"I am still a bit conflicted. If we don't use Kirschner wires, what impact will it have on the child?"
The consultation was almost over, this mother suddenly asked me. She was worried that the Kirschner wires would be very painful and wanted to know if polydactyly surgery necessarily required them.
Her child's case was quite complex, involving both syndactyly (webbed fingers) and small extra digits hidden on both hands. During surgery, besides separating the webbed fingers, the extra digits also needed to be removed.
Left Hand
For some relatively simple cases of polydactyly, if the removal does not involve tendons, joint capsules, ligaments, or bones, internal fixation might not be necessary. However, this is rare. Most surgeries do involve tendons, and in this child's case, there is also syndactyly, so Kirschner wires are needed for internal fixation to assist with finger stabilization.
Why Is Postoperative Fixation Necessary?
The child's mother didn't understand the purpose of Kirschner wires. I explained that during surgery, the removal of extra digits and separation of webbed fingers involve areas like tendons. To ensure better postoperative finger development, the fingers need to be kept in a stable position.
Left Hand
Since young children are not very compliant, if internal fixation is not used to protect the fingers, and the child freely waves their fingers, the surgical repairs could be disrupted. Therefore, postoperative internal fixation is essential. Additionally, we use not only internal fixation but also external fixation with aluminum splints after removing the Kirschner wires to continue stabilizing the fingers, ensuring a stable environment during the recovery process.
Is Removing Kirschner Wires Painful? Will It Cause Additional Harm?
The child's mother was concerned that the child would not be able to handle the wire removal, but this is a misunderstanding. The process is simple and quick, not as frightening as imagined. The child will not feel significant pain or discomfort.
For example, one child who had polydactyly surgery came for a follow-up, and the parents mentioned that the child accidentally dislodged the Kirschner wire while playing at home without feeling anything and without crying. So, parents need not worry excessively.
Right Hand
Some parents also asked me if anesthesia is needed for removing Kirschner wires.
This is another misunderstanding. Removing the wires is not a major operation; they are gently taken out without the need for anesthesia, and it does not cause additional harm to the child.
Both Hands
With her concerns alleviated, the mother decided to go ahead with the surgery when the child was seven months old. I performed the surgery for the child.
Postoperative Left Hand
After the surgery, the parents felt that the baby was recovering very well and was quite strong. They were very satisfied, and I was reassured. Separating the webbed fingers made the child's activities much more convenient, which is very meaningful.