SynthesisEuropean journal of trauma and emergency surgery : official publication of the European Trauma Society2026
What to do with K-wires in displaced upper extremity fractures in children - where to bury or not.
Synthesis in European journal of trauma and emergency surgery : official publication of the European Trauma Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Kirschner wires (K-wires) are the standard fixation method for displaced pediatric upper extremity fractures, yet no consensus exists on whether wire ends should be buried subcutaneously or left exposed epicutaneously. While epicutaneous K-wires offer cost-effectiveness and avoid second anesthesia, concerns remain regarding infection risk and psychological distress. To systematically review and compare complication rates between buried and exposed K-wire fixation in pediatric upper extremity fractures, including infection, refracture, skin erosion, and secondary implant displacement. We conducted a systematic review following PRISMA guidelines, searching Cochrane, PubMed, EmBase, and Ovid databases. Inclusion criteria were: modified Coleman Methodology Score (mCMS) > 60, upper extremity fractures treated with K-wire fixation, and age < 16 years. Studies including adult patients and biomechanical studies were excluded. Meta-analysis compared outcomes across 12 studies encompassing 1,977 patients. Buried K-wires demonstrated significantly lower overall infection rates (OR = 1.74; 95% CI: 1.19-2.56; p = 0.004). However, no significant difference was observed in deep surgical siteinfections (OR = 1.56; 95% CI: 0.60-4.0; p = 0.36). Exposed wires showed significantly lower skin irritation rates (OR = 0.09; 95% CI: 0.04-0.21; p < 0.00001). No significant differences were found in secondary implant displacement (OR = 1.26; 95% CI: 0.10-15.75; p = 0.86) or refracture rates (OR = 1.90; 95% CI: 0.91-3.96; p = 0.09). Geographic subgroup analysis revealed significant regional differences: infection rate differences were significant in Asia/Africa (OR = 2.90; 95% CI: 1.61-5.22; p = 0.0004) but not in Europe/USA (OR = 1.16; 95% CI: 0.69-1.95; p = 0.57). Epicutaneous K-wire fixation shows higher overall infection rates than buried wires but does not increase deep surgical site infections requiring operative revision. Considering the avoidance of additional anesthesia, favorable cost-benefit profile, and geographic variation in infection risk, epicutaneous K-wires are recommended when no patient-specific contraindications exist, particularly in temperate climates. Level III (Systematic Review of Level II-III Studies).
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