K-wire Fixation of Closed Hand Fractures Outside the Main Operating Room Does Not Increase Infections

Area of Science:

• Orthopedic Surgery
• Infectious Disease Control
• Health Economics

Background:

• Closed reduction and internal fixation (CRIF) for hand fractures is significantly more expensive in the main operating room (OR).
• A common concern regarding performing CRIF outside the OR is the potential for increased infection rates.
• This perceived risk leads to a reluctance in adopting less expensive, out-of-OR procedures.

Purpose of the Study:

• To prospectively compare the infection rates of CRIF for closed metacarpal and phalangeal fractures performed inside versus outside the main OR.
• To evaluate the safety and efficacy of performing hand fracture fixation in different surgical settings.

Main Methods:

• A multicenter prospective analysis was conducted on patients undergoing CRIF for metacarpal or phalangeal fractures.
• Data collected included demographics, injury details, surgical information, and postoperative infectious complications (cellulitis, pus, osteomyelitis).
• A total of 1042 patients and 2265 Kirschner-wires (K-wires) were analyzed.

Main Results:

• Infection rates were not statistically different between the two settings: 2.5% cellulitis and 1.4% frank pus for out-of-OR (719 patients) versus 3.4% cellulitis and 2.5% frank pus for in-OR (323 patients).
• The in-OR group experienced longer times to operation and procedure duration.
• Conversely, the in-OR group had a shorter duration for K-wire placement.

Conclusions:

• K-wire fixation for closed hand fractures performed outside the OR under field sterility is safe.
• This practice does not lead to an increased incidence of infectious complications compared to CRIF within the main OR under full sterility.
• Out-of-OR fixation offers a safe and potentially more cost-effective alternative for managing these fractures.