K-Wire Removal Procedure
K-wires should be removed in the outpatient clinic without anesthesia when left protruding through the skin, typically at 2-4 weeks for finger fractures or 4-5 weeks for other locations once radiographic union is confirmed. 1, 2
Pre-Removal Assessment
- Verify adequate fracture healing with serial radiographs showing satisfactory union before proceeding with removal 3
- Assess pin site condition: Discharging pin sites (present in 28% of cases) do NOT warrant early wire removal unless there are signs of deep infection, osteomyelitis, or pyoarthrosis 3
- Document wire configuration: Exposed wires can be removed in clinic; buried wires require operating room removal in 17.2% of cases 4
Removal Technique for Exposed K-Wires
No anesthesia is required for exposed K-wire removal in the outpatient setting. 2 This is a key advantage of leaving wires protruding through the skin rather than burying them.
- Prepare the site with standard antiseptic technique 1
- Grasp the bent end of the protruding wire with appropriate instruments (needle holder or wire cutters) 5
- Apply steady traction to withdraw the wire along its insertion path 2
- Avoid excessive force or rotation that could cause wire breakage 6
- Confirm complete removal by verifying the entire wire length is present 5
Management of Buried K-Wires
Buried K-wires require readmission to the operating room for removal in 17.2% of patients, which represents a significant disadvantage of this technique. 4
- Removal under local or general anesthesia is necessary when wires are buried beneath the skin 4
- Small incision over the wire tip location is required for access 4
- This approach should prompt reconsideration of burying wires given the high reoperation rate 4
Timing of Removal
Remove K-wires at 2-4 weeks for finger fractures to minimize stiffness, as early protected movement combined with early removal contributes to better functional outcomes. 1
For other locations, remove at 4-5 weeks depending on patient age and radiographic evidence of healing. 2
- Earlier removal (3-5 days) with pain-guided protected movement is safe for finger fractures if patients avoid movements that cause pain 1
- Longer duration of wire retention increases complication rates including loosening and pin tract infection 6
Management of Complications During Removal
Wire loosening at removal (occurs in 14 cases per study) requires careful extraction to avoid wire breakage. 6
- If wire breaks during removal, the retained fragment may require surgical extraction 6
- Retrograde wire migration (4% incidence) necessitates fluoroscopic guidance to locate and remove the wire 6
Pin tract infection (6% incidence) does not require early removal unless deep infection develops. 3, 6
- Superficial infections can be managed with systemic antibiotics while leaving wires in situ until union is achieved 3
- Only 2 of 14 patients with discharging sites had positive cultures requiring antibiotics 3
Post-Removal Care
- Apply sterile dressing to pin sites after removal 1
- Monitor for delayed complications including hypersensitive scarring (1% incidence) 6
- Assess nerve function as neurapraxia occurs in 3% of cases, though most resolve after wire removal 6
Common Pitfalls to Avoid
Do not remove wires prematurely based solely on pin site discharge, as 28% of patients develop discharge that is often sterile and does not indicate deep infection. 3
Do not bury K-wires routinely, as this provides no reduction in infection rates (4.1% buried vs 6.5% exposed, p=0.311) but significantly increases reoperation requirements. 4
Do not use excessive force during removal, as wire breakage necessitates surgical retrieval of retained fragments. 6
Ensure wires traverse both cortices during initial insertion, as single-cortex fixation increases loosening and infection rates at the time of removal. 6