JHS - 2026-03-02 - Journal Article
Kirschner Wire Skeletal Fixation in the Hand and Wrist: Risk of Infection and Predictors of Progression to Major Complications.
Mologne MS, Perugini JM, Calotta NA, Wall LB, Goldfarb CA
Topics
Key Takeaway
K-wire infections occurred in 3.3% of 3,425 hand/wrist cases, with 20.4% of infected patients progressing to major complications predicted by initial purulence and need for a second antibiotic course.
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Summary
This study quantified K-wire infection rates and identified predictors of major complications in 3,425 hand/wrist K-wire cases over 6 years. Of 113 infected patients (3.3% overall rate), 23 (20.4%) developed major complications. Multivariable regression identified initial purulence and requirement for a second oral antibiotic course as significant independent predictors of major infectious complications.
Key Limitation
The single-institution retrospective design limits generalizability, and the absence of a standardized definition or grading system for 'major' versus 'minor' complications reduces reproducibility of the risk stratification algorithm.
Original Abstract
PURPOSE
Kirschner wire (K-wire) infections continue to be a challenge in hand surgery. Our purpose was to quantify the frequency of K-wire site infections of the hand and wrist, to tabulate major and minor infectious manifestations, to identify factors that may predispose a patient to major complications, and to generate an updated algorithm for prognostication and treatment of K-wire site infections.
METHODS
Patients treated with K-wires in the fingers, hand, and wrist who developed infections between 2018 and 2024 at our institution were identified. Information regarding patient factors, injury, treatment, and subsequent infectious complications was collected. Variables from single variable regression were entered into a standard multiple variable regression model.
RESULTS
A total of 3425 patients treated with K-wires in the finger, hand, or wrist were assessed; 113 patients with a mean age of 46 years had an infection and were included in this study (36 women [32%]), giving an overall infection rate of 3.3%. The mean time to presentation of infection was 29 ± 18 days. Major infection-related complications occurred in 23 patients (20.4%). The presence of postoperative purulence and the necessity of a second course of oral antibiotics were significant predictors of major infection on multivariable regression.
CONCLUSIONS
K-wire associated infections were present in 3.3% of patients, manifesting, on average, 29 days after surgery. Purulence as an initial manifestation of infection and the necessity for a second course of antibiotics were significantly associated with developing major complications. Clinicians should closely follow patients for the entire course of K-wire presence, as well as consider a lower threshold for intervention.
TYPE OF STUDY/LEVEL OF EVIDENCE
Prognostic IIb.