Buried or exposed Kirschner wire for the management of hand and forearm fractures: A systematic review, meta-analysis, and meta-regression.

BACKGROUND: The recommendation on whether to bury or expose the Kirschner wire (K-wire) for the management of fractures has still been controversial with inconsistent results in the published studies due to the potential issue associated with exposed K-wire is the heightened risk of infection, as it comes into direct contact with the external environment and air. This study aims to summarize the specific outcomes between buried and exposed K-wire for the management of hand and forearm fractures. METHODS: We conducted relevant literature searches on Europe PMC, Medline, Scopus, and Cochrane Library databases using specific keywords. This investigation focuses on individuals of any age diagnosed with hand or forearm fractures who underwent surgery involving Kirschner wire (K-wire) fixation. It examines the comparison between buried and exposed K-wire fixation, emphasizing primary outcome pin infection, along with secondary outcomes such as early pin removal, days to pin removal, and surgical duration. The study includes observational studies (cohort/case-control) or randomized clinical trials (RCTs). The results of continuous variables were pooled into the standardized mean difference (SMD), while dichotomous variables were pooled into odds ratio (OR) along with 95% confidence intervals using random-effect models. The quality of included studies was assessed with Cochrane Collaborations, Risk of Bias version 2 (RoB v2). RESULTS: A total of 11 studies were included. Our pooled analysis revealed that buried K-wire was associated with a lower risk of pin site infection [RR 0.49 (95% CI 0.36-0.67), p < 0.00001, I2 = 0%] and 33.85 days longer duration until pin removal [MD 33.85 days (95% CI 18.68-49.02), p < 0.0001, I2 = 99%] when compared with exposed K-wire. However, the duration of surgery was 9.98 minutes significantly longer in the buried K-wire [MD 6.98 minutes (95% CI 2.19-11.76), p = 0.004, I2 = 42%] with no significant difference in the early pin removal rate [RR 0.73 (95% CI 0.36-1.45), p = 0.37, I2 = 0%]. Further regression analysis revealed that sample size, age, sex, and duration of follow-up did not affect those relationships. CONCLUSION: Buried K-wire may offer benefits in reducing the infection rate with a longer duration until pin removal. However, further RCTs with larger sample sizes are still needed to confirm the results of our study.

Replantation using groin flap in thirty-four years old male with traumatic total degloving of little finger: A case report.

INTRODUCTION AND IMPORTANCE: Degloving injuries of the hand or fingers have a devastating presentation which challenges a surgeon to conduct reconstruction in order to resurface the naked finger and recover its function. The gold standard treatment for degloving injuries is using skin grafting and flap. The pedicle of groin flap is based on superficial circumflex iliac artery. It is one of standard flaps used in reconstruction of degloving fingers. In this study, we use groin flap for reconstruction of traumatic total degloving little finger. PRESENTATION OF CASE: This is a case of 34-years old man with total degloving of his left little finger because stuck inside running cutting machine in a clothes factory. The patient was then brought to the Hasan Sadikin General Hospital. The patient underwent thorough debridement, preparation of the donor site, and groin flap. After a week, the wound was in good condition with no signs of infection. CLINICAL DISCUSSION: The groin or skin flap is pedicled and vascularized by superficial circumflex artery. It can be considered as an option for treatment of single finger degloving wound because of its compliant nature and vascularization reliability. Despite this, it often results in bulky appearance which needs to be reconstructed later. THE CONCLUSION: Groin flaps are an appropriate method in managing degloving little fingers and are still cosmetically acceptable.