History and Application of Kirschner Wire in Orthopedic Surgery

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History of Kirschner wire
The Role of Kirschner Wire in orthopedic surgery
Application of Kirschner wire in orthopedic surgery

Kirschner wire is the most familiar instrument to orthopedic surgeons, especially trauma orthopedic surgeons. Kirschner wires are used in almost every operation, and the use of Kirschner wires has become a daily practice. This article will focus on sharing the development of Kirschner wires and some ingenious usages.

History of Kirschner wire

In 1907, Dr. Fritz Steinmann (1872-1932) from Switzerland began to use a relatively thick “nail”, which is known as the Steinmann Pin. The insertion method is to drill a hole first, and then drive the Steinmann pin into the bone. It’s used for traction and maintenance of bone fragments.

In 1909, recognizing the shortcomings of the Steinmann Pin-its excessive thickness which significantly increased the risk of infection, the potential for infection from pre-drilling, and its unreliable fixation-Dr. Kirschner introduced a thinner, smooth-surfaced “needle” to emergency medicine for traction purposes. This innovative device later became widely recognized as the K-wire.

The initial design of the K-wire featured a diamond-shaped head, which was later modified to a trocar shape, each with its own set of advantages and disadvantages. The diamond-shaped design offered lower temperatures but provided slightly weaker fixation, while the trocar shape ensured solid fixation but generated higher temperatures. With the development of Kirschner wires, there are various types: ones with thread, limiter, scale, or that are single-headed, double-headed, or made from different materials, etc. In terms of material: Stainless steel K-wire has high rigidity, temporary fixation, or short-term traction use. Titanium K-wire has high strength, and good corrosion resistance, mostly used for long-term fixation.

The Role of Kirschner Wire in orthopedic surgery

In general, the clinical use of K-wires in orthopedics can be classified into two categories: implants and tools.

1. Use as an implant

Currently, the most widely used is the treatment of fractures in children. Due to the particularity of children’s epiphyses, Kirschner wires have the advantages of little influence on epiphyseal growth, easy operation, and percutaneous insertion. Kirschner wires are also essential in the use of tension band systems such as patellar fractures, olecranon fractures, etc. Kirschner wires are also very important in the treatment of metacarpal and phalanx fractures

2. Use as a tool

At present, the largest use of K-wires is the temporary fixation of bone plates. After temporary fixation, K-wires can also be used as guide wires to facilitate the insertion of other internal fixation objects, such as cannulated screws and Herbert screws. During the operation, it can also be used as a reset device to pry and reset the fracture. At the same time, it can also be used as a reference mark for the line of limbs to guide the placement of implants and osteotomy during surgery.

Application of Kirschner wire in orthopedic surgery

1. As guide wire

Inserting the K-wire from the bone surface first can provide guidance for the next step of drilling and screw placement, and improve the success rate of drilling and screw placement. Common anatomical sites for K-wire insertion include the pelvis, condyle, and femoral neck, among others.

2. Temporary fixation

The K-wire can not only temporarily fix the bone block to achieve a good reduction and create an environment for placing the implant; it can also temporarily fix the internal fixation to facilitate the next operation.

3. Long-term fixation

Using K-wires instead of elastic intramedullary nails to treat fractures in children and adults can also achieve very good therapeutic effects.

In conclusion, the Kirschner wire has become an indispensable instrument in orthopedic surgery due to its versatility and ease of use. From its humble beginnings as a thinner alternative to the Steinmann Pin, it has evolved into various forms and materials to cater to different clinical needs. The K-wire has greatly contributed to the advancement of orthopedic surgery and will continue to do so in the future.