KIRSCHNER WIRE PLACEMENT IN THE EMERGENCY ROOM - IS THERE A RISK

To evaluate the safety of inserting Kirschner wires into bones or acro ss joints in a setting other than a completely sterile operating theat re, a prospective study of all hand fractures treated by closed reduct ion and internal fixation was conducted in a mid-city Emergency Depart ment. Indications for percutaneous fixation were displaced, unstable l ong bone fractures of the hand. 71 fractures in 68 patients were treat ed, and in 91% the fixation crossed a joint. No patient developed oste omyelitis or pyarthrosis, and there was no deep pin track sepsis. Seve n patients with open fractures healed without infection or delayed uni on. Patients in whom data were available obtained 90% to 95% of the mo tion of the contralateral digit. The taboo against percutaneous fixati on of fractures in a non-operating theatre setting is not warranted. T he procedure can be performed with minimal complications in an out-pat ient setting.