Buried or Exposed Kirschner Wire for the Management of Hand and Forearm Fractures: A Systematic Review, Meta-Analysis, and Meta-Regression

Background The recommendation on whether to bury or expose the Kirschner wire (K-wire) for the management of fractures has still been controversial with inconsistent results in the published studies. This study aims to summarize the comparison between buried and exposed K-wire for the management of hand and forearm fractures. Methods We conducted relevant literature searches on Europe PMC, Medline, Scopus, and Cochrane Library databases using specific keywords. The results of continuous variables were pooled into the standardized mean difference (SMD), while dichotomous variables were pooled into odds ratio (OR) along with 95% confidence intervals (95% CI) using random-effect models. Results A total of 11 studies were included. Our pooled analysis revealed that buried K-wire was associated with a lower risk of pin site infection [RR 0.49 (95% CI 0.36 – 0.67), p < 0.00001, I 2 = 0%] and longer duration until pin removal [MD 33.85 days (95% CI 18.68 – 49.02), p < 0.0001, I 2 = 99%] when compared with exposed K-wire. However, the duration of surgery was significantly longer in the buried K-wire [MD 6.98 minutes (95% CI 2.19 – 11.76), p = 0.004, I 2 = 42%] with no significant difference in the early pin removal rate [RR 0.73 (95% CI 0.36 – 1.45), p = 0.37, I 2 = 0%]. Further regression analysis revealed that sample size, age, sex, and duration of follow-up did not affect those relationships. Conclusion Buried K-wire may offer benefits in reducing the infection rate with a longer duration until pin removal. However, further RCTs with larger sample sizes are still needed to confirm the results of our study.