Kirschner Wire Skeletal Fixation in the Hand and Wrist: Risk of Infection and Predictors of Progression to Major...

Kirschner wire (K-wire) infections continue to be a challenge in hand surgery. Our purpose was to quantify the frequency of K-wire site infections of the hand and wrist, to tabulate major and minor infectious manifestations, to identify factors that may predispose a patient to major complications, and to generate an updated algorithm for prognostication and treatment of K-wire site infections.

Patients treated with K-wires in the fingers, hand, and wrist who developed infections between 2018 and 2024 at our institution were identified. Information regarding patient factors, injury, treatment, and subsequent infectious complications was collected. Variables from single variable regression were entered into a standard multiple variable regression model.

A total of 3425 patients treated with K-wires in the finger, hand, or wrist were assessed; 113 patients with a mean age of 46 years had an infection and were included in this study (36 women [32%]), giving an overall infection rate of 3.3%. The mean time to presentation of infection was 29 ± 18 days. Major infection-related complications occurred in 23 patients (20.4%). The presence of postoperative purulence and the necessity of a second course of oral antibiotics were significant predictors of major infection on multivariable regression.

K-wire associated infections were present in 3.3% of patients, manifesting, on average, 29 days after surgery. Purulence as an initial manifestation of infection and the necessity for a second course of antibiotics were significantly associated with developing major complications. Clinicians should closely follow patients for the entire course of K-wire presence, as well as consider a lower threshold for intervention.

Prognostic IIb.