Chen Andrew T, Wang Carolyn, Ripan Victor, Huang Elena, O'Connor Avalon, Kim Patrick J, Dunn Emily, Thoma Achilleas, Retrouvey Helene
Department of Surgery, Division of Plastic Surgery, McMaster University, Hamilton, ON, Canada.
Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
Plast Surg (Oakv). 2025 Aug 8:22925503251363056. doi: 10.1177/22925503251363056.
Kirschner-wire (K-wire) fixation (KF) is the most common operative technique for hand fractures among Canadian plastic surgeons. However, postoperative rehabilitation varies widely and rely on low-quality studies and expert opinion. The study reviewed KFs of phalangeal and metacarpal fractures at a single academic center to quantify practice variation and patient outcomes. This retrospective chart review analyzed all cases of KF of isolated phalangeal and metacarpal fractures performed by all plastic surgeons at a single tertiary care center in the last 7 years. The primary outcome was the duration from operation to K-wire removal. Secondary outcomes included the time from KF to range of motion (ROM) initiation, the interval between K-wire removal and ROM initiation, postoperative complications, and functional outcomes. Among 289 patients, mean time from KF to K-wire removal was 28.6 days (SD 8.2). There was a high variability among the surgeons, with the shortest duration averaging 26 ± 6 days and the longest averaging 33.7 ± 8.6 days ( < .001). Mean time to initiation of ROM was similar across surgeons (mean 25.2 ± 11.4 days). Postoperative complications occurred in 26 patients (10.9%), primarily pin site infections (6.7%). Early versus late K-wire removal did not affect complication rates. There were no differences in functional outcomes between surgeons. There is considerable variability in postoperative rehabilitation following KF of hand fractures among surgeons at a single academic center. Our study suggests that supervised ROM can be initiated safely as early as 3 weeks postoperatively, regardless of whether K-wires remain in situ.
克氏针固定术（KF）是加拿大整形外科医生治疗手部骨折最常用的手术技术。然而，术后康复差异很大，且基于质量不高的研究和专家意见。本研究回顾了单一学术中心指骨和掌骨骨折的克氏针固定术，以量化实际操作差异和患者预后。这项回顾性图表研究分析了过去7年中单一三级护理中心所有整形外科医生对孤立指骨和掌骨骨折进行克氏针固定术的所有病例。主要结局指标是手术至克氏针取出的持续时间。次要结局指标包括从克氏针固定到开始活动度（ROM）训练的时间、克氏针取出与开始ROM训练之间的间隔、术后并发症及功能结局。在289例患者中，从克氏针固定到克氏针取出的平均时间为28.6天（标准差8.2）。外科医生之间存在很大差异，最短平均持续时间为26±6天，最长平均持续时间为33.7±8.6天（P＜0.001）。不同外科医生开始ROM训练的平均时间相似（平均25.2±11.4天）。26例患者（10.9%）发生术后并发症，主要是针道感染（6.7%）。早期与晚期取出克氏针对并发症发生率无影响。不同外科医生的功能结局无差异。单一学术中心的外科医生在手部骨折克氏针固定术后的康复方面存在很大差异。我们的研究表明，无论克氏针是否仍在位，术后3周即可安全地开始在监督下进行ROM训练。
