Infection after buried or exposed K-wire fixation of distal radial fractures: a randomized clinical trial

We treated 220 extra-articular distal radial fractures with closed reduction and percutaneous K-wire fixation and randomized K-wire placement to buried or exposed. We analysed the incidence and severity of infection and the mobility of the metacarpophalangeal joints. At 6 weeks postoperatively, 12 patients in the exposed group had infections versus two in the buried group, which was a statistically significant difference. Mobility was statistically but not clinically better in the buried group. One patient in each group had wires removed before fracture healing due to infection, which resulted in malunion. From this study we conclude that, in the treatment of distal radial fractures, it is better to bury the K-wires under the skin, especially when geographical conditions make it difficult to control the patients' adherence to hygiene and postoperative care despite the higher costs incurred with removal of buried K-wires.Level of evidence: II.