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Kirschner wire infections in pediatric orthopaedic surgery
Rick Tosti1, Abtin Foroohar, Peter D Pizzutillo
1*Department of Orthopaedic Surgery and Sports Medicine, Temple University School of Medicine ‡St Christopher's Hospital for Children, Orthopaedic Center for Children, Philadelphia, PA †Department of Orthopaedic Surgery, South Bay Medical Center-Kaiser Permanente, Harbor City, CA.
Insights
Kirschner wire infections in children are rare but can lead to serious complications. Improved patient education on post-operative care may help prevent these infections, which are often caused by Staphylococcus aureus.
Area of Science:
- Pediatric Orthopedics
- Infectious Diseases
- Surgical Site Infections
Background:
- Kirschner wire infections in pediatric patients are infrequently documented.
- Understanding presentation, bacteriology, risk factors, and complications is crucial for prevention and treatment.
Purpose of the Study:
- To describe the characteristics of Kirschner wire infections in pediatric patients.
- To identify risk factors and complications associated with these infections.
- To inform prevention and treatment strategies.
Main Methods:
- Retrospective review of pediatric patients (birth to 16 years) hospitalized for Kirschner wire infection from 1995 to 2012.
- Data collected on presentation, hospital course, bacteriology, outcomes, and complications.
- Development of a management algorithm based on clinical experience.
Main Results:
- Twelve pediatric patients were identified with Kirschner wire infections.
- Common presentations included cellulitis, soft-tissue abscess, osteomyelitis, and toxic shock syndrome.
- Methicillin-sensitive Staphylococcus aureus (MSSA) and Pseudomonas aeruginosa were the most common pathogens. Complications included joint destruction and loss of range of motion.
Conclusions:
- Infected Kirschner wires are rare; superficial infections may not impede bone healing.
- A history of missed appointments or improper dressing care was noted in 60% of cases, suggesting a need for improved patient education.
- Osteomyelitis often followed pin-site drainage and failed oral antibiotics; empiric therapy should consider MSSA and Pseudomonas.
Background:
Few studies have described the presentation, bacteriology, risk factors, and complications of Kirschner wire infections in pediatrics. The purpose of this study is to describe these factors to better understand, prevent, and treat infectious complications of smooth wires.
Methods:
A retrospective review was performed to identify all patients (birth to 16 y) who were hospitalized for Kirschner wire infection from 1995 to 2012. Presentation, hospital course, bacteriology, outcomes, and complications were recorded. A management algorithm was developed from the experience.
Results:
Kirschner wire infections were present in 12 patients: 5 supracondylar fractures, 3 lateral humeral condylar fractures, a distal tibia physeal fracture, a great toe open fracture, a distal radius fracture, and an elective osteotomy for hallux valgus. The patients presented with cellulitis in 3 cases, soft-tissue abscess in 4 cases, osteomyelitis in 4 cases, and 1 case of toxic shock syndrome. A history of missed appointments or wet dressing was present in 60% of cases. Reoperation was required in 5 patients with abscess, septic arthritis, or osteomyelitis. Methicillin-sensitive Staphylococcus aureus (MSSA) was the most common pathogen followed by Pseudomonas aeruginosa. Methicillin-resistant S. aureus was not seen. Complications were present in 5 patients and included: loss of range of motion, joint destruction, wound breakdown, catheter migration, and toxic shock syndrome.
Conclusions:
Infected Kirschner wires are rare and may be maintained in a nonunited bone if the infection is superficial. Infections in this series commonly had a history of missed appointments and wet dressings, which suggests that improved postoperative education may reduce the risk. Osteomyelitis was often preceded by pin-site drainage and failed oral antibiotic therapy. MSSA and Pseudomonas were most commonly cultured and should be considered when empiric antibiotic therapy is necessary.
Level Of Evidence:
Prognostic level IV.
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