Infectious complications of K-wire fixation in pediatric fractures: Risk factors and management at a tertiary care center.

INTRODUCTION

Kirschner wires (K-wires) are frequently used for pediatric fracture fixation. Infectious complications range from 1 % to 20 %, but the few available studies mostly focus on the adult population. The severity of infection varies from minor pin tract infections (PTIs) to severe osteomyelitis. Current literature on this topic is limited, especially regarding the pediatric population.

METHODS

In this retrospective observational study, we enrolled children (0-18 years old) with traumatic bone fractures treated with smooth (unthreaded) K-wires at the Orthopedics Unit of Meyer Children's Hospital in Florence between January 1, 2020, and December 31, 2024. The aim was to evaluate infection rates at our institution, describe clinical presentations and risk factors, identify the most frequent pathogens, and assess the treatment strategies adopted.

RESULTS

A total of 1386 patients were included, of whom 1349 (97.3 %) had fractures of the upper extremities (including the hand) and 37 (2.7 %) had fractures of the lower extremities (including the foot). We recorded 33 infections, with an infection rate of 2.4 %. PTIs were the most common infectious complication (16/33, 48.5 %), followed by osteomyelitis (11/33, 33.3 %) and deep soft tissue infections (3/33, 9.1 %). Fever of unknown origin (FUO), associated with elevated inflammatory markers, was observed in 3/33 (9.1 %) patients. The most common pathogen was Staphylococcus aureus, with no cases of methicillin-resistant strains. Children younger than 9 years were 2.8 times more likely to develop an infectious complication, as confirmed by both univariate (p = 0.012) and multivariate analysis (p = 0.036). Surgery during the summer season was significantly associated with a twofold increased risk of infection in univariate (p = 0.014) and multivariate analysis (p = 0.033). The timing of surgery, number of wires, fracture site, and type of reduction were not associated with a higher risk of infection.

CONCLUSION

This study describes the infection rate following K-wire fixation in a large pediatric cohort at a tertiary care facility. Based on our findings, these complications are rare, and patient education on wound and cast care may play a role in reducing their occurrence.