To assist you in understanding some of the jargon of surgical medicine, I would like to explain the k-wire and its purpose. The full name of this smooth, stainless steel pin is a “Kirschner wire”, pronounced [KERSH – NER], after Martin Kirschner who first introduced this in 1909. This pin or wire can be sterilized for use in orthopedic surgery.
K-wires are used for “fixation” of bone fragments during the healing period. Depending on the application, there are different sizes. When a pin is placed through the skin it is call percutaneous pin fixation. Larger pins are used to provide pull or traction on the bone in order to aid in alignment of the ends of the bone.
Are K-wires outdated?
We need to dispel a rumor that k-wires are outdated and antiquated. This is simply not true, and the rumor is perpetuated by some who do not perform surgery. Neither is the k-wire an archaic, or barbaric part of surgery. It is not outdated at all.
K-wires and Hammer digit surgery
As seen in the xray above, k-wires are used most frequently in hammer digit surgery, the most common orthopedic foot procedure. Over the last 10-15 years, surgeons have attempted to find a better way to secure the bones after hammer toe surgery. For years, the standard was k-wire fixation, with this pin sticking out of the toe. Newer devices and implants are expensive and don’t always add up to an increased benefit equal to the additional cost. In fact, k-wire fixation outcomes are almost similar and is a very cost-effective method of temporary fixation. This method is coming back in vogue because of the increased cost conscious healthcare marketplace. Therefore, why spend $900 on a $45 problem? improved outcome for the patient.
Leaving it in?
It might seem weird that a piece of metal is coming out of the toes, out of the foot, or out of the hand. Yet, failure of the surgery is worse than temporary (usually 3-4 weeks) inconvenience of the k-wires. Also, the concept of “out of site, out of mind” applies. With hammer digit surgery, the pain generally goes away after about 2 weeks. Without the pain to slow you down, you may injure the surgical site prior to healing (usually 4-6 weeks). The k-wire helps remind you to be more cautious. The bone and soft tissue still needs to heal. Remember, surgeons want an excellent outcome just as much as the patient!
Will it hurt coming out of the bone?
The short answer is no, it will not hurt. The bone is able to recognize solid metal as foreign. When it does, it start a process of breaking down the bone just around the pin/k-wire. A film or glycocalyx forms around the pin and allows the pin to simply slide out at the 3-4 week mark. If you’re afraid of the pain you might experience, taking a prophylactic dose of pain medication.