Kirschner wire placement in the emergency room. Is there a risk?

To evaluate the safety of inserting Kirschner wires into bones or across joints in a setting other than a completely sterile operating theatre, a prospective study of all hand fractures treated by closed reduction and internal fixation was conducted in a mid-city Emergency Department. Indications for percutaneous fixation were displaced, unstable long bone fractures of the hand. 71 fractures in 68 patients were treated, and in 91% the fixation crossed a joint. No patient developed osteomyelitis or pyarthrosis, and there was no deep pin track sepsis. Seven patients with open fractures healed without infection or delayed union. Patients in whom data were available obtained 90% to 95% of the motion of the contralateral digit. The taboo against percutaneous fixation of fractures in a non-operating theatre setting is not warranted. The procedure can be performed with minimal complications in an out-patient setting.