Introduction: In some centers across countries, Kirschner wires are still widely used for fixation of mandible fractures. Kirshner wire fixation for mandibular fracture can be a cost-effective alternative for fracture fixation. The present study is aimed at highlighting the relevance of Kirschner wire fixation a simple technique which gives desired result with much less cost and it is easier to learn.

Material and Method: A total of 254 patients with mandibular fractures treated by Kirschner wire fixation between March 2014 to February 2019 are prospectively analyzed. All patients complied to the uniform Kirschner wire care protocol, and maintained regular follow up for 6 months. Post-operative complication was categorized in two categories minor or major and further subdivided into pin tract infection, pin migration, pin loosening, delayed union, malunion, pin fracture, non-union, osteomyelitis, facial asymmetry and sensory nerve damage.

Result: A satisfactory treatment outcome was recorded in 221(87.4%) of the 254 patients while complications occurred in 33(12.6%) of the patients. Most complications were minor, commonly superficial pin tract infection in 10(6%) patients. Major complication that led to revision surgery deep infection, malunion, nonunion. And fracture of pin. Development of infection is due to poor compliance with pin care.

Discussion: Kirschner Wire internal fixation can be a reasonable alternative for the surgical treatment of non-comminuted, and comminuted mandibular fractures and those without bone loss, in the setting of limited resources and minimally invasive technique.

Keywords: Mandibular fracture, Kirschner wire internal fixation, Minimally invasive, Cost-effective.

1. Sugiura, T., Yamamoto, K., Murakami, K. and Sugimura, M. A comparative evaluation of osteosynthesis with lag screws, miniplates, or Kirschner wires for mandibular condylar process fractures. Journal of Oral and Maxillofacial Surgery 2001;59(10):1161-1168.
2. Sudheer R,Chakravarthy BD, Vura, N, Rajshekhar G. Management of Angle Mandible Fractures by 3D Rectangular Grid Plate: A Prospective Study. J. Maxillofac. Oral Surg.2020;19:420-424.
3. Gorzelnik, L. and Kozlovsky, E. BicorticalExtraoral Plating of Mandibular Fractures. Atlas of the Oral and Maxillofacial Surgery Clinics 2009; 17(1):35-43.
4. Richardson M, Hayes J, Jordan JR, Puckett A, & Fort M. Biomechanical Evaluation of a Mandibular Spanning Plate Technique Compared to Standard Plating Techniques to Treat Mandibular Symphyseal Fractures. Surgery Research and Practice. 2015;2015:569030.
5. Lim HY, Jung CH, Kim SY, Cho JY, Ryu JY, Kim HM. Comparison of resorbable plates and titanium plates for fixation stability of combined mandibular symphysis and angle fractures. J Korean Assoc Oral Maxillofac Surg. 2014;40(6):285‐290.
6. Boutros SG. Closed reduction and fluoroscopically assisted percutaneous stabilization of displaced subcondylar mandible fractures. PlastReconstr Surg. 2005;116:971–977.
7. Sanam M, Kadakia S, Ducic Y. Postoperative Maxillomandibular Fixation After Open Reduction of Mandible Fractures. JAMA Facial Plast Surg. 2014;16(6):410-413.
8. Beogo R, Bouletreau P, Konsem T, Traore I, Coulibaly AT, Ouedraogo D. Wire internal fixation: an obsolete, yet valuable method for surgical management of facial fractures. Pan Afr Med J. 2014;17:219.
9. Morris, Lisa M. et al. Complications in Facial Trauma Facial Plastic Surgery Clinics, 2013; 21(4): 605 – 617.
10. Dorr MC, Backes M, Luitse, JSK, De Jong, V M &Schepers T. Complications of Kirschner Wire Use in Open Reduction and Internal Fixation of Calcaneal Fractures. The Journal of Foot and Ankle Surgery.2016; 55(5): 915–917.
11. Lethaby A, Temple J, Santy J. Pin site care for preventing infections associated with external bone fixators and pins. Cochrane Database Syst Rev 2008;4:CD004551.
12. Zosa, BM, Elliott CW, Kurlander DE, Johnson F, Ho VP, & Claridge JA. Facing the facts on prophylactic antibiotics for facial fractures. Journal of Trauma and Acute Care Surgery.2018; 85(3): 444–450.
13. Odom EB, & Snyder WAK. Mandible Fracture Complications and Infection. Plastic and Reconstructive Surgery.2016; 138(2):282e–289e.
14. Haghighi K, Manolakakis MG, Balog C. Open Reduction with K-Wire Stabilization of Fracture Dislocations of the Mandibular Condyle: A Retrospective Review. J Oral Maxillofac Surg. 2017;75(6):1238.e1-1238.e7.
15. Kim JH, Nam DH. Closed reduction of displaced or dislocated mandibular condyle fractures in children using threaded Kirschner wire and external rubber traction. Int J Oral Maxillofac Surg. 2015;44(10):1255-1259.
16. Haghighi, K, ManolakakisMG, & Balog C. Open Reduction With K-Wire Stabilization of Fracture Dislocations of the Mandibular Condyle: A Retrospective Review. Journal of Oral and Maxillofacial Surgery, 2017;75(6): 1238.e1–1238.e7.
17. Kang DH, Jung DW, Yong HK, Kim TG, Lee JH, Chung KJ. Kirschner wire fixation for the treatment of comminuted zygomatic fractures. Archives of craniofacial surgery 2015;16(3):119-124

Dr Sourav Kumar Rout

Consultant Department of Cranio Maxillofacial Surgery, Ashwini Hospital, Cuttack, Odisha