Sussex SURGERY

Hand K Wire Fixation of

Surgery Hand Fractures

SURGERY

K Wire Fixation of
Hand Fractures
What does this involve? When is surgery needed? Which operation is the • External fixation. This involves
right one for me? pins into the bones connected
This involves holding broken bone Most hand fractures heal up well together outside the finger. The
fragments together using small, by themselves given time and Other options for displaced connection pulls on the bony
sharp wires passed through the appropriate support and exercises. fractures in the hand are: fragments to keep them lined up
skin into the bones using x-ray but the pins are carefully placed
If the bones are very badly out of • ‘Manipulation under
control. The bones are first pulled to allow joint movement. This is
position after a fracture the finger anaesthesia’ (MUA) alone. This
into the right position particularly useful in fractures
may not work so well if the bones involves moving the broken
(manipulation under anaesthesia). involving the proximal
are left to heal where they are. K bones about by pulling on the
The wires are cut off outside the interphalangeal joint of the
wire fixation is one option that finger to try and realign them.
finger and bent over so they don’t fingers which get stiff very
may be considered in such The new position might be
catch too much. A padded dressing quickly after they have been
circumstances. supported with tape between
and plaster cast (or splint) is also injured.
the fingers or a splint.
needed to supplement the K wires
as they are not strong enough • Open Reduction and Internal
alone to support the broken bones Fixation (ORIF, plates and Your surgeon will discuss the
completely. screws). This involves using small options with you.
screws, and sometimes plates as
well, placed on the bone to hold
the bone fragments together. The
metalwork is buried under the
skin and is only visible on x-ray.

Xray of finger after

K wire fixation

Wires holding bones in place

Fracture line just visible

going into the joint

Type of Operation Day case

Length of Procedure Half an hour
Anaesthesia Local Anaesthetic (finger numb)
Regional Anaesthetic (whole arm
numb) or (rarely) General
Anaesthetic (asleep)
 Sussex SURGERY
Hand K Wire Fixation of
Surgery Hand Fractures

What are the main risks of this operation? Post Operative Course
Swelling, Stiffness and Scar pain Day 1-7
This can be reduced by keeping the arm elevated and moving all the free • A dressing and padded bandage with a splint or plaster cast
joints as soon as possible. In most people the general swelling reduces incorporated is applied after the operation
dramatically in the first week after the operation. • Keep the dressings clean and dry
Local swelling around the surgical site can persist for several months. Local • Keep the arm elevated in a sling or on pillows to reduce swelling
swelling can be helped by massaging the tissues around the injured part.
• Start moving any free joints immediately to prevent stiffness
The fingers are complex structures with many layers of tissue that
• Take painkillers before the anaesthetic wears off and as necessary
normally glide smoothly over each other during motion. These smooth
thereafter
gliding layers can become stuck down after an injury and an operation.
This will make the finger stiff and poorly mobile. Early exercises to regain
Day 5 - 7
normal gliding between the tissue layers is important but cannot start
with K wire fixation until the wires are removed, usually 4 weeks after the • An appointment will be made for a K wire check, dressing change and
surgery. a new splint or plaster to be made.
Occasionally patients are troubled by more swelling and stiffness than • Exercises should continue on the joints left free.
average. In this case complex regional pain syndrome (CRPS) is sometimes • Do not load or move the joint or bones with the wires in place.
the cause (see relevant information sheet in ‘Conditions we Treat’). Severe
CRPS occurs in less than 1% of cases. Four Weeks
• A clinic appointment will be made for you to have your wire(s)
Infection removed. This is done with pliers but only takes a fraction of a second
and is usually only transiently uncomfortable.
Minor infections around K wires as they exit the skin are fairly
common, occurring in up to 10% of patients. They can be minimised by • A check x-ray will usually be taken after the wires have been removed
keeping the pins dry and clean. Superficial infections can often be to look at the position of the bony fragments.
treated with oral antibiotics. Occasionally a significant infection around • Further rehabilitation will depend on your particular fracture. Your
a K wire will mean that it has to be removed early. Very rarely a deep surgeon will advise you on your individual requirement.
infection along the course of a pin will require more aggressive surgery.
Plaster Cast Information
Contact your surgical centre if:
Nerve Damage
• Your fingers become blue, swollen or numb and tingling with a plaster
The nerves most at risk with these operations are the small skin
cast in place
branches supplying sensation around the k wire. If fixation has been very
difficult the nerves supplying the tip of the finger can be damaged. • You see any discharge, wetness or detect any unpleasant smells from
Often this is just bruising around the nerve which will recover, but rarely around your cast
numbness in the finger tip will persist after this sort of injury. • The cast becomes cracked, soft, loose or uncomfortable.
Outside normal working hours you may need to attend your local
Metalwork problems Accident and Emergency Department for help with these issues.
The K wires used in hand fracture fixation are strong enough to support
fracture fragments but not to resist bending and straightening of the Driving
finger. Sudden extra loads on the finger, particularly if the splint has You may drive when you feel confident to control the car, even in an
been removed for some reason, can result in the wires breaking inside emergency.
the finger or falling out. This can mean that more surgery is required. It might be six weeks before you feel able to consider driving again but
some patients and fracture types will recover more quickly than this.
Loss of bony position Your surgeon can advise you on your individual case.
The K wires used in hand fracture fixation are supporting the bony You should discuss it with your insurer if you are considering driving
fragments, not rigidly fixing them. Sudden extra loads on the finger, with a splint in place.
particularly if the splint has been removed for some reason, can result in
the bone fragments moving out of position. This can mean that more Time off Work
surgery is required. This will vary depending on the nature of your job and the exact nature
of your surgery.
Failure of Bone Healing Sick notes can be provided on the day of your operation, at your clinic
This is a rare complication for most hand fractures but does occasionally visits and by your own GP.
occur. If the bones do not heal up securely further surgery may be
required.

www.sussexhandsurgery.co.uk These notes are intended as a guide and some of the © Sussex Hand Surgery
details may vary depending on your individual January 2018
circumstance and at the discretion of your surgeon.