Morbidity of Kirschner Wires Versus Internal Fixation Devices for Partial Wrist Fusion

• Published in: Canadian journal of plastic surgery Vol. 25; no. 2; p. 139
• Main Authors: Hayward, V, Maqbool, T, Baltzer, H, von Schroeder, H
• Format: Journal Article
• Language: English
• Published: Montreal SAGE PUBLICATIONS, INC 01.07.2017
• Subjects: Morbidity; Wire
• ISSN: 2292-5503; 2292-5511

Purpose: We hypothesize that there would be a higher 30-day morbidity of PWFs performed with k-wires versus internal fixation especially with regards to infection rate and readmission. Long-term data comparing the morbidity of these 2 techniques was also compared. Method: A retrospective study of all patients that underwent PWFs at a single institution from 1999 to July 2011 was performed. Data on demographics, method of fixation, 30-day morbidity and healthcare utilization, and long-term outcomes was extracted. Mann-Whitney U, Chi-squared and Fischer's exact tests were performed to compare 30-day and long-term outcomes between fixation groups (P < .05, a priori). Results: 150 PWFs were analyzed and there was no significant differences in operative time, 30-day post-operative emergency and unscheduled clinic visits (P = .452, P = .089, P = 1.000). In the K-wire group, 3 (4.3%) patients had infections (P = .095), with 2 requiring re-admissions and one requiring a return to the operating room. Six (7.4%) patients with internal fixation had persistent carpal tunnel symptoms ultimately requiring median nerve decompression (P = .031). Looking at long-term data, the internal fixation group had a higher incidence of hardware irritation/ impingement (P = .003) and nonunion (P = .048). They required a greater number of revision surgeries (0.000), including revision PWFs (P = .007), total wrist fusion (P = .001), and hardware removal due to irritation/impingement (P = .007). Conclusion: Patients undergoing arthrodesis with internal fixation devices versus k-wire were more likely to have persistent carpal tunnel symptoms and a higher incidence of hardware complications and revision surgery. Although not statistically significant, the k-wire group had a higher incidence of infection within 30 days. Learning Objectives: Participants will be able to understand and compare the shortterm and long-term morbidity of using k-wires versus internal fixation devices for PWFs.