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Kirschner Wire Infections in Pediatric Orthopaedic Surgery
Journal article   Peer reviewed

Kirschner Wire Infections in Pediatric Orthopaedic Surgery

Rick Tosti, Abtin Foroohar, Peter D. Pizzutillo and Martin J. Herman
Journal of pediatric orthopaedics, v 35(1)
Jan 2015
DOI: https://doi.org/10.1097/BPO.0000000000000208
PMID: 24787310
Featured in Collection :   UN Sustainable Development Goals @ Drexel

Abstract

Life Sciences & Biomedicine Orthopedics Pediatrics Science & Technology
Background: Few studies have described the presentation, bacteriology, risk factors, and complications of Kirschner wire infections in pediatrics. The purpose of this study is to describe these factors to better understand, prevent, and treat infectious complications of smooth wires. Methods: A retrospective review was performed to identify all patients (birth to 16 y) who were hospitalized for Kirschner wire infection from 1995 to 2012. Presentation, hospital course, bacteriology, outcomes, and complications were recorded. A management algorithm was developed from the experience. Results: Kirschner wire infections were present in 12 patients: 5 supracondylar fractures, 3 lateral humeral condylar fractures, a distal tibia physeal fracture, a great toe open fracture, a distal radius fracture, and an elective osteotomy for hallux valgus. The patients presented with cellulitis in 3 cases, soft-tissue abscess in 4 cases, osteomyelitis in 4 cases, and 1 case of toxic shock syndrome. A history of missed appointments or wet dressing was present in 60% of cases. Reoperation was required in 5 patients with abscess, septic arthritis, or osteomyelitis. Methicillin-sensitive Staphylococcus aureus (MSSA) was the most common pathogen followed by Pseudomonas aeruginosa. Methicillin-resistant S. aureus was not seen. Complications were present in 5 patients and included: loss of range of motion, joint destruction, wound breakdown, catheter migration, and toxic shock syndrome. Conclusions: Infected Kirschner wires are rare and may be maintained in a nonunited bone if the infection is superficial. Infections in this series commonly had a history of missed appointments and wet dressings, which suggests that improved postoperative education may reduce the risk. Osteomyelitis was often preceded by pin-site drainage and failed oral antibiotic therapy. MSSA and Pseudomonas were most commonly cultured and should be considered when empiric antibiotic therapy is necessary. Level of Evidence: Prognostic level IV.

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26 citations in Web of Science
31 citations in Scopus

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Collaboration types
Domestic collaboration
Web of Science research areas
Orthopedics
Pediatrics
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