To bury or not to bury the k-wires after fixation of a pediatric both bone forearm fracture, a randomized controlled trial

Abstract

Objectives The primary objective was to compare refracture incidence of both radius and ulna fracture in two groups treated using intramedullary k-wires where the wires were buried in group I and left exposed in group II. The secondary objective was to compare the final functional outcomes and complications incidence. Methods Between March 2019 and February 2021, 60 pediatric patients presented with unstable radius and ulna fractures amenable to surgical intervention using intramedullary K-wires were randomized into Group I (k-wires were buried under the skin) or group II (k-wires were exposed above the skin by 2 cm). In group I, k-wires were removed after full union under general anesthesia as a day case procedure; in group II they were removed in the outpatient clinic. Functional outcome per Price criteria was reported at one-year follow-up. Results Included patients had a mean age of 7.6 years (range 5 to 10). The mean operative time was significantly higher in group I (32.33 ± 7.51 vs. 36.77 ± 8.70 minutes, P = 0.03), no difference regarding intraoperative x-ray exposure (43.12 ± 15.52 vs. 41.6 ± 11.96 seconds, P = 0.67). Fracture union was achieved after a mean of 44 ± 2.6 days in group I and 43 ± 1.87 days in group II. One patient had refracture, and two had deep infection necessitated surgical debridement in group I. All patients reported excellent scores per Price criteria and achieved full wrist and elbow ROM compared to the contralateral non-injured side. Conclusion Exposed implants are a safe option when dealing with pediatric forearm fractures with similar complications rate and functional outcomes compared to buried implants; however, it confers fewer hospital admissions.

Buried or exposed Kirschner wire for the management of hand and forearm fractures: A systematic review, meta-analysis, and meta-regression

“…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 – 19 ] were judged to have “some concern” risk of bias. One RCT [ 18 ] used consecutive non-random sampling for the selection of participants which was deemed an inappropriate method for randomization, but there was no significant difference in the baseline characteristics of participants in the two groups of intervention, suggesting no serious problems during randomization, therefore was judged to have “some concern” risk of bias in the randomization process.…”

“…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 due to high risk of infection [ 9 , 10 ]. The gap in existing reviews becomes apparent as these studies do not offer a cohesive and thorough comprehension of the effectiveness and risks associated with exposed versus buried K-wires.…”

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

“…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. Given these inconsistencies, a meta-analysis may help.…”

“…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.…”

“…[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. Given these inconsistencies, a meta-analysis may help.…”