1. Does burying Kirschner wires influence infection rate following fixation of upper extremity fractures?
A systematic review
Justin C.R. Wormald (1), Matthew D. Gardiner (1,2), Hawys Lloyd-Hughes (2,3), Sonya
Gardiner (3), Abhilash Jain (1,2)
IFSSH & IFSHT Triennial Congress, 24-28th October 2016, Buenas Aires, Argentina
(1) Department of Plastic and Reconstructive Surgery, Imperial College Healthcare NHS trust, St Mary’s Hospital, London, W2 1NY
(2) Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Roosevelt Drive, Oxford, OX3 7FY, UK
(3) Royal Free Hospital, Pond Street, London, NW3 2QG
Mr. Justin CR Wormald MBBS MRes MRCS
Core Surgical Trainee (CT1)
Chelsea and Westminster Hospital NHS Foundation Trust
London

2. Buried vs. Non-buried K-wires
Advantages of buried K-wires:
Patient comfort
Reduced infection rate?
Disadvantages of buried K-wires
Wire removal – second procedure (LA/GA)
Financial implications
Advantages of non-buried K-wires:
Quick and easy removal
More cost-effective?
Disadvantages of non-buried K-wires:
Higher rate of post-operative infection?
Delayed mobilisation

3. Research Objective
Buried versus non-buried K-wires for upper extremity fracture – to review the literature and provide clinical guidance
Methods:
Systematic review +/- meta-analysis
Registered with PROSPERO
Primary outcome:
Post-operative infection

4. Search Strategy

5. Results Demographics 3 adult studies; 5 paediatric studies
Male > female
Closed fractures > open fractures
Intervention and Comparison
Buried versus non-buried K-wires
Outcome
Rate of post-operative infection (all studies)
Study design
1 RCT and 7 case series
Study n
Methods
Shoemaker 1999
Forearm 32
Case series
Hargreaves 2004
Distal radius 56
RCT
Rafique 2006
Metacarpal/phalangeal 60
Chan 2011
Lateral condyle elbow 75
Koc 2012
104
McGongagle 2012 69
Das De 2012
235
Kelly 2014
170

6. Post-operative infection – Forest Plot

7. Post-operative infection (by site of K-wire)%

8. Discussion Conclusions
Quality of literature: RCT data for wrist, case series data for all others
Post-operative infection: apparent difference in metacarpo-phalangeal fracture (case series) and in distal radius (RCT)
Cost: Two of the studies reported the additional costs associated with burying K-wires compared to non-buried
Skin erosion: A major cause for return to theatre lateral condyle elbow fracture
Systematic review – likely difference in infection rate between buried and non-buried K-wires for metacarpo-phalangeal fractures
Evidence for buried versus non-buried K-wires in hand fractures is poor
Question has not been answered – question has been established
Identified need for joint orthopaedic and plastic RCT to answer question
First phase underway - national survey of practice with RSTN