Comparison of Infection Rate in Buried vs. Exposed Ends of K-wire Used in Fixation of Pediatric Supracondylar Humerus Fracture

Muhammad Qasim; Awais Wali; Shafi ul Haq; Muhammad Waqar

doi:10.70749/ijbr.v3i4.982

Authors

Muhammad Qasim Orthopedic and Spine Unit, MTI Hayatabad Medical Complex, Peshawar, Pakistan
Awais Wali Orthopedic and Spine Unit, MTI Hayatabad Medical Complex, Peshawar, Pakistan
Shafi ul Haq Orthopedic and Spine Unit, MTI Hayatabad Medical Complex, Peshawar, Pakistan
Muhammad Waqar Orthopedic and Spine Unit, MTI Hayatabad Medical Complex, Peshawar, Pakistan

DOI:

https://doi.org/10.70749/ijbr.v3i4.982

Keywords:

K-Wires (Kirschner Wires), Supracondylar Humerus Fracture, Pin Site Superficial Infection

Abstract

Objectives: This study aims to compare the rate of pin site infection in pediatric supracondylar fracture fixation in exposed vs. buried K-wire tips. Methodology: This prospective study was conducted at Orthopedic and spine unit MTI-HMC, Peshawar from January 2023 to December 2023. This study included 50 pediatric patients that were treated with closed reduction and percutaneous pinning for displaced supracondylar humerus fracture. Patients were followed from fist post-operative till removal of K-wire at 03 weeks for any pin site infection. Data was then recorded, analyzed and presented in percentages. Results: Patient with Expose K-wires end were assigned group 1 while buried K-wire ends group was assigned as group 2. 07(14.9%) out of 47 patients in Group 1 developed superficial infection. while 06(14.3%) out of 42 patients in group 2 developed superficial infection. K-wires in group 1 were removed in outpatient department without sedation while K-wires in group 2 were removed Operation Theater under sedation. Infection in both groups was managed with oral antibiotics. Conclusion: Infection at pin sites in exposed K-wire ends group was slightly more as compared to buried K-wires end group but they were managed easily with oral antibiotics. Removal of K-wires in buried K-wire ends group required second surgery. Thus, leaving K-wire ends outside skin after fixation of displaced supracondylar humerus fracture is more convenient and cost-effective technique for patient, family and hospital.

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References

Zhao H, Xu S, Liu G, Zhao J, Wu S, Peng L. Comparison of lateral entry and crossed entry pinning for pediatric supracondylar humeral fractures: a meta-analysis of randomized controlled trials. J Orthop Surg Res. 2021 Jun 9;16(1):366. PMID: 34107972; PMCID: PMC8188794. https://doi.org/10.1186/s13018-021-02505-3.

Gupta, Sumit K et al. “Effect of Antibiotic Prophylaxis on Infection Rates in Pediatric Supracondylar Humerus Fractures Treated with Closed Reduction and Percutaneous Pinning: A Prospective Double-Blinded Randomized Controlled Trial.” The Journal of the American Academy of Orthopaedic Surgeons vol. 32,9 (2024): 410-416. https://doi.org/10.5435/JAAOS-D-23-00795

Ezeokoli, Ekene U et al. “Early Postoperative Infections After Closed Reduction and Percutaneous Pinning in Type II and Type III Pediatric Supracondylar Humerus Fractures.” Journal of pediatric orthopedics vol. 42,7 (2022): e732-e735. https://doi.org/10.1097/BPO.0000000000002176

Micheloni GM, Novi M, Leigheb M, Giorgini A, Porcellini G, Tarallo L. Supracondylar fractures in children: management and treatment. Acta Biomed. 2021 Jul 26;92(S3):e2021015. PMID: 34313666; PMCID: PMC8420822. https://doi.org/10.23750/abm.v92iS3.11725.

Kumar V, Singh A. Fracture Supracondylar Humerus: A Review. J Clin Diagn Res. 2016 Dec;10(12):RE01-RE06.. Epub 2016 Dec 1. PMID: 28208961; PMCID: PMC5296534. https://doi.org/10.7860/JCDR/2016/21647.8942

Koşucu T, Şimşek EK, Haberal B, Dincer R, Kovalak E, Baykal YB. Does posterior approach always lead to poor functional and cosmetic outcomes in displaced pediatric supracondylar humeral fractures? Ulus Travma Acil Cerrahi Derg. 2023 Apr;29(4):523-529. PMID: 36995201; PMCID: PMC10214893. https://doi.org/10.14744/tjtes.2022.29403.

Pullan, J., Ayeko, O., & Metcalfe, J. (2025). Buried or exposed kirschner wires in paediatric upper extremity fracture fixation: A systematic review and meta-analysis of infection rates and complications. Injury, 56(2), 112155. https://doi.org/10.1016/j.injury.2025.112155

Wormald JCR, Park CY, Eastwood DM. A systematic review and meta-analysis of adverse outcomes following non-buried versus buried Kirschner wires for paediatric lateral condyle elbow fractures. J Child Orthop. 2017 Dec 1;11(6):465-471. PMID: 29263760; PMCID: PMC5725774. https://doi.org/10.1302/1863-2548.11.170119.

Al-Algawy AA, Aliakbar AH, Witwit IH. Open versus closed reduction and k-wire fixation for displaced supracondylar fracture of the humerus in children. Eur J Orthop Surg Traumatol. 2019;29:397–403 https://doi.org/10.1007/s00590-018-2305-9.

Yellin, J.L., England, P., Flynn, J.M. (2023). Supracondylar Humerus Fractures in Children. In: Abzug, J.M., Kozin, S., Zlotolow, D.A. (eds) The Pediatric Upper Extremity. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8758-6_52-2

Babal JC, Mehlman CT, Klein G. Nerve injuries associated with pediatric supracondylar humeral fractures: a meta-analysis. J Pediatr Orthop. 2010;30(3):253–63. https://doi.org/10.1097/bpo.0b013e3181d213a6

Zaman, S. U., Julfikar, A., & Islam Nissan, M. N. (2025). Supracondylar Humerus Fracture in Children: A Retrospective Study. Medicine Today, 37(1), 88–92. https://doi.org/10.3329/medtoday.v37i1.79322

Farnsworth, Christine; Silva, Patricia; Mubarak, Scott. Etiology of Supracondylar Humerus Fractures. Journal of Pediatric Orthopaedics 18(1):p 38-42, January 1998. https://doi.org/10.1097/01241398-199801000-00008

Carrazzone, Oreste Lemos et al. “Crossed versus lateral K-wire fixation of supracondylar fractures of the humerus in children: a meta-analysis of randomized controlled trials.” Journal of shoulder and elbow surgery vol. 30,2 (2021): 439-448. https://doi.org/10.1016/j.jse.2020.09.021

Bashyal, Ravi K et al. “Complications after pinning of supracondylar distal humerus fractures.” Journal of pediatric orthopedics vol. 29,7 (2009): 704-8. https://doi.org/10.1097/BPO.0b013e3181b768ac

Abzug, Joshua M, and Martin J Herman. “Management of supracondylar humerus fractures in children: current concepts.” The Journal of the American Academy of Orthopaedic Surgeons vol. 20,2 (2012): 69-77. https://doi.org/10.5435/JAAOS-20-02-069

Dineen, Hannah A et al. “Closed Reduction Percutaneous Pinning of a Pediatric Supracondylar Distal Humerus Fracture.” Journal of orthopaedic trauma vol. 33 Suppl 1 (2019): S7-S8. https://doi.org/10.1097/BOT.0000000000001523

Kashyap A, Ravoof A, Karigowda H, Lakkireddy M, Srikanth E. Comparative Study of the Functional Outcome of Elbow Joint in Supracondylar Fractures of Children Treated With k Wire Fixation Using Lateral and Posterior Approaches. Cureus. 2022 Aug 21;14(8):e28232. PMID: 36158419; PMCID: PMC9491684. https://doi.org/10.7759/cureus.28232.

Lu, Di et al. “Management of pin tract infection in pediatric supracondylar humerus fractures: a comparative study of three methods.” European journal of pediatrics vol. 176,5 (2017): 615-620. https://doi.org/10.1007/s00431-017-2884-1

Kao, HK., Chen, MC., Lee, WC. et al. A prospective comparative study of pin site infection in pediatric supracondylar humeral fractures: daily pin care vs. no pin care. Arch Orthop Trauma Surg 134, 919–923 (2014). https://doi.org/10.1007/s00402-014-2004-x

Battle, Jacob, and Kelly D Carmichael. “Incidence of pin track infections in children's fractures treated with Kirschner wire fixation.” Journal of pediatric orthopedics vol. 27,2 (2007): 154-7. https://doi.org/10.1097/bpo.0b013e3180317a22

Cuomo, Anna V et al. “Gartland type I supracondylar humerus fractures in children: is splint immobilization enough?.” Pediatric emergency care vol. 28,11 (2012): 1150-3. https://doi.org/10.1097/PEC.0b013e3182716fea

Ponce, Brent A et al. “Complications and timing of follow-up after closed reduction and percutaneous pinning of supracondylar humerus fractures: follow-up after percutaneous pinning of supracondylar humerus fractures.” Journal of pediatric orthopedics vol. 24,6 (2004): 610-4. https://doi.org/10.1097/00004694-200411000-00002

Schroeder, Nicholas O et al. “Utility of Postoperative Antibiotics After Percutaneous Pinning of Pediatric Supracondylar Humerus Fractures.” Journal of pediatric orthopedics vol. 37,6 (2017): 363-367. https://doi.org/10.1097/BPO.0000000000000685

Santy JE, Kamal J, Abdul-Rashid AH, Ibrahim S. The Rubber Stopper: A Simple and Inexpensive Technique to Prevent Pin Tract Infection following Kirschner Wiring of Supracondylar Fractures of Humerus in Children. Malays Orthop J. 2015 Jul;9(2):13-16. PMID: 28435603; PMCID: PMC5333656. https://doi.org/10.5704/MOJ.1507.006.

Joshi P, Dawadi P, Rana K, Bista NR, Bisht R, Kayastha P. Epidemiological and Clinical Pattern of Pediatric Supracondylar Fracture of Humerus in A Provincial Hospital: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc. 2021 Jan 31;59(233):12-14. PMID: 34508440; PMCID: PMC7893385. https://doi.org/10.31729/jnma.6047.