Outcome of Buried Versus Exposed Kirchner Wires in Terms of Infection in Fractures of Phalanges and Metacarpal Bones of Hand

Introduction and objective The fracture of hand bones is very common among manual hand workers and a fractured hand imparts a great effect on a person’s productivity both socioeconomically and from a body image point of view. The most common method of hand fractures fixation is with the help of Kirschner wires. Kirchner wires can be inserted in exposed or in buried manner. There are a few studies that provide a comparative analysis of rate of infection between these two techniques. This study aimed to assess the rate of infection in buried versus exposed Kirschner (K)-wires for hand fractures. Material and method The study was designed as a randomized controlled trial with consecutive non-random sampling. It was conducted in the Department of Plastic Surgery, Holy Family Hospital, Rawalpindi, Pakistan, and lasted from June to December 2019. Blinding was not possible as both the operating surgeon and patient were aware of the procedure being done; however, the assessor was blinded and was not aware which group got which treatment. Total 122 patients with fractures of metacarpals and phalanges of hand were included in the study and were divided into two groups with 61 patients in each. Group A was treated with buried K-wires and group B with exposed K-wires. The patients were followed for one month for the outcomes in terms of infection in the patients. Results Group A had 24 females (39.3%) and 37 males (60.7%). Group B had 16 females (26.2%) and 45 males (73.8%). In group A, nine (14.8%) patients had ages between 10 and 20 years, 18 (29.5%) patients between 21 and 30 years, 14 (23.0%) patients between 31 and 40 years, 11 (18.0%) patients between 41 and 50 years, and nine (14.8%) were between 51 and 60 years. The mean duration of surgery was 35.16 minutes for group A and 27.30 minutes for group B. Based on modified Oppenheim scoring system for pin site infection, out of 61 patients, seven (11.5%) with buried K-wires while 14 (23%) with exposed K-wires developed pin site infection. Conclusion Rate of infection is low in buried K-wires as compared to exposed K-wires though not statistically significant (p>0.05) for the fractures of metacarpals and phalangeal fractures of hand.