Complications of K-Wire Fixation in Procedures Involving the Hand and Wrist

Purpose Surgeons often use smooth K-wires for bone stabilization in the hand and wrist. The purposes of this study were to observe the incidence of postoperative complications of K-wire fixation in the hand and wrist and to identify associated risk factors. Methods A total of 189 patients underwent bone and soft tissue procedures in the hand and wrist with insertion of 408 smooth K-wires. All patients were instructed to comply with a uniform pin care protocol and were observed for a minimum of 1 examination after pin removal. Complications were categorized as minor or major, with 3 subcategories for infectious complications. We compared total complications and infectious complications with patient age, comorbidities, soft tissue integrity, pin exposure (external or buried), number of pins inserted, pin location, compliance with pin site care, and empiric antibiotic treatment. Results We found that 39 patients experienced postoperative complications involving 58 K-wires (14% of all pins). Most complications were minor, commonly superficial pin track infection (24 pins, 6% of all pins). Major complications occurred less frequently (11 pins, 3% of all pins) and included complications that led to additional surgery (deep infection, malunion, or nonunion) and fractures through the pin track. The development of an infectious complication was associated with 2 factors: pin location in the hand versus the wrist and poor compliance with pin site care. Patient age, medical comorbidities, soft tissue integrity, pin exposure, number of pins inserted, and empiric antibiotic treatment had no statistically significant relationships to the occurrence of complications. Conclusions Complications with smooth K-wire fixation in the hand and wrist are relatively uncommon. Most complications involve minor, superficial pin track infections. Location of pins in the hand as compared with the wrist and poor patient compliance with pin site care may increase the risk of infection. Type of study/level of evidence Therapeutic IV.