The WIRE Trial: should Kirschner wires be buried or not buried following adult hand fracture fixation?
Hand fractures are common injuries. In those patients managed surgically, Kirschner wires are the most common form of fracture fixation. These temporary wires are usually removed within six weeks of surgery. Once placed a wire is either cut flush and buried beneath the skin, or left sitting proud. Wire removal in the former needs an operation whereas non-buried wires are usually removed in clinic. A systemic review and national survey, performed by the WIRE Collaborative, highlighted clinical and patient uncertainty around burying or not burying wires.
The primary aim of the WIRE Trial is to assess whether Kirschner wires should be buried or not buried in adult patients undergoing hand fracture fixation. The aim of this proposal is to prepare for the definitive study.
The overall WIRE objectives are to assess whether burying or not alters the risk of surgical site infection, patient-reported pain and the economic impact of the two approaches. As part of that, this proposed feasibility project will aid the design of a multi-centre trial by achieving the following:
- Establish patient and public involvement to refine study design
- Optimise data collection procedures including patient-reported outcomes
- Evaluation of the acceptability to patients and clinicians of the randomisation process and intervention
- Evaluation of the resources required to carry out a definitive RCT
- Explore the standardisation of other variables, such as perioperative antibiotics, dressings, and follow up arrangements
- Preliminary analysis for sample size calculations