K-wire advice

For Paediatric pre-operative\post-operative day surgery patients.

What is a k-wire?

A k-wire is a thin metallic wire that is used to stabilise two pieces of broken bone together, enabling them to heal in the correct position.

Why insert a wire?

A K-wire is used to stabilise and hold two pieces of bone together and to keep in a stable position while the bone heals in the correct position.

Before the day of your child’s operation

The plastic trauma co-ordinator will contact you with a date and time for your child to come in for surgery. They may arrange for your child to either be seen face to face or have a telephone pre-assessment. This is to check your child is fit and well for the anaesthetic and to refer to an anaesthetist for further input if needed prior to the day of surgery. You will also be given fasting times for the day of surgery; no food for 6 hours prior to admission time, no breast milk for 4 hours prior to admission time and no clear fluids for 2 hours prior to admission time.

Please make sure that you have a supply of paracetamol and ibuprofen (if your child can take these) at home to give after the operation. These are not supplied for you to take home after the operation.

If your child is unwell from the time of being listed for surgery and the day of admission, please contact the plastics trauma co-ordinator to inform them, as surgery may need to be postponed depending on the risk of leaving the fracture for longer and the increased risk of general anaesthetic.

On the day of surgery

When your child arrives on the ward

Please arrive on the ward on the correct date and admission time of your child’s planned surgery. Please make sure fasting instructions have been followed if these have not been followed the procedure may not be able to go ahead.

The time of admission is not the time your child will be going down to theatre, this is arranged by age and clinical need of the patients.

A nurse will admit your child to the ward this includes checking you child’s details, if they have any allergies and checking you child’s temperature, pulse and blood pressure. Numbing cream may be applied to your child’s hands depending on their age, if they are going to be asleep during the operation.

You will see the surgical team who will gain written permission (consent) from you to say you are happy for the procedure to go ahead, prior to signing this the surgical team will discuss what the procedure includes and the risks and benefits of carrying out the surgery. You also can ask any questions that you may have about the procedure. They will also mark the area with a surgical marker pen that requires a k-wire.

The anaesthetist will also see you and your child prior to going to theatre. They will check that you child is medically fit for the procedure and general anaesthetic (if your child is having this). They will also discuss and assess the best way to give the general anaesthetic. They will also discuss the different ways that anaesthetic can be given, and which method is best for your child.

In theatre

You can accompany your child to the anaesthetic room. You will not be able to go into theatre with your child.

If your child did not have a cannula inserted in their hand in the anaesthetic room, they will have one inserted once they are asleep, this is so medications can be given during the operation and also after surgery if required.

Once your child is asleep a member of staff will take you to recovery, where the recovery staff will take a contact number to contact you on when your child comes out of theatre.

The area to be operated on will be cleaned. Local anaesthetic will be injected into the area to make your child comfortable on return.

The wire is inserted through the skin into the pieces of broken bone, this is normally done under x-ray guidance to ensure the correct positioning of the bone. The K-wire is normally left sticking out of the skin so that it can be removed in clinic.

A dressing is applied over the k-wire site to keep it clean. Then a splint or cast is normally applied to protect the fracture and k-wire. A bandage is then placed over the top to keep the fracture, splint/cast and k-wire in place.

After the operation

The children’s recovery team will contact you to inform you that your child is in recovery.

After the surgery your child may feel drowsy or sleep, they may be restless and upset after waking from the surgery (this normally settles on its own).

Your child can eat and drink as they feel able to after the procedure.

There may be swelling and bruising to the area. This will go down with elevation of the limb and should settle over the following days/weeks.

The nurses on the ward will carry out checks on the limb to ensure that the cast doesn’t become too tight or start to dig into the skin.

You may go home once your child has eaten, drank and passed urine. We will also make ensure that your child is comfortable after the procedure, before you go home.

After you go home

Paracetamol and ibuprofen should be given regularly for the first couple of days.

The area needs to be kept dry will the splint or cast is on to protect the k-wire.

Keep the limb elevated as much as possible.

You will have an appointment in 7-10 days in the children’s plastic dressing clinic. Here the cast will be removed, and the wounds will be checked, and another dressing is normally applied, another cast or splint will be applied. Your child may require another x-ray to check the position of the bones and how they are healing. If the k-wire is sticking out of the skin, you will be shown how to care for it and change the dressing at home.

Your child will normally be seen by a consultant in the outpatient clinic four to six weeks after the operation. Another x-ray may be taken at this time to check the position and healing, if the x-ray shows good healing and a good position the k-wire will be removed in clinic, if it is buried then your child will be added to the theatre list to have the wire removed.

Depending on your child’s age they may require hand therapy to assist your child to move their fingers if they are very stiff.

Plaster cast problems

If you notice any of the follow please go straight to A&E:

• The fingers or toes feel cold or look blue.
• The cast is too tight or painful.
• Swelling to the fingers or toes that does not improve with elevation.
• Your child complains of pins and needles or a strange sensation.
• If the cast is rubbing or digging into the skin.
• The cast becomes too loose and start slipping.
• The cast gets wet, starts to break or crumbles.
• Your child is unable to move the fingers or toes.

Signs of infection

• Redness to around wound or spreading away from the wound.
• Increased pain to wound that is out of proportion to the surgery carried out.
• Hot to touch, when compared with the temperature of the surrounding skin.
• There is a foul smell coming from the wound.
• There is pus or excessive ooze from the wound.
• Your child has a temperature and feels unwell

It is normal for there to be some oozing. If at home, there is fresh blood visible please contact the children’s plastics surgery CNS: 07729 107964 or attend A&E.

If any of these signs appear please contact your GP, but if your child is very ill take them straight to A&E.

Medication

Bring all your medicines (including inhalers, injections, creams, eye drops or patches) and a current repeat prescription from your GP

Please tell the ward staff about all of the medicines you use. During your stay If you wish to take your medication yourself (self-medicate) please speak with your nurse. Pharmacists visit the wards regularly and can help with any medicine queries.

MyChart

We would encourage you to sign up for MyChart. This is the electronic patient portal at Cambridge University Hospitals that enables patients to securely access parts of their health record held within the hospital’s electronic patient record system (Epic). It is available via your home computer or mobile device

If you are interested in this please let us know and we can provide information, or look on our website: MyChart

Contacts/further information

Paediatric Plastic Surgery CNS: 07729 107964

Email the paediatric plastics department

Privacy and dignity

Same sex bays and bathrooms are offered in all wards except critical care and theatre recovery areas where the use of high-tech equipment and/or specialist one to one care is required.