Management and Outcome of Kirschner Wire-related Osteomyelitis in Pediatric Patients After Treatment of Closed Fracture

BACKGROUND: Kirschner wires are commonly used for percutaneous fixation of closed fractures in children. This arouses the concern of pin site infection. However, only a small part of pin site infections would progress into osteomyelitis. This article specifically analyzes the clinical manifestations, imaging, surgery, and complications of osteomyelitis associated with Kirschner wire fixation for closed fractures in children. METHODS: A retrospective study was conducted on children with acute or chronic osteomyelitis who were admitted to our institution between 2012 and 2024. Their initial treatment, onset and progression of osteomyelitis, imaging, surgical and non-surgical treatment, and the final outcome of the last follow-up were documented and analyzed. RESULTS: A total of 16 patients (male:female, 11:5) with an average age of 7.4 years were included: 15 patients received surgical treatment for osteomyelitis and 1 patient was treated non-surgically. All the patients healed after the final treatment without recurrence. Despite the high incidence of septic arthritis (11/15, 73.3%), necrosis of the secondary ossification center (6/10, 60%) and partial or total premature closure of the growth plates (9/15, 60%), all the patients had good joint function and normal daily life within an average of 2.1-year follow-up. CONCLUSION: For cases with Kirschner wire fixation, bone infection mainly occurs along the path of one of the pins. It may involve the joint and the growth plate that the pin goes across. Early and thorough debridement along the path, combined with antibiotic-impregnated artificial bone grafts, can achieve good results. LEVEL OF EVIDENCE: Level IV.