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

Maradei-Pereira, João Alberto Ramos; Santos, Anadalvo Juazeiro dos; Martins, José Carlos Amado; Maradei-Pereira, Marcia R.

doi:10.1177/1753193420936543

Cited by 5 publications

(11 citation statements)

References 13 publications

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“…Techniques employed by surgeons lack robust evidence regarding their utility. There are only eight trials evaluating antimicrobial techniques in hand trauma surgery, [35][36][37][38][39][40][41][42] five of which evaluated the effect of systemic antibiotics in open hand trauma, and three evaluated SSI after Kirschner (K)-wire fixation of hand and wrist fractures. A meta-analysis of studies assessing the use of antibiotics in open hand trauma revealed no significant distinction between antibiotic use or not.…”

Section: Discussionmentioning

confidence: 99%

Hand and Wrist trauma: Antimicrobials and Infection Audit of Clinical Practice (HAWAII ACP) protocol

Shafi,

Yoshimura,

Harrison

et al. 2024

Bone Jt Open

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AimsHand trauma, consisting of injuries to both the hand and the wrist, are a common injury seen worldwide. The global age-standardized incidence of hand trauma exceeds 179 per 100,000. Hand trauma may require surgical management and therefore result in significant costs to both healthcare systems and society. Surgical site infections (SSIs) are common following all surgical interventions, and within hand surgery the risk of SSI is at least 5%. SSI following hand trauma surgery results in significant costs to healthcare systems with estimations of over £450 per patient. The World Health Organization (WHO) have produced international guidelines to help prevent SSIs. However, it is unclear what variability exists in the adherence to these guidelines within hand trauma. The aim is to assess compliance to the WHO global guidelines in prevention of SSI in hand trauma.MethodsThis will be an international, multicentre audit comparing antimicrobial practices in hand trauma to the standards outlined by WHO. Through the Reconstructive Surgery Trials Network (RSTN), hand surgeons across the globe will be invited to participate in the study. Consultant surgeons/associate specialists managing hand trauma and members of the multidisciplinary team will be identified at participating sites. Teams will be asked to collect data prospectively on a minimum of 20 consecutive patients. The audit will run for eight months. Data collected will include injury details, initial management, hand trauma team management, operation details, postoperative care, and antimicrobial techniques used throughout. Adherence to WHO global guidelines for SSI will be summarized using descriptive statistics across each criteria.DiscussionThe Hand and Wrist trauma: Antimicrobials and Infection Audit of Clinical Practice (HAWAII ACP) will provide an understanding of the current antimicrobial practice in hand trauma surgery. This will then provide a basis to guide further research in the field. The findings of this study will be disseminated via conference presentations and a peer-reviewed publication.Cite this article: Bone Jt Open 2024;5(4):361–366.

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Section: Discussionmentioning

confidence: 99%

Hand and Wrist trauma: Antimicrobials and Infection Audit of Clinical Practice (HAWAII ACP) protocol

Shafi,

Yoshimura,

Harrison

et al. 2024

Bone Jt Open

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“…The risk of bias assessment by using the RoB v2 tool revealed that only 1 RCT [9] had a "low risk" of bias in all five assessment domains. The remaining four RCTs [10,[17][18][19] were judged to have "some concern" risk of bias.…”

Section: Quality Of Study Assessmentmentioning

confidence: 99%

“…Several studies have been conducted to compare buried and exposed K-wires in the management of hand and forearm fractures but have yielded inconsistent results. [9,10] A randomized trial study conducted by Maradei-Pereira JAR et al[9] distal radial, fractures showed a greater risk of infection when K-wires were left exposed than when they were buried. On the other hand, Khaled M et al[10] showed no significant difference in the complication rate, including pin infection incidence between exposed and buried K-wire.…”

Section: Introductionmentioning

confidence: 99%

Buried or Exposed Kirschner Wire for the Management of Hand and Forearm Fractures: A Systematic Review, Meta-Analysis, and Meta-Regression

Hidajat,

Magetsari,

Prasetiyo

et al. 2023

Preprint

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BackgroundThe recommendation on whether to bury or expose the Kirschner wire (K-wire) for the management of fractures has still been controversial with inconsistent results in the published studies. This study aims to summarize the comparison between buried and exposed K-wire for the management of hand and forearm fractures.MethodsWe conducted relevant literature searches on Europe PMC, Medline, Scopus, and Cochrane Library databases using specific keywords. The results of continuous variables were pooled into the standardized mean difference (SMD), while dichotomous variables were pooled into odds ratio (OR) along with 95% confidence intervals (95% CI) using random-effect models.ResultsA total of 11 studies were included. Our pooled analysis revealed that buried K-wire was associated with a lower risk of pin site infection [RR 0.49 (95% CI 0.36 – 0.67),p< 0.00001,I2= 0%] and longer duration until pin removal [MD 33.85 days (95% CI 18.68 – 49.02),p< 0.0001,I2= 99%] when compared with exposed K-wire. However, the duration of surgery was significantly longer in the buried K-wire [MD 6.98 minutes (95% CI 2.19 – 11.76),p= 0.004,I2= 42%] with no significant difference in the early pin removal rate [RR 0.73 (95% CI 0.36 – 1.45),p= 0.37,I2= 0%]. Further regression analysis revealed that sample size, age, sex, and duration of follow-up did not affect those relationships.ConclusionBuried K-wire may offer benefits in reducing the infection rate with a longer duration until pin removal. However, further RCTs with larger sample sizes are still needed to confirm the results of our study.

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“…Kirschner wire fixation is often used for hand and wrist fractures. There is a good deal of evidence that superficial wires are associated with a high rate of infection and that burying the wires beneath the skin decreases the frequency of this complication [70][71][72] .…”

Section: Fracture Carementioning

confidence: 99%

What’s New in Hand and Wrist Surgery

Bohn

Wise

2022

Journal of Bone and Joint Surgery

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The intent is to serve as an update of the hand surgery literature for the practicing general orthopaedic surgeon. Carpal Tunnel SyndromeCarpal tunnel syndrome is one of the most common disorders in hand surgery. Nevertheless, the optimum method for diagnosis remains controversial. A growing body of evidence suggests that electrodiagnostic studies [1][2][3][4] are not more sensitive and specific than diagnosis by ultrasound or clinical history and examination. D'Auria et al. 5 examined the role of electrodiagnostic studies compared with clinical judgment and found that the utility of electrodiagnostic studies may be greatest in patients for whom a diagnosis of carpal tunnel syndrome is questionable. Even so, electrodiagnostic studies are performed in many patients with carpal tunnel syndrome 6 . Less expensive, office-based diagnostic tools such as the Carpal Tunnel Syndrome 6 (CTS-6), a 26-point scale that incorporates aspects of the history and clinical examination to predict the probability of carpal tunnel syndrome, and ultrasound will likely supplant the routine use of electrodiagnostic studies for carpal tunnel syndrome.Strong evidence exists for the use of night splints and corticosteroid injections for early treatment of carpal tunnel syndrome. In a comparison of the 2 treatments, 100 patients with a diagnosis of carpal tunnel syndrome were randomized to a night splint or a corticosteroid injection 7 . In the 95 patients who completed follow-up, corticosteroid injections were superior in terms of nocturnal paresthesias, pain, and Boston Carpal Tunnel Questionnaire (BCTQ) function and symptom domains at 1, 3, and 6 months.A novel study on hand function with decreased sensation showed that a digital nerve block to the thumb had the greatest negative impact on dexterity and a loss of sensation in the index and long fingers caused decreased grip and chuck pinch strength, thus explaining the common symptoms of decreased dexterity and strength in patients with carpal tunnel syndrome 8 .Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/G899).

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

Cited by 5 publications

References 13 publications

Hand and Wrist trauma: Antimicrobials and Infection Audit of Clinical Practice (HAWAII ACP) protocol

Hand and Wrist trauma: Antimicrobials and Infection Audit of Clinical Practice (HAWAII ACP) protocol

Buried or Exposed Kirschner Wire for the Management of Hand and Forearm Fractures: A Systematic Review, Meta-Analysis, and Meta-Regression

What’s New in Hand and Wrist Surgery

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