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)....
| Päätekijät: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Aineistotyyppi: | Journal article |
| Kieli: | English |
| Julkaistu: |
Wolters Kluwer Health
2018
|
| _version_ | 1826279338655350784 |
|---|---|
| author | 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 |
| author_facet | 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 |
| author_sort | Gardiner, M |
| collection | OXFORD |
| description | <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. |
| first_indexed | 2024-03-06T23:57:13Z |
| format | Journal article |
| id | oxford-uuid:74a5adaf-16c6-412f-bc66-2b937d3ad2f2 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T23:57:13Z |
| publishDate | 2018 |
| publisher | Wolters Kluwer Health |
| record_format | dspace |
| spelling | oxford-uuid:74a5adaf-16c6-412f-bc66-2b937d3ad2f22022-03-26T20:04:23ZBuried versus exposed Kirschner wires following fixation of hand fractures: l clinician and patient surveysJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:74a5adaf-16c6-412f-bc66-2b937d3ad2f2EnglishSymplectic Elements at OxfordWolters Kluwer Health2018Gardiner, MGardiner, SIssa, FJain, ALloyd-Hughes, HPezas, TRodrigues, JWormald, JAcquaah, FBrierley, NBickerton, SChow, WClutton, JCoulson, SCrowley, PEdmondson, SFowler, AGallagher, MHowles, SJones, JKhan, LKulendran, DLangley, CManton, RMohamed, MNg, LSalibi, ASameer, GSegaren, NSharma, KShiatis, ASteele, KJay-Stewart, CSuwito, CTam, AThind, AWade, RWielogorska, NYoung, KWIRE Research Collaborative<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. |
| spellingShingle | 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 Buried versus exposed Kirschner wires following fixation of hand fractures: l clinician and patient surveys |
| title | Buried versus exposed Kirschner wires following fixation of hand fractures: l clinician and patient surveys |
| title_full | Buried versus exposed Kirschner wires following fixation of hand fractures: l clinician and patient surveys |
| title_fullStr | Buried versus exposed Kirschner wires following fixation of hand fractures: l clinician and patient surveys |
| title_full_unstemmed | Buried versus exposed Kirschner wires following fixation of hand fractures: l clinician and patient surveys |
| title_short | Buried versus exposed Kirschner wires following fixation of hand fractures: l clinician and patient surveys |
| title_sort | buried versus exposed kirschner wires following fixation of hand fractures l clinician and patient surveys |
| work_keys_str_mv | AT gardinerm buriedversusexposedkirschnerwiresfollowingfixationofhandfractureslclinicianandpatientsurveys AT gardiners buriedversusexposedkirschnerwiresfollowingfixationofhandfractureslclinicianandpatientsurveys AT issaf buriedversusexposedkirschnerwiresfollowingfixationofhandfractureslclinicianandpatientsurveys AT jaina buriedversusexposedkirschnerwiresfollowingfixationofhandfractureslclinicianandpatientsurveys AT lloydhughesh buriedversusexposedkirschnerwiresfollowingfixationofhandfractureslclinicianandpatientsurveys AT pezast buriedversusexposedkirschnerwiresfollowingfixationofhandfractureslclinicianandpatientsurveys AT rodriguesj buriedversusexposedkirschnerwiresfollowingfixationofhandfractureslclinicianandpatientsurveys AT wormaldj buriedversusexposedkirschnerwiresfollowingfixationofhandfractureslclinicianandpatientsurveys AT acquaahf buriedversusexposedkirschnerwiresfollowingfixationofhandfractureslclinicianandpatientsurveys AT brierleyn buriedversusexposedkirschnerwiresfollowingfixationofhandfractureslclinicianandpatientsurveys AT bickertons buriedversusexposedkirschnerwiresfollowingfixationofhandfractureslclinicianandpatientsurveys AT choww buriedversusexposedkirschnerwiresfollowingfixationofhandfractureslclinicianandpatientsurveys AT cluttonj buriedversusexposedkirschnerwiresfollowingfixationofhandfractureslclinicianandpatientsurveys AT coulsons buriedversusexposedkirschnerwiresfollowingfixationofhandfractureslclinicianandpatientsurveys AT crowleyp buriedversusexposedkirschnerwiresfollowingfixationofhandfractureslclinicianandpatientsurveys AT edmondsons buriedversusexposedkirschnerwiresfollowingfixationofhandfractureslclinicianandpatientsurveys AT fowlera buriedversusexposedkirschnerwiresfollowingfixationofhandfractureslclinicianandpatientsurveys AT gallagherm buriedversusexposedkirschnerwiresfollowingfixationofhandfractureslclinicianandpatientsurveys AT howless buriedversusexposedkirschnerwiresfollowingfixationofhandfractureslclinicianandpatientsurveys AT jonesj buriedversusexposedkirschnerwiresfollowingfixationofhandfractureslclinicianandpatientsurveys AT khanl buriedversusexposedkirschnerwiresfollowingfixationofhandfractureslclinicianandpatientsurveys AT kulendrand buriedversusexposedkirschnerwiresfollowingfixationofhandfractureslclinicianandpatientsurveys AT langleyc buriedversusexposedkirschnerwiresfollowingfixationofhandfractureslclinicianandpatientsurveys AT mantonr buriedversusexposedkirschnerwiresfollowingfixationofhandfractureslclinicianandpatientsurveys AT mohamedm buriedversusexposedkirschnerwiresfollowingfixationofhandfractureslclinicianandpatientsurveys AT ngl buriedversusexposedkirschnerwiresfollowingfixationofhandfractureslclinicianandpatientsurveys AT salibia buriedversusexposedkirschnerwiresfollowingfixationofhandfractureslclinicianandpatientsurveys AT sameerg buriedversusexposedkirschnerwiresfollowingfixationofhandfractureslclinicianandpatientsurveys AT segarenn buriedversusexposedkirschnerwiresfollowingfixationofhandfractureslclinicianandpatientsurveys AT sharmak buriedversusexposedkirschnerwiresfollowingfixationofhandfractureslclinicianandpatientsurveys AT shiatisa buriedversusexposedkirschnerwiresfollowingfixationofhandfractureslclinicianandpatientsurveys AT steelek buriedversusexposedkirschnerwiresfollowingfixationofhandfractureslclinicianandpatientsurveys AT jaystewartc buriedversusexposedkirschnerwiresfollowingfixationofhandfractureslclinicianandpatientsurveys AT suwitoc buriedversusexposedkirschnerwiresfollowingfixationofhandfractureslclinicianandpatientsurveys AT tama buriedversusexposedkirschnerwiresfollowingfixationofhandfractureslclinicianandpatientsurveys AT thinda buriedversusexposedkirschnerwiresfollowingfixationofhandfractureslclinicianandpatientsurveys AT wader buriedversusexposedkirschnerwiresfollowingfixationofhandfractureslclinicianandpatientsurveys AT wielogorskan buriedversusexposedkirschnerwiresfollowingfixationofhandfractureslclinicianandpatientsurveys AT youngk buriedversusexposedkirschnerwiresfollowingfixationofhandfractureslclinicianandpatientsurveys AT wireresearchcollaborative buriedversusexposedkirschnerwiresfollowingfixationofhandfractureslclinicianandpatientsurveys |