[Fixation of pediatric fractures with percutaneous Kirschner-wire: should we leave the wire exposed or buried?]

Introduction: The percutaneous Kirschner-wire fixation is a minimally invasive operative technique in pediatric fracture treatment. The advantage of the K-wire technique is that it requires little instrumentation and removing the wire is easy. The disadvantage is that it requires plaster cast or brace. Objective: Our aim was to examine the following: did exposed wires have more septic complications, were the total hospital stays and the number of narcosis during metal removal lower, than in the case of buried wires? Method: A retrospective observational cohort study was enrolled in Heim Pál National Pediatric Institute between 2017 and 2021. Patients under 18 years were included with fractures treated via closed reduction and percutaneous K-wiring. Exclusion criteria were the open reduction, other surgery at the same time, open fractures, if the wire removal was fractionated, documentation was missing or the treatment was started/finished in other hospital. Patients were grouped according to the position of the wires (buried or exposed). The observed parameters were the type of anaesthesia during the wire removal, the cumulative length of hospital stay, the rate of infective complications. For statistical analysis, the t-probe and the chi2-test were used. Results: In the study period, 427 patients with the average age of 10 years were included. The wires were buried in 138/427 and exposed in 289/427 cases. The cumulative length of hospital stay was 3.44 days in average in buried cases and 1.92 days in exposed cases (p = 0.0158). During wire removal, general anaesthesia was needed in 33/138 cases in buried wire patients and 19/289 in exposed wire patients (p<0.0001). Infective complication was observed in 6/138 buried and 16/289 exposed wire patients (p = 0.6). Discussion: Using exposed K-wires, the cumulative length of hospital stay is shorter, needing general anaesthesia during the implant removal is less according to buried wires. There is no difference in infective complications between the two techniques. Conclusion: Using exposed K-wires is feasible: in the majority of the cases, the implant removal does not needi general anaesthesia, so the cumulative hospital stay can be reduced. Orv Hetil. 2024; 165(23): 908–912.