Kirschner wires (K-wires) are stiff, straight wires that are sometimes needed to repair a fracture (broken bone). K-wires are also commonly called ‘pins’.

If your child has a fracture that requires surgery, they may need K-wires to help hold the bones in place until they heal. They are most commonly used for supracondylar (elbow) or wrist injuries. Depending on the location and severity of the fracture, sometimes multiple K-wires are needed. 

K-wires are only needed temporarily – once the bones have healed, the K-wires are removed during an outpatient appointment.

What to expect with K-wire insertion

A surgeon will need to put K-wires in during an operation – the surgeon will intentionally place the K-wires so the ends stick out of your child’s skin. This is so the wires can be removed three to four weeks after surgery, without the need for another operation.

The wires are covered with a padded dressing and the injured area is placed in a removable backslab (a partial cast held in place with bandages) or in a ready-made splint. 

Care at home while the K-wires are in

Your child will not be able to see or feel the wires under the padded dressing and it is important that you or your child do not to try to see or disturb the wires.

• Keep the cast and bandages dry and provide simple pain relief (e.g. paracetamol) if it is needed.
• Your child will not usually require any checks of the pin sites (where the wires stick out) or dressings.

For more information about fractures and plaster cast care, see our fact sheet Fractures (broken bones). 

When to see a doctor

Even though complications are rare, you will need to monitor your child at home for possible problems after K-wire insertion. Irritation where the wires exit the skin is common, but infection is rare (about one in one hundred patients). If your child shows any of the following signs of infection, you should contact your doctor or treating hospital:

• increased pain, or pain that you cannot control with simple pain relief (especially new pain that starts two to three weeks after surgery
• a temperature over 38ºC
  
• a bad smell or ooze coming from the cast
  
• you are worried for any other reason.
  

What to expect with K-wire removal

Before the procedure

Your child will have an appointment scheduled three to four weeks after surgery so that the K-wires can be removed.

If you think your child (or you as a parent/carer) will be particularly anxious or worried and need additional support during the procedure, please let your doctor know before your appointment. For patients of The Royal Children’s Hospital, a child life therapist or Comfort Kids team member may be available to provide strategies to alleviate procedure-related anxiety. You can check what supports are available with your treating hospital or medical team. See our fact sheet Your child’s hospital stay.

In rare cases light sedation is available but your child will have to fast from food and drink for a minimum of two hours ahead of time, however the majority of patients can have successful removal of K-wires without sedation. See our fact sheet Sedation for procedures.

On the day of the appointment:

• If your child likes a particular book, video or game, it is useful to bring this with you to the appointment so that it can be used to distract your child from the procedure.
  
• An X-ray may be performed first (you will be told if your doctor has requested this), followed by a visit to the orthopaedic doctor. You should arrive ahead of your appointment to allow time for your child to have an X-ray.
  
• We recommend you give your child a dose of paracetamol (e.g. Panadol) or ibuprofen (e.g. Nurofen) 30 minutes prior to their appointment time. 

During the procedure

Throughout the procedure, your doctor or a nurse will use distraction techniques to help reduce stress for your child. Clear explanations and reassurance will be given by the team and you are encouraged to help comfort and reassure your child.

• First, the cast will be removed. Partial casts (backslabs or ready-made splints) can be removed simply by unwrapping the bandage. A full cast (if used) will be removed with a cast remover, which is a machine that splits the hard part of the cast, but doesn’t cut through the padding underneath.
• A soft blue plastic shield is then placed in such as way so that your child cannot easily see the wires (e.g. over the arm or leg).
• The dressing over the wires is then taken off and the wires are rotated and removed. This is usually very quick – each wire removal only takes one to two seconds.
• Your child may feel tugging, along with some very brief discomfort. 
  

After the procedure

Once the wires are pulled, there will be tiny wounds (called pin sites) which may bleed, so a gauze dressing will be applied with some pressure for 30–60 seconds. Once the bleeding stops, the wounds will be covered with a clear dressing.

• For elbow injuries, a sling is usually applied and worn for up to two days after the procedure or until your child feels comfortable enough to start moving the limb on their own.
• Depending on your child’s injury, sometimes a new backslab or full cast is applied for a further three weeks after the K-wires are removed.
  

Care at home after the K-wires are removed

• If your child’s K-wires and backslab have been removed, keep any dressings dry for 24 hours. After 24 hours, your child can have a shower, but afterwards you will need to replace wet dressings with new dry dressings. Keep your child’s wound out of other water (e.g. baths, swimming pools, beaches) for five to seven days until the pin sites have healed.
• If your child has a new cast applied, follow the same cast care instructions given to you after the initial operation. Also see our fact sheet Plaster cast care. Your doctor will let you know when you need to return to have the cast or backslab removed.

Your child’s skin may be dry and itchy after the cast has been removed. Once the pin sites have healed, bathe the skin with warm soapy water, and apply a plain, non-perfumed moisturiser.

After a fracture, children normally regain strength by gradually participating in gentle activity and play. Physiotherapy is usually not needed.

Key points to remember

• K-wires are stiff straight wires (commonly called pins) inserted during an operation to help hold a fractured bone in the correct position for healing.
  
• Your child will have a dressing to cover the K-wires, and a backslab or splint in place for three to four weeks.
  
• It is important that you or your child do not to try to see or disturb the wires.
  
• K-wires are usually removed at an outpatient appointment without the need for another operation.
  
• Your child may need some simple pain relief and distraction during the K-wire removal procedure.
  
• If at any stage you have concerns about plaster care, pain management or complications, or you are worried for any other reason, take your child back to their treating hospital or your closest hospital emergency department.
  

For more information

• Be positive (B+): X-ray – broken bone
  
• Be positive (B+): A child's guide: Nitrous oxide
  
• Be positive (B+): Fracture Clinic
  
• Kids Health Info fact sheet: Fractures (broken bones)
  
• Kids Health Info fact sheet: Fracture care: supracondylar elbow
  
• Kids Health Info fact sheet: Plaster cast care
  
• Kids Health Info fact sheet: Pain relief for children
  
• Kids Health Info fact sheet: Wound care
  

Developed by The Royal Children's Hospital Orthopaedic department. We acknowledge the input of RCH consumers and carers. 

Developed October 2019.

This information is awaiting routine review. Please always seek the most recent advice from a registered and practising clinician.

Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit www.rchfoundation.org.au.