Journal of Pediatric Orthopaedics - 2026-09-10 - Journal Article
Management and Outcome of Kirschner Wire-related Osteomyelitis in Pediatric Patients After Treatment of Closed Fracture.
Lao J, Bai H, Lu S, Li G, Ali S, Zhu T, Liu T, Wang E
Topics
Key Takeaway
K-wire-related osteomyelitis after pediatric closed fracture fixation carries a 73.3% rate of septic arthritis and 60% rate of premature physeal closure, yet all 16 patients achieved good functional outcomes at mean 2.1-year follow-up with aggressive surgical debridement and antibiotic-impregnated bone graft.
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Summary
This retrospective series examined clinical presentation, imaging, and outcomes of K-wire-related osteomyelitis following percutaneous fixation of closed pediatric fractures at a single institution from 2012–2024. Fifteen of 16 patients underwent surgical debridement with antibiotic-impregnated artificial bone graft; one was managed nonoperatively. Despite high rates of septic arthritis (73.3%), secondary ossification center necrosis (60%), and premature physeal closure (60%), all patients healed without recurrence and maintained good joint function at final follow-up.
Key Limitation
With only 16 patients over 12 years at a single center, the cohort is too small and heterogeneous in fracture type, pin configuration, and organism to draw generalizable conclusions about optimal debridement technique or antibiotic-impregnated graft efficacy.
Original Abstract
BACKGROUND
Kirschner wires are commonly used for percutaneous fixation of closed fractures in children. This arouses the concern of pin site infection. However, only a small part of pin site infections would progress into osteomyelitis. This article specifically analyzes the clinical manifestations, imaging, surgery, and complications of osteomyelitis associated with Kirschner wire fixation for closed fractures in children.
METHODS
A retrospective study was conducted on children with acute or chronic osteomyelitis who were admitted to our institution between 2012 and 2024. Their initial treatment, onset and progression of osteomyelitis, imaging, surgical and non-surgical treatment, and the final outcome of the last follow-up were documented and analyzed.
RESULTS
A total of 16 patients (male:female, 11:5) with an average age of 7.4 years were included: 15 patients received surgical treatment for osteomyelitis and 1 patient was treated non-surgically. All the patients healed after the final treatment without recurrence. Despite the high incidence of septic arthritis (11/15, 73.3%), necrosis of the secondary ossification center (6/10, 60%) and partial or total premature closure of the growth plates (9/15, 60%), all the patients had good joint function and normal daily life within an average of 2.1-year follow-up.
CONCLUSION
For cases with Kirschner wire fixation, bone infection mainly occurs along the path of one of the pins. It may involve the joint and the growth plate that the pin goes across. Early and thorough debridement along the path, combined with antibiotic-impregnated artificial bone grafts, can achieve good results.
LEVEL OF EVIDENCE
Level IV.