Incidence of Pin Site Infection in Buried versus Unburied K-wire Fixation Techniques in Fracture Fixation
Dr. Jojin Jose Chitten,
Assistant Professor, Department of Orthopaedics, Sri Lakshmi Narayana Institute of Medical Sciences, Koodapakkam, Osudu-605502, Puducherry, India.
Introduction: Kirschner Wires (K-wires) are widely used in orthopaedic procedures. The most common complication of K-wire fixation is pin site infection. There are only few studies which compare the infection rate between buried and unburied K-wires and there is no consensus regarding whether the K-wires should be buried under the skin or left unburied after fracture fixation, to reduce the chance of post operative infection. While some advocate there is definite advantage of burying K-wires in terms of post operative pin site infection, some studies have shown that the infection rate is similar in both the groups.
Aim: To determine whether there is a difference in the incidence of pin site infection between buried and unburied K-wire fixation techniques of fracture fixation.
Materials and Methods: A multi centric retrospective, cohort study in two tertiary care centres in Puducherry, in patients who underwent K-wire fixations for various fractures in upper limbs and lower limbs during the time period between January 2010 to August 2017. Data were retrieved from medical records and radiology archives.
Results: A total of 474 patients were included in the present study. Their median age was 32 years (range: 2-87 years), 409 (86%) were males and 65 (14%) were females. Surgeons buried K-wires in 141 patients and left K-wires unburied in 333 patients. Overall, post operative infection rates were lower in buried K-wire fixation compared to unburied K-wire fixation. However, the difference was not statistically significant. In the sub analysis of closed fractures, infection rates were significantly lower in the buried K-wire technique compared to unburied K-wire technique. Among open fractures, post operative infection rates were not significantly different between these two groups.
Conclusion: Significant lower infection in buried K-wire fixations compared to unburied K-wire fixations in closed fractures. Hence, we recommend that K-wires should be kept buried after fracture fixation in closed fractures.