Buried K-wires significantly reduce overall infection rates in pediatric upper extremity fractures compared to exposed wiresBuried wires show lower infection rates in children with fractures

European journal of trauma and emergency surgery : official publication of the European Trauma Society Published September 30, 2026 Study authors: Frodl Andreas, Borbely Marietta, Karvouniaris Nikos, Mühlenfeld Nils, Siegel Markus, Kuminack Kersti… PubMed ↗ DOI ↗ Editorial oversight: Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

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Key Takeaway

Note that buried K-wires reduce overall infection rates, but do not significantly impact deep surgical site infections.

This meta-analysis of 12 studies evaluated the outcomes of buried versus exposed K-wire fixation in 1977 pediatric patients with upper extremity fractures. The analysis focused on complications including infection, refracture, skin erosion, and secondary implant displacement.

Findings indicate that buried K-wires are associated with significantly lower overall infection rates (OR 1.74, 95% CI: 1.19-2.56, p = 0.004) compared to exposed wires. Conversely, exposed wires showed significantly lower rates of skin irritation (OR 0.09, 95% CI: 0.04-0.21, p < 0.00001). No significant differences were observed for deep surgical site infections (p = 0.36), secondary implant displacement (p = 0.86), or refracture rates (p = 0.09).

A notable regional difference was observed in infection rates for patients in Asia and Africa (OR 2.90, 95% CI: 1.61-5.22, p = 0.0004), whereas no significant regional difference was found for patients in Europe and the USA (p = 0.57).

Clinically, epicutaneous K-wire fixation is recommended when no patient-specific contraindications exist, particularly in temperate climates, due to its cost-benefit profile and the lack of increased deep surgical site infections. The evidence level is categorized as Level III.

When a child breaks a bone in their arm or hand, doctors often use K-wires to hold the bone in place. These wires can either be buried under the skin or left sticking out, known as exposed wires. Choosing the right method is vital for the child's comfort and safety during the healing process.

A large review of 1,977 pediatric patients found that buried wires led to significantly lower overall infection rates than exposed wires. However, the study found no difference in deep surgical site infections or the risk of the bone breaking again. Interestingly, while buried wires were safer from infection, exposed wires were actually linked to much lower rates of skin irritation.

Doctors suggest that keeping wires exposed is still a good option in many cases, especially in milder climates. Because there was no increase in deep infections for exposed wires, the choice often comes down to the specific needs of the child and the local environment. Talk to a specialist to decide which method is best for a specific injury.

What this means for you:

Buried K-wires lower overall infection rates in children, but exposed wires result in less skin irritation.

Common questions

Are buried wires safer for children with arm fractures?

Buried K-wires showed significantly lower overall infection rates compared to exposed wires. However, the study did not find a significant difference in deep surgical site infections or the rate of fractures occurring again. Because both methods have different benefits, your doctor can help choose the best option based on the specific injury.

What are the risks of keeping wires outside the skin?

Wires left outside the skin, known as exposed wires, were linked to significantly higher rates of skin irritation. On the other hand, they did not show a significant increase in deep surgical site infections or secondary implant displacement. This makes them a viable option in many cases, especially in temperate climates.

How do infection rates differ by region?

The study found a significant regional difference in infection rates for patients in Asia and Africa. In contrast, no significant regional difference in infection rates was found for patients in Europe and the USA. These variations may depend on local conditions and environment.

Study Details

Study typeMeta analysis

Sample sizen = 1,977

EvidenceLevel 1

PublishedSep 2026

PMID42809107

View Original Abstract ↓

Kirschner wires (K-wires) are the standard fixation method for displaced pediatric upper extremity fractures, yet no consensus exists on whether wire ends should be buried subcutaneously or left exposed epicutaneously. While epicutaneous K-wires offer cost-effectiveness and avoid second anesthesia, concerns remain regarding infection risk and psychological distress. To systematically review and compare complication rates between buried and exposed K-wire fixation in pediatric upper extremity fractures, including infection, refracture, skin erosion, and secondary implant displacement. We conducted a systematic review following PRISMA guidelines, searching Cochrane, PubMed, EmBase, and Ovid databases. Inclusion criteria were: modified Coleman Methodology Score (mCMS) > 60, upper extremity fractures treated with K-wire fixation, and age < 16 years. Studies including adult patients and biomechanical studies were excluded. Meta-analysis compared outcomes across 12 studies encompassing 1,977 patients. Buried K-wires demonstrated significantly lower overall infection rates (OR = 1.74; 95% CI: 1.19-2.56; p = 0.004). However, no significant difference was observed in deep surgical siteinfections (OR = 1.56; 95% CI: 0.60-4.0; p = 0.36). Exposed wires showed significantly lower skin irritation rates (OR = 0.09; 95% CI: 0.04-0.21; p < 0.00001). No significant differences were found in secondary implant displacement (OR = 1.26; 95% CI: 0.10-15.75; p = 0.86) or refracture rates (OR = 1.90; 95% CI: 0.91-3.96; p = 0.09). Geographic subgroup analysis revealed significant regional differences: infection rate differences were significant in Asia/Africa (OR = 2.90; 95% CI: 1.61-5.22; p = 0.0004) but not in Europe/USA (OR = 1.16; 95% CI: 0.69-1.95; p = 0.57). Epicutaneous K-wire fixation shows higher overall infection rates than buried wires but does not increase deep surgical site infections requiring operative revision. Considering the avoidance of additional anesthesia, favorable cost-benefit profile, and geographic variation in infection risk, epicutaneous K-wires are recommended when no patient-specific contraindications exist, particularly in temperate climates. Level III (Systematic Review of Level II-III Studies).

Buried K-wires significantly reduce overall infection rates in pediatric upper extremity fractures compared to exposed wiresBuried wires show lower infection rates in children with fractures

Common questions

Study Details

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Buried K-wires significantly reduce overall infection rates in pediatric upper extremity fractures compared to exposed wiresBuried wires show lower infection rates in children with fractures

Common questions

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