title: The removal of percutaneous Kirschner wires used in the stabilisation of fractures in children.
abstract: Kirschner wires are commonly used to stabilise fractures in children. There is a wide range of practice across the United Kingdom with regard to their removal, with some units routinely readmitting children for removal of wires under a general anaesthetic and others leaving the wires long and extracting them in the outpatient clinic. In a prospective study performed at The Barts and Royal London National Health Service Trust between November 1997 and December 1999, the acceptability and problems associated with the latter approach were assessed. A total of 203 percutaneous Kirschner wires were used to stabilise 119 fractures following closed reduction in 113 children. The majority of the fractures were in the upper limb and the children ranged in age from five months to fifteen years and five months. The Kirschner wires were subsequently removed in clinic without anaesthetic. Details of wire placement and complications associated with wire use and their removal were recorded. The most common complication seen was overgranulation at the entry point of the wire (5.4%). In two cases, wires had migrated below the skin surface, requiring local anaesthetic infiltration to enable retrieval. Using a visual analogue pain score, the mean pain score immediately after wire removal was 2.8 out of a maximum of 10, reducing to 0.9 after one minute. It is concluded that K-wires can be removed safely without anaesthetic in the outpatient clinic and that this is tolerated well by children.
authors.affiliation: Children's Orthopaedic Services, The Royal London Hospital, Whitechapel, London E1 1BB, UK. sbv_symons@doctors.org.uk
authors.forename: Sean
authors.initials: S
authors.lastname: Symons
authors.forename: Ram
authors.initials: R
authors.lastname: Persad
authors.forename: Mark
authors.initials: M
authors.lastname: Paterson
mesh_terms: D000293:Adolescent; D000772:Anesthesia, Local; D001864:Bone Wires / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D020878:Device Removal / Q000379:methods*; D005260:Female; D005549:Foreign-Body Reaction / Q000209:etiology*; D005592:Fracture Fixation / Q000295:instrumentation* / Q000379:methods*; D005596:Fractures, Closed / Q000601:surgery*; D006099:Granuloma / Q000209:etiology*; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D016896:Treatment Outcome; D006113:United Kingdom