Aim and objective: To elaborate the current stand on K-wire usage in orthopedic clinical practice.
Background: K-wire is a commonly used implant, and is an inevitable instrument in orthopedic practice. Even with the rampant usage of this implant for centuries, the literature stating the basic details, principles of use, current clinical indications, complications encountered and techniques to avoid the same is not many. In this review article, we have taken into consideration the essential details, techniques, various clinical scenarios and extended indications for which a K-wire can be used. We believe that this article will comprehensively enlighten all the perspectives of K-wire usage, yet unmentioned and highlighted so far in any available literature.
Review results: K-wire has been introduced into orthopedic practice more than 100 years ago. This is the oldest implant that has stood the test of time in the management of many fractures of both upper and lower limbs. The indications for which the K-wire was invented has changed completely and current indications are totally diverse. With recent developments of newer technologies to stabilize fractures or reconstructive procedures with the newer implants, K-wire still has an important role in the management of fractures. This flexible implant has an immense role in minimally invasive surgical management.
Conclusion: A gap exists in the literature on the techniques and procedures employed using K-wires, which warrants more research. This article serves to enlighten the current rationale of the use of K-wires in orthopedic practice and its future perspectives.
Clinical significance: Considering the cost of healthcare, this implant satisfies cost-effective management with good functional outcomes in fixation of a certain peripheral skeleton and pediatric fractures with the least complication rate. K-wire has many advantages like ease of application, minimally invasive, easy availability on the shelves of operating rooms, in any nook and corner of the world, and the versatility of its use in difficult scenarios.
Franssen BB, Schuurman AH, Van der Molen, et al. One century of Kirschner wires and Kirschner wire insertion techniques: a historical review. Acta Orthop Belg 2010;76(1):1–6. PMID: 20306956.
C Rex. K wiring principles and techniques. Thieme. 2014:1–11.
Rex C, Patel K, Sandeep KM. A method of treating comminuted phalangeal fractures by ligamentotaxis using a single Kirschner wire. J Hand Surg Eur Vol 42(9)2017:971-972. DOI: 10.1177/1753193417718417
Zamani AR, Oyadiji SO. Analytical modelling of Kirschner wires in Ilizarov circular external fixator as pretensioned slender beams. J R Soc Interface 2009:243–256. DOI: 10.1098/rsif.2008.0251
Magovern B, Ramsey ML, Percutaneous fixation of proximal humerus fractures. Orthop Clin N Am 2008;39:405–416. DOI: 10.1016/j.ocl.2008.05.005
Walde TA, Sauer B, Degreif J, et al. Closed reduction and percutaneus Kirschner wire fixation for the treatment of dislocated calcaneal fractures: surgical technique, complications, clinical and radiological results after 2–10 years. Arch Orthop Trauma Surg 2008;128:585–591. DOI: 10.1007/s00402–008-0590–1
R Maalla, M Youssef, G Ben Jdidia, et al. Extension-block pinning for fracture-dislocation of the proximal interphalangeal joint Orthop Traumatol Surg Res 2012;98:559–563. DOI: 10.1016/j.otsr.2012.02.009
Srikumaran U, Tan EW, Belkoff SM, et al. Enhanced biomechanical stiffness with large pins in the operative treatment of pediatric supracondylar humerus fractures. J Pediatr Orthop 2012;32(2):201–205. DOI: 10.1097/bpo.0b013e31824536c8, PMID: 22327456.
Tosti R, Foroohar A, Pizzutillo PD, et al. Kirschner wire infections in pediatric orthopaedic Surgery. Pediatr Orthop 2015;35:69–73. DOI: 10.1097/BPO.0000000000000208.
Irianto KA, Edward M, Fiandana A. K-wire migration to unexpected site. Int J Surg Open 2018; 18e21. DOI: 10.1016/j.ijso.2018.04.003
Gil D, Shuvaev S, Frank-Kamenetskii A, et al. Novel antibacterial coating on orthopedic wires to eliminate pin tract infections. Antimicrob Agents Chemother 2017;61(7):e00442-17. DOI: 10.1128/AAC.00442–17;2017.617e00442–17
Zhou L, Liu Q, Zhou Z, et al. Efficacy of tobramycin- loaded coating K-wire in an open-fracture rabbit model contaminated by Staphylococcus aureus. Int J Clin Exp Med 2017;10(4): 6004-6016.
Fabritius M, Al-Munajjed AA, Freytag C, et al. Antimicrobial silver multilayer coating for prevention of bacterial colonization of orthopedic implants. Materials 2020;13:1415. DOI: 10.3390/ma13061415
Ashbaugha AG, Jiangb X, Zhenge J, et al. Polymeric nanofiber coating with tunable combinatorial antibiotic delivery prevents biofilm-associated infection in vivo. PNAS 2016;113(45):E6919-E6928; DOI: 10.1073/pnas.1613722113
Popkov AV, Gorbach EN, Kononovich NA, et al. Bioactivity and osteointegration of hydroxyapatite-coated stainless steel and titanium wires used for intramedullary osteosynthesis. Strat Traum Limb Recon 2017;12:107–113. DOI: 10.1007/s11751–017-0282-x