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Post-operative management of Kirschner-wire fixation of all phalangeal and metacarpal fractures at a single tertiary care center: A retrospective review
Andrew Tiger Chen, MD
1, Carolyn Wang, BHSc
1, Victor Ripan, BSc
1, Elena Huang, BHSc
1, Avalon O'Connor, MD
1, Patrick Jinhyung Kim, MD
1, Emily Dunn, MKin
1, Achilles Thoma, MD, MSc, FRCS(C)
2; Helene Retrouvey, MD, PhD, FRCS(C)
3(1)McMaster University, Hamilton, ON, Canada, (2)Department of Surgery, Division of Plastic Surgery, St. Joseph's Healthcare and McMaster University, Hamilton, ON, Canada, (3)McMaster University, Hamilton, MT
Introduction: Kirschner-wire (K-wire) fixation (KF) is the most common operative technique for hand fractures among Canadian plastic surgeons. However, post-operative rehabilitation varies widely and rely on low-quality studies and expert opinion. The study reviewed KFs of phalangeal and metacarpal fractures at a single academic center to quantify practice variation and patient outcomes.
Methods: This retrospective chart review analyzed all cases of KF of isolated phalangeal and metacarpal fractures performed by all plastic surgeons at a single tertiary care center in the last seven years. The primary outcome was the duration from operation to K-wire removal. Secondary outcomes included the time from KF to range of motion (ROM) initiation, the interval between K-wire removal and ROM initiation, postoperative complications, and functional outcomes.
Results: Among 289 patients, mean time from KF to K-wire removal was 28.6 days (SD 8.2). There was a high variability amongst the surgeons, with the shortest duration averaging 26 +/- 6 days and the longest averaging 33.7 +/- 8.6 days (p<0.001). Mean time to initiation of ROM was similar across surgeons (mean 25.2 +/- 11.4 days). Postoperative complications occurred in 26 patients (10.9%), primarily pin site infections (6.7%). Early versus late K-wire removal did not affect complication rates. There were no differences in functional outcomes between surgeons.
Conclusion: There is considerable variability in postoperative rehabilitation following KF of hand fractures among surgeons at a single academic center. Our study suggests that supervised ROM can be initiated safely as early as 3 weeks postoperatively, regardless of whether K-wires remain in situ.
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