Surgeons routinely choose whether to bury the end of a K-wire beneath the skin or leave it poking out after fixing a broken hand or wrist, but no one knows for certain which option causes fewer infections. This matters because hand and wrist fractures are common, and K-wires are the most frequent method of surgical fixation. Existing low-quality data suggests exposed wires carry a substantially higher risk of surgical site infection, yet burying them may cost the NHS more. Without a robust randomised comparison, surgeons lack clear evidence to guide their choice. The trial will recruit 470 patients across plastic surgery, hand surgery and orthopaedic departments. It will measure infection rates at 90 days using both clinician reports and patient-reported outcomes, alongside hand function, quality of life and resource use at 90 days and six months. If the results show one technique is clearly safer or more cost-effective, they will directly inform NICE guidelines and national specialty guidelines for managing hand and wrist fractures in the NHS. This could change routine surgical practice, reducing infection rates and improving patient outcomes without requiring new technology or training.
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Research question Is there a difference in risk of surgical site infection between exposed and buried K-wires following fixation of hand or wrist fractures? Background Hand and wrist fractures are common injuries that need acute care within the NHS. If surgery is needed to stabilise the fracture, then fixation with K-wires is the most common procedure. There is a risk of superficial and deep surgical site infection (SSI) when K-wires are placed. Once a K-wire has been inserted, the end can be buried beneath the skin or left exposed. Existing, low quality data suggests a substantially higher risk of SSI when wires are left exposed. Burying the wires may reduce the SSI risk but is probably more expensive for the health service. A robust randomised comparison has yet to be conducted. In this study, the two techniques will be compared in terms of SSI risk and cost-effectiveness within a pragmatic randomised controlled trial of patients with hand and wrist fractures. Objectives To compare the risk of SSI between exposed and bured K-wires in patients treated for hand and wrist fractures Methods A multi-centre, parallel group, superiority, pragmatic, randomised controlled trial of 470 participants with fractures of the hand or wrist that require fixation with K-wires. This will be based in secondary care plastic surgery, hand surgery and orthopaedic departments that manage hand and wrist fractures. The primary outcome of SSI will be measured at 90 days post-randomisation via both site-reported and patient-reported outcome measures, in accordance with the Centre for Disease Control definitions of SSI. Secondary outcomes include hand function (PROMIS UE), health-related quality of life (EQ-5D-5L) and resource use at 90 days and 6 months. Dissemination Results will be presented through patient-facing infographics and at national scientific meetings, published in a peer-reviewed high-impact journal and disseminated via the clinical research and trainee research networks for plastic, hand and orthopaedic trauma surgery. Impact The results will inform both NICE guidelines and national specialty guidelines for the management of hand and wrist fractures in the NHS.
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