Buried versus exposed Kirschner wires following fixation of hand fractures: l clinician and patient surveys

Buried versus exposed Kirschner wires following fixation of hand fractures: l clinician and patient surveys

<strong>Background:</strong> Fractures of the metacarpals and phalanges are common. Placement of Kirschner wires (K-wires) is the most common form of surgical fixation. After placement, a key decision is whether to bury the end of a K-wire or leave it protruding from the skin (exposed)....

Full description

Bibliographic Details
Main Authors: Gardiner, M, Gardiner, S, Issa, F, Jain, A, Lloyd-Hughes, H, Pezas, T, Rodrigues, J, Wormald, J, Acquaah, F, Brierley, N, Bickerton, S, Chow, W, Clutton, J, Coulson, S, Crowley, P, Edmondson, S, Fowler, A, Gallagher, M, Howles, S, Jones, J, Khan, L, Kulendran, D, Langley, C, Manton, R, Mohamed, M, Ng, L, Salibi, A, Sameer, G, Segaren, N, Sharma, K, Shiatis, A, Steele, K, Jay-Stewart, C, Suwito, C, Tam, A, Thind, A, Wade, R, Wielogorska, N, Young, K, WIRE Research Collaborative
Format: Journal article
Language:English
Published: Wolters Kluwer Health 2018
Description
Summary:<strong>Background:</strong> Fractures of the metacarpals and phalanges are common. Placement of Kirschner wires (K-wires) is the most common form of surgical fixation. After placement, a key decision is whether to bury the end of a K-wire or leave it protruding from the skin (exposed). A recent systematic review found no evidence to support either approach. The aim of study was to investigate current clinical practice, understand the key factors influencing clinician decision-making, and explore patient preferences to inform the design of a randomized clinical trial. <strong>Methods:</strong> The steering group developed surveys for hand surgeons, hand therapists, and patients. Following piloting, they were distributed across the United Kingdom hand surgery units using the Reconstructive Surgery Trials Network. <strong>Results:</strong> A total of 423 hand surgeons, 187 hand therapists, and 187 patients completed the surveys. Plastic surgeons and junior surgical trainees preferred to leave K-wires not buried. Ease of removal correlated with a decision to leave wires exposed, whereas perceived risk of infection correlated with burying wires. Cost did not affect the decision. Hand therapists were primarily concerned about infection and patient-related outcomes. Patients were most concerned about wire-related problems and pain. <strong>Conclusion:</strong> This national survey provides a new understanding of the use of Kwires to manage hand fractures in the United Kingdom. A number of nonevidencebased factors seem to influence the decision to bury or leave K-wires exposed. The choice has important clinical and health economic implications that justify a randomized controlled trial.

Similar Items