Strategies in Trauma and Limb Reconstruction

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VOLUME 19 , ISSUE 1 ( January-April, 2024 ) > List of Articles


Clinical Outcome following Management of Severe Osteomyelitis due to Pin Site Infection

Florian A Frank, Eoghan Pomeroy, Andrew J Hotchen, David Stubbs, Jamie Y Ferguson, Martin McNally

Keywords : Local antibiotics, One-stage surgery, Osteomyelitis, Pin site infection, Retrospective cohort study

Citation Information : Frank FA, Pomeroy E, Hotchen AJ, Stubbs D, Ferguson JY, McNally M. Clinical Outcome following Management of Severe Osteomyelitis due to Pin Site Infection. 2024; 19 (1):21-25.

DOI: 10.5005/jp-journals-10080-1607

License: CC BY-NC 4.0

Published Online: 06-05-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Aim: This study has investigated cases of pin site infection (PSI) which required surgery for persistent osteomyelitis (OM) despite pin removal. Materials and methods: Patients requiring surgery for OM after PSI between 2011 and 2021 were included in this retrospective cohort study. Single-stage surgery was performed in accordance with a protocol at one institution. This involved deep sampling, debridement, implantation of local antibiotics, culture-specific systemic antibiotics and soft tissue closure. A successful outcome was defined as an infection-free interval of at least 24 months following surgery. Results: Twenty-seven patients were identified (the sites were 22 tibias, 2 humeri, 2 calcanei, 1 radius); about 85% of them were males with a median age of 53.9 years. The majority of infections (21/27) followed fracture treatment. Fifteen patients were classified as BACH uncomplicated and 12 were BACH complex. Staphylococci were the most common pathogens, polymicrobial infections were detected in five cases (19%). Seven patients required flap coverage which was performed in the same operation. After a median of 3.99 years (2.00–8.05) follow-up, all patients remained infection free at the site of the former OM. Wound leakage after local antibiotic treatment was seen in 3/27 (11.1%) cases but did not require further treatment. Conclusion: Osteomyelitis after PSI is uncommon but has major implications for the patient as 7 patients needed flap coverage. This reinforces the need for careful pin placement and pin site care to prevent deep infection. These infections were treated in accordance with a protocol and were not managed simply by curettage. All patients treated in this manner remained infection-free after a minimum follow-up of 2 years suggesting that this protocol is effective. Clinical significance: Pin site infection is a very common complication in external fixation. The sequela of a chronic pin site OM is rare but the implications to the patient are huge. In this series, more than a quarter of patients required flap coverage as part of the treatment of the deep infection.

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