{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T21:01:32Z","timestamp":1790715692315,"version":"4.1.0"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Trauma Emerg Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Kirschner wires (K-wires) are the standard fixation method for displaced pediatric upper extremity fractures, yet no consensus exists on whether wire ends should be buried subcutaneously or left exposed epicutaneously. While epicutaneous K-wires offer cost-effectiveness and avoid second anesthesia, concerns remain regarding infection risk and psychological distress. To systematically review and compare complication rates between buried and exposed K-wire fixation in pediatric upper extremity fractures, including infection, refracture, skin erosion, and secondary implant displacement. We conducted a systematic review following PRISMA guidelines, searching Cochrane, PubMed, EmBase, and Ovid databases. Inclusion criteria were: modified Coleman Methodology Score (mCMS) &gt; 60, upper extremity fractures treated with K-wire fixation, and age\u2009&lt;\u200916\u2009years. Studies including adult patients and biomechanical studies were excluded. Meta-analysis compared outcomes across 12 studies encompassing 1,977 patients. Buried K-wires demonstrated significantly lower overall infection rates (OR\u2009=\u20091.74; 95% CI: 1.19\u20132.56;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.004). However, no significant difference was observed in deep surgical siteinfections (\n                    <jats:italic>OR\u2009=\u20091.56; 95% CI: 0.60\u20134.0; p\u2009=\u20090.36<\/jats:italic>\n                    ). Exposed wires showed significantly lower skin irritation rates (OR\u2009=\u20090.09; 95% CI: 0.04\u20130.21;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.00001). No significant differences were found in secondary implant displacement (OR\u2009=\u20091.26; 95% CI: 0.10\u201315.75;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.86) or refracture rates (OR\u2009=\u20091.90; 95% CI: 0.91\u20133.96;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.09). Geographic subgroup analysis revealed significant regional differences: infection rate differences were significant in Asia\/Africa (OR\u2009=\u20092.90; 95% CI: 1.61\u20135.22;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.0004) but not in Europe\/USA (OR\u2009=\u20091.16; 95% CI: 0.69\u20131.95;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.57). Epicutaneous K-wire fixation shows higher overall infection rates than buried wires but does not increase deep surgical site infections requiring operative revision. Considering the avoidance of additional anesthesia, favorable cost-benefit profile, and geographic variation in infection risk, epicutaneous K-wires are recommended when no patient-specific contraindications exist, particularly in temperate climates. Level III (Systematic Review of Level II-III Studies).\n                  <\/jats:p>","DOI":"10.1007\/s00068-026-03353-8","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T07:41:15Z","timestamp":1790667675000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["What to do with K-wires in displaced upper extremity fractures in children \u2013 where to bury or not"],"prefix":"10.1007","volume":"52","author":[{"given":"Andreas","family":"Frodl","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marietta","family":"Borbely","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikos","family":"Karvouniaris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nils","family":"M\u00fchlenfeld","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Siegel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerstin","family":"Kuminack","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlotta","family":"Pietsch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ferdinand C.","family":"Wagner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Erdle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hagen","family":"Schmal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"issue":"1","key":"3353_CR1","doi-asserted-by":"publisher","first-page":"314","DOI":"10.1186\/s12887-014-0314-3","volume":"14","author":"A Joeris","year":"2014","unstructured":"Joeris A, Lutz N, Wicki B, Slongo T, Audig\u00e9 L. 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