Hand And Wrist: Antimicrobials and Infection – burieD vs. exposed K-wiRes In Fracture fixaTion
Musculoskeletal
This trial is a multi-centre, two-arm, parallel design, superiority, randomised controlled clinical study. Participants will be randomised to either buried K-wires or exposed K-wires for treatment of their hand or wrist fracture; the randomisation will be on a 1:1 basis, stratified by hand or wrist injury, research site and open or closed injury at presentation. A total of 470 participants will be recruited across a minimum of 22 research sites within the UK. A member of the research team at each site will initially screen patients for eligibility upon their presentation to hand trauma clinics or fracture clinics. If eligibility is confirmed, a trained member of the research team will approach the patient to give them a participant information sheet (PIS) and to explain the study to them. If they wish to proceed with participation, they will provide informed consent. Participants will then complete baseline questionnaires based on how they were feeling before their injury (answered retrospectively) and how they are feeling today on their presentation to the hand/fracture clinic. When the participant returns to have their surgery, their eligibility for the study will be reassessed to check that they are still eligible (e.g. they haven't contracted a skin infection over the intended site of the wire placement). This could also mean that a patient who was previously ineligible for the study may become eligible at this point. For example, if a nonoperative approach was initially decided when the patient was first screened, but now they will be having surgery, they may be approached to take part in the study. Once eligibility is confirmed, the participant will be randomised in the operating theatre, and subsequently followed up at 90 days and 6 months post-randomisation. Web-based randomisation will be used, provided by the OCTRU using a REDCap platform. Stratification will be used with random permuted blocks within each stratum with an allocation ratio of 1:1. Allo
1. Age 16 years and above 2. Open or closed hand/wrist fracture(s) which, in the opinion of the treating clinician, require manipulation under anaesthetic and fixation with K-wires
Current exclusion criteria as of 12/05/2026: 1. Insufficient soft tissue cover to bury the wire 2. Presence of overlying or adjacent skin infection/disorder 3. Injury is more than 2 weeks old at time of screening 4. Inability of participants to adhere to the trial procedures and/or follow-up procedures Previous exclusion criteria: 1. Insufficient soft tissue cover to bury the wire 2. Presence of overlying or adjacent skin infection/disorder 3. Injury is more than 2 weeks old 4. Inability of participants to adhere to the trial procedures and/or follow-up procedures