BURIED VERSUS UNBURIED K-WIRE FIXATION: A COMPARATIVE STUDY OF PIN TRACT INFECTIONS IN PEDIATRIC GARTLAND TYPE III SUPRACONDYLAR HUMERUS FRACTURES
Main Article Content
Keywords
Supracondylar humerus fracture, K-wire fixation, Gartland type III, pin tract infection, buried wires.
Abstract
Objective: To assess the prevalence of pin tract infection in children with Gartland type III supracondylar humerus fractures who had buried or unburied Kirschner wire (K-wire) fixation.
Study design: A Randomized controlled study.
Place and Duration: This study was done at, Liaquat Institute of Medical and Health Science Thatta Hospital for period of 2 years from Fabruary 2023 date to Fabruary 2025.
Methods: In a tertiary care facility, this trial was carried out. Group A (buried K-wires) and Group B (unburied K-wires) were allocated to two equal groups of 80 pediatric patients with closed, radiologically confirmed Gartland type III fractures. All underwent lateral-entry K-wire fixation and were followed for 4 weeks postoperatively for assessment of PTI using the Modified Oppenheim Classification. Statistical analysis was conducted using the Chi-square test, with a significance level of p < 0.05 maintained.
Results: Out of 80 patients, 16 (20%) developed pin tract infections. Group A (buried wires) showed a significantly lower PTI rate (12.5%, n=5) compared to Group B (27.5%, n=11). Most infections (68.7%) occurred in the unburied group. Infection was more prevalent in patients with delayed intervention beyond two weeks (38.9%) versus those treated within 1–2 weeks (17.7%). Underweight children predominantly received buried wires (93.3%), while overweight/obese children were more often treated with unburied wires. Gender differences were also noted; males were more likely to receive unburied K-wires (67.5%).
Conclusion: Buried K-wire fixation significantly reduces the incidence of pin tract infections. Timely surgical intervention and BMI considerations also play a role in infection outcomes.
Study design: A Randomized controlled study.
Place and Duration: This study was done at, Liaquat Institute of Medical and Health Science Thatta Hospital for period of 2 years from Fabruary 2023 date to Fabruary 2025.
Methods: In a tertiary care facility, this trial was carried out. Group A (buried K-wires) and Group B (unburied K-wires) were allocated to two equal groups of 80 pediatric patients with closed, radiologically confirmed Gartland type III fractures. All underwent lateral-entry K-wire fixation and were followed for 4 weeks postoperatively for assessment of PTI using the Modified Oppenheim Classification. Statistical analysis was conducted using the Chi-square test, with a significance level of p < 0.05 maintained.
Results: Out of 80 patients, 16 (20%) developed pin tract infections. Group A (buried wires) showed a significantly lower PTI rate (12.5%, n=5) compared to Group B (27.5%, n=11). Most infections (68.7%) occurred in the unburied group. Infection was more prevalent in patients with delayed intervention beyond two weeks (38.9%) versus those treated within 1–2 weeks (17.7%). Underweight children predominantly received buried wires (93.3%), while overweight/obese children were more often treated with unburied wires. Gender differences were also noted; males were more likely to receive unburied K-wires (67.5%).
Conclusion: Buried K-wire fixation significantly reduces the incidence of pin tract infections. Timely surgical intervention and BMI considerations also play a role in infection outcomes.
References
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2. Baidoo PK, Kumah-Ametepey R, Segbefia M, Buunaaim ADB-i. Treatment and outcomes of pediatric supracondylar humeral fractures in Korle Bu Teaching Hospital. OTA International. 2021;4(2)
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5. Micheloni GM, Novi M, Leigheb M, Giorgini A, Porcellini G, Tarallo L. Supracondylar fractures in children: management and treatment. Acta Bio Medica: Atenei Parmensis. 2021;92(Suppl 3):e2021015
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8. Parikh SN, Lykissas MG, Roshdy M, Mineo RC, Wall EJ. Pin tract infection of operatively treated supracondylar fractures in children: long-term functional outcomes and anatomical study. Journal of children's orthopaedics. 2015;9(4):295-302
9. Qin Y-F, Li Z-J, Li C-K, Bai S-C, Li H. Unburied versus buried wires for fixation of pediatric lateral condyle distal humeral fractures: A meta-analysis. Medicine. 2017;96(34)
10. McGonagle L, Elamin S, Wright DM. Buried or unburied K-wires for lateral condyle elbow fractures. The Annals of The Royal College of Surgeons of England. 2012;94(7):513-6.doi:10.1308/003588412X13171221592375
11. Bhatti SH, Abbasi MK, Naqvi ASAH, Shahzad A, Haider SB. Percutaneous pinning vs open reduction K wire fixation in Gartland Type III supracondylar humerus fracture in children at Gambat Hospital, Sindh, Pakistan. Rawal Medical Journal. 2022;47(3):640-
12. Pescatori E, Memeo A, Brivio A, Trapletti A, Camurri S, Pedretti L, et al. Supracondylar humerus fractures in children: a comparison of experiences. Journal of Pediatric Orthopaedics B. 2012;21(6)
13. Pullan J, Ayeko O, Metcalfe J. Buried or exposed kirschner wires in paediatric upper extremity fracture fixation: A systematic review and meta-analysis of infection rates and complications. Injury. 2025:112155
14. Kafle G, Pokhrel A, Gupta MK, Panthee R, Nepal S, Sah RK, et al. Comparison of outcomes in buried versus exposed Kirschner wire for treatment of paediatric supracondylar humerus fracture. Birat Journal of Health Sciences. 2023;8(3):2126-32
15. Abdullah S, Soh E, Ngiam C, Sapuan J. A Prospective Study Comparing the Infection Rate Between Buried vs Exposed Kirschner Wires in Hand and Wrist Fixations. Cureus. 2023;15.doi:10.7759/cureus.36558
16. Hanim A, Wafiuddin M, Azfar MA, Awang MS, Adel NANA, Razak AHA. Biomechanical Analysis of Crossed Pinning Construct in Supracondylar Fracture of Humerus: Does the Point of Crossing Matter? Cureus. 2021;13(3)
17. Yawar B, Khan MN, Asim A, Qureshi A, Yawar A, Faraz A, et al. Comparison of lateral and crossed k-wires for paediatric supracondylar fractures: a retrospective cohort study. Cureus. 2022;14(7)
18. Zhao H, Xu S, Liu G, Zhao J, Wu S, Peng L. Comparison of lateral entry and crossed entry pinning for pediatric supracondylar humeral fractures: a meta-analysis of randomized controlled trials. Journal of Orthopaedic Surgery and Research. 2021;16(1):366.doi:10.1186/s13018-021-02505-3
19. Rees AB, Schultz JD, Wollenman LC, Moore-Lotridge SN, Martus JE, Schoenecker JG, et al. A Mini-Open Approach to Medial Pinning in Pediatric Supracondylar Humeral Fractures May Be Safer Than Previously Thought. JBJS. 2022;104(1)
20. Seeley MA, Gagnier JJ, Srinivasan RC, Hensinger RN, VanderHave KL, Farley FA, et al. Obesity and its effects on pediatric supracondylar humeral fractures. JBJS. 2014;96(3):e18
21. Sangkomkamhang T, Singjam U, Leeprakobboon D. Risk factors for loss of fixation in pediatric supracondylar humeral fractures. J Med Assoc Thai. 2014;97(Suppl 9):S23-8
22. Sharma H, Taylor G, Clarke N. A review of K-wire related complications in the emergency management of paediatric upper extremity trauma. The Annals of The Royal College of Surgeons of England. 2007;89(3):252-8
23. Iobst CA, Liu RW. A systematic review of incidence of pin track infections associated with external fixation. Journal of Limb Lengthening & Reconstruction. 2016;2(1)
2. Baidoo PK, Kumah-Ametepey R, Segbefia M, Buunaaim ADB-i. Treatment and outcomes of pediatric supracondylar humeral fractures in Korle Bu Teaching Hospital. OTA International. 2021;4(2)
3. Pilla NI, Rinaldi JM, Hatch MD, Hennrikus WL. Epidemiology of displaced supracondylar fractures. Archives of Orthopaedics. 2020;1(3):68-73
4. Tomaszewski R, Wozowicz A, Wysocka-Wojakiewicz P. Analysis of Early Neurovascular Complications of Pediatric Supracondylar Humerus Fractures: A Long-Term Observation. BioMed Research International. 2017;2017(1):2803790.doi:https://doi.org/10.1155/2017/2803790
5. Micheloni GM, Novi M, Leigheb M, Giorgini A, Porcellini G, Tarallo L. Supracondylar fractures in children: management and treatment. Acta Bio Medica: Atenei Parmensis. 2021;92(Suppl 3):e2021015
6. H. R G, Mahendranath, Malik D, N GP. Supracondylar humerus fracture in children: K wire pinning with minimal sterile technique. International Journal of Research in Orthopaedics. 2021;7(4):840-2.doi:10.18203/issn.2455-4510.IntJResOrthop20212433
7. Inam M, Ullaha T, Rahman W. Comparison of Pin Tract Infection Rate in Buried Versus Unburid Krischner Wires Fixation in the Management of Gartland Type III Supracondylar Fracture of Humerus in Children. Journal of Pakistan Orthopaedic Association. 2024;36(01):41-7
8. Parikh SN, Lykissas MG, Roshdy M, Mineo RC, Wall EJ. Pin tract infection of operatively treated supracondylar fractures in children: long-term functional outcomes and anatomical study. Journal of children's orthopaedics. 2015;9(4):295-302
9. Qin Y-F, Li Z-J, Li C-K, Bai S-C, Li H. Unburied versus buried wires for fixation of pediatric lateral condyle distal humeral fractures: A meta-analysis. Medicine. 2017;96(34)
10. McGonagle L, Elamin S, Wright DM. Buried or unburied K-wires for lateral condyle elbow fractures. The Annals of The Royal College of Surgeons of England. 2012;94(7):513-6.doi:10.1308/003588412X13171221592375
11. Bhatti SH, Abbasi MK, Naqvi ASAH, Shahzad A, Haider SB. Percutaneous pinning vs open reduction K wire fixation in Gartland Type III supracondylar humerus fracture in children at Gambat Hospital, Sindh, Pakistan. Rawal Medical Journal. 2022;47(3):640-
12. Pescatori E, Memeo A, Brivio A, Trapletti A, Camurri S, Pedretti L, et al. Supracondylar humerus fractures in children: a comparison of experiences. Journal of Pediatric Orthopaedics B. 2012;21(6)
13. Pullan J, Ayeko O, Metcalfe J. Buried or exposed kirschner wires in paediatric upper extremity fracture fixation: A systematic review and meta-analysis of infection rates and complications. Injury. 2025:112155
14. Kafle G, Pokhrel A, Gupta MK, Panthee R, Nepal S, Sah RK, et al. Comparison of outcomes in buried versus exposed Kirschner wire for treatment of paediatric supracondylar humerus fracture. Birat Journal of Health Sciences. 2023;8(3):2126-32
15. Abdullah S, Soh E, Ngiam C, Sapuan J. A Prospective Study Comparing the Infection Rate Between Buried vs Exposed Kirschner Wires in Hand and Wrist Fixations. Cureus. 2023;15.doi:10.7759/cureus.36558
16. Hanim A, Wafiuddin M, Azfar MA, Awang MS, Adel NANA, Razak AHA. Biomechanical Analysis of Crossed Pinning Construct in Supracondylar Fracture of Humerus: Does the Point of Crossing Matter? Cureus. 2021;13(3)
17. Yawar B, Khan MN, Asim A, Qureshi A, Yawar A, Faraz A, et al. Comparison of lateral and crossed k-wires for paediatric supracondylar fractures: a retrospective cohort study. Cureus. 2022;14(7)
18. Zhao H, Xu S, Liu G, Zhao J, Wu S, Peng L. Comparison of lateral entry and crossed entry pinning for pediatric supracondylar humeral fractures: a meta-analysis of randomized controlled trials. Journal of Orthopaedic Surgery and Research. 2021;16(1):366.doi:10.1186/s13018-021-02505-3
19. Rees AB, Schultz JD, Wollenman LC, Moore-Lotridge SN, Martus JE, Schoenecker JG, et al. A Mini-Open Approach to Medial Pinning in Pediatric Supracondylar Humeral Fractures May Be Safer Than Previously Thought. JBJS. 2022;104(1)
20. Seeley MA, Gagnier JJ, Srinivasan RC, Hensinger RN, VanderHave KL, Farley FA, et al. Obesity and its effects on pediatric supracondylar humeral fractures. JBJS. 2014;96(3):e18
21. Sangkomkamhang T, Singjam U, Leeprakobboon D. Risk factors for loss of fixation in pediatric supracondylar humeral fractures. J Med Assoc Thai. 2014;97(Suppl 9):S23-8
22. Sharma H, Taylor G, Clarke N. A review of K-wire related complications in the emergency management of paediatric upper extremity trauma. The Annals of The Royal College of Surgeons of England. 2007;89(3):252-8
23. Iobst CA, Liu RW. A systematic review of incidence of pin track infections associated with external fixation. Journal of Limb Lengthening & Reconstruction. 2016;2(1)
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Published
Apr 21, 2025
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How to Cite
Tahir Ahmed, Azizullah Bhayo, Syed Muhammad Azfar, Salman Adil, Mushtaque Ahmed Shaikh, & Waseem Ahmed. (2025). BURIED VERSUS UNBURIED K-WIRE FIXATION: A COMPARATIVE STUDY OF PIN TRACT INFECTIONS IN PEDIATRIC GARTLAND TYPE III SUPRACONDYLAR HUMERUS FRACTURES. Journal of Population Therapeutics and Clinical Pharmacology, 32(3), 598-605. https://doi.org/10.53555/40b88s32
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Author Biographies
Tahir Ahmed
Senior Registrar Orthopaedics, Liaquat Institute of Medical and Health Science Thatta Pakistan.
Azizullah Bhayo
Associate Professor Orthopaedics, Ghulam Muhammad Mahar Medical College Sukkur Pakistan.
Syed Muhammad Azfar
Associate Professor Orthopaedics, Liaquat College of Medicine and Dentistry Karachi Pakistan.
Salman Adil
Senior Professor Orthopaedics, Bahria University of Health Sciences Karachi Pakistan.
Mushtaque Ahmed Shaikh
Professor Orthopaedics, SMBBMU @ CMC Larkana Pakistan.
Waseem Ahmed
Associate Professor Orthopaedics, Muhammad Medical College, Ibn-e-Sina University Hospital Mirpurkhas Pakistan.
How to Cite
Tahir Ahmed, Azizullah Bhayo, Syed Muhammad Azfar, Salman Adil, Mushtaque Ahmed Shaikh, & Waseem Ahmed. (2025). BURIED VERSUS UNBURIED K-WIRE FIXATION: A COMPARATIVE STUDY OF PIN TRACT INFECTIONS IN PEDIATRIC GARTLAND TYPE III SUPRACONDYLAR HUMERUS FRACTURES. Journal of Population Therapeutics and Clinical Pharmacology, 32(3), 598-605. https://doi.org/10.53555/40b88s32