent pin site complications. The purpose of our study was to perform a systematic review and meta-analysis comparing pin-site infection and total complication rates in hand and wrist fractures treated with buried versus exposed K-wire fixation.

Methods: The MEDLINE, EMBASE, and Cochrane Control Register of Controlled Trials databases were queried to identify potentially relevant publications, altogether yielding 537 unique studies. Two reviewers assessed each potential study against the inclusion criteria, coming to a consensus that 47 met inclusion criteria for systematic review and 5 for meta-analysis (Figure 1). For these studies we performed data extraction relevant to primary outcomes, quality assessment for risk of bias, and Q statistic/I² calculations to assess heterogeneity of results. Meta-analysis using the R software (Lucent Technologies, version 3.3) was performed using a random-effects model. Statistical heterogeneity was assessed using a chi-square test with a p=0.05 threshold for significance.

Results: Among the 14 studies with buried K-wires (658 fractures; 1,547 pins), 9 were of moderate-high quality. For the 35 studies that included exposed K-wires (1,787 fractures, 4,059 pins), 28 were of moderate-high quality. The pooled infection rate for buried K-wire fixation was 3.0% [range: 0-8.0%] with Q value of 5.3 and I² of 0%. The pooled infection rate for exposed K-wire fixation was 6.1% [range: 0-34.5%] with Q value of 51.9 and I² of 34.5%. The pooled total complication rate for buried and exposed K-wire fixation was 24.0% [range: 0-62.0%] and 18.6% [range: 0-57.9%], respectively. In sub-analysis of distal radius fractures (2,397 fractures) buried versus exposed technique yielded pin-site infection rates of 3.9% and 7.5%. In comparison, the pin-site infection rate among metacarpal/phalangeal fractures (198 fractures) was 3.8% for buried and 6.8% for exposed K-wires. Results of meta-analysis using a random-effects model demonstrated a non-significantly decreased pin-site infection rate in buried versus exposed K-wires (OR 0.40, CI: 0.16-1.01)(Figure 2).

Conclusion:

Our findings suggest a non-significant trend towards diminished pin-site infection rates among buried compared to exposed K-wires in hand and wrist fractures. Additional high quality studies

evaluating pin-site infections and complications of buried versus exposed K-wires are needed.

Figure 1

Figure 2