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)....

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मुख्य लेखकों: 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
स्वरूप: Journal article
भाषा:English
प्रकाशित: 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.
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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
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