A Prospective Study of K-wire Complications in Hand Surgery
Kevin Lutsky, MD; Jonas Matzon, MD; Jack Abboudi, MD; Michael Rivlin, MD; Pedro Beredjiklian, MD
Institute at Thomas Jefferson University Hospital, Philadelphia, PA
Hypothesis: Kirschner wires (K-wires) are commonly used during hand surgical procedures, often for fixation of fractures or stabilization of soft tissue repairs. Complications such as loosening, migration, or infection are not uncommon and can compromise surgical outcome. The purpose of our study was to prospectively evaluate the frequency of K-wire related complications during hand surgical procedures.
Methods: All patients who had K-wires placed as part of their surgical procedure by one of 12 attending hand surgeons over a 3-month period were included. Patients were enrolled prospectively. Complications were recorded by the attending surgeon at follow-up visits and reported to the principal investigator. Demographics and patient comorbidities including diabetes mellitus and smoking history were recorded.
Results: There were 141 patients enrolled during the study period and 290 pins used. There were 62 women and 75 men. The mean age was 40.7 years. Thirteen patients were smokers, and 8 patients had a history of diabetes. There were 35 soft tissue procedures and 106 fractures. There were 92 fingers, 25 hands, and 24 wrists. There were 35 complications (25%). There was a 12% rate of infection (n= 17) including 2 cases of osteomyelitis. There were 18 other complications 9 of which were major complications (6.4%). Smoking, age, and location (hand/fingers vs. wrist) were significantly associated with infection.
Summary Points: Use of K-wires is common in hand surgical procedures. There is a high rate of complications, especially in patients who are smokers. The most common of these is pin site infection and this occurred in more than 1 out of 10 patients. While K-wires are often needed during hand surgery, surgeons should be aware that adverse events are frequent. Patients and surgeons should be vigilant in the peri-operative period.
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