Subacute Osteomyelitis on Phalangeal Bone Resulting from Multiple Kirschner Pin Fixation: Case Report.

Kim, Jae Woo; Choi, Hwan Jun; Kim, Mi Sun; Kim, Jun Hyuk

Case Report

Journal of the Korean Society of Plastic and Reconstructive Surgeons 2007;34(3):409-412.
Published online May 1, 2007.

Subacute Osteomyelitis on Phalangeal Bone Resulting from Multiple Kirschner Pin Fixation: Case Report.

Jae Woo Kim, Hwan Jun Choi, Mi Sun Kim, Jun Hyuk Kim

Department of Plastic and Reconstructive Surgery, College of Medicine, Soon Chun Hyang University, Gumi, Korea. medi619@hanmail.net

Abstract

PURPOSE
Percutaneous Kirschner wire fixation is common method for hand fracture. It is simple but has risk of ascending infection through the pin and bony injury by multiple drilling. Ascending infection through pin tract is mostly superficial and can be treated with antibiotics and aseptic dressing. This is a case review of subacute osteomyelitis on phalangeal bones after Kirschner wire fixation with literature review. METHODS: A 40-years-old man with distal phalangeal fracture on right second finger is presented. He went to a local clinic and had percutaneous Kirschner wire fixation under local anesthesia. He was transferred to our hospital for ulcerative wound on DIP joint at 4 weeks after operation. Radiography showed osteolytic change around medulla of middle and distal phalanges, leading to diagnosis of a subacute osteomyelitis. We treated it with amputation at the level of shaft of middle phalanx.
RESULTS
The postoperative course was uneventful. We thought several possible reasons for osteomyelitis in our case. First, it could resulted from ascending infection through the wire. Second, it could be resulted from a bony burn by repeated drilling. And bony necrosis could be a consequence of arterial insufficiency caused by 2 pin insertion.
CONCLUSION
We suggest that a precise pinning based on accurate anatomical understanding is required for a percutaneous Kirschner wire fixation. The fre-quency of drilling should be minimized. Careful observation and patient education for pin site care are essential.

Keywords: Kirschner wire; Subacute osteomyelitis