Kirschner wire infections in pediatric orthopaedic surgery.
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.


METHODS
Prognostic level IV.
*Department of Orthopaedic Surgery and Sports Medicine, Temple University School of Medicine ‡St Christopher's Hospital for Children, Orthopaedic Center for Children, Philadelphia, PA †Department of Orthopaedic Surgery, South Bay Medical Center-Kaiser Permanente, Harbor City, CA.
Rick
R
Tosti
Abtin
A
Foroohar
Peter D
PD
Pizzutillo
Martin J
MJ
Herman
D000293:Adolescent; D001170:Arthritis, Infectious / Q000209:etiology / Q000601:surgery; D001864:Bone Wires / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005592:Fracture Fixation / Q000295:instrumentation* / Q000379:methods; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D008297:Male; D010019:Osteomyelitis / Q000209:etiology / Q000601:surgery; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D016059:Range of Motion, Articular; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000209:etiology / Q000601:surgery; D013211:Staphylococcus aureus / Q000302:isolation & purification