Strategies in Trauma and Limb Reconstruction

Register      Login

VOLUME 7 , ISSUE 2 ( August, 2012 ) > List of Articles

Review

Prevention and management of external fixator pin track sepsis

Leonard Charles Marais

Keywords : Pin site, Infection, Complications, External fixation

Citation Information : Marais LC. Prevention and management of external fixator pin track sepsis. 2012; 7 (2):67-72.

DOI: 10.1007/s11751-012-0139-2

License: CC BY-NC-SA 4.0

Published Online: 31-08-2012

Copyright Statement:  Copyright © 2012; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Pin track-associated complications are almost universal findings with the use of external fixation. These complications are catastrophic if it leads to the failure of the bone–pin interface and could lead to pin loosening, fracture non-union and chronic osteomyelitis. Strategies proposed for the prevention and management of pin track complications are diverse and constantly changing. Prevention of external fixation pin track infection is a complex and ongoing task that requires attention to detail, meticulous surgical technique and constant vigilance.


PDF Share
  1. Rogers LC, Bevilacqua NJ, Frykberg RG, Armstrong DG (2007) Predictors of postoperative complications of Ilizarov external ring fixators in the foot and ankle. J Foot Ankle Surg 46(5):372-375
  2. Bibbo C, Brueggeman J (2010) Prevention and management of complications arising from external fixation pin sites. J Foot Ankle Surg 49:87-92
  3. Parameswaran AD, Roberts CS, Seligson D, Voor M (2003) Pin track infection with contemporary external fixation: how much of a problem? J Orthop Trauma 17:503-507
  4. Patterson MM (2005) Multicentre pin care study. Orthop Nurs 24(5):349-360
  5. Rose REC (2010) Pin site care with the Ilizarov circular fixator. The Internet J Orthop Surg 16(1). doi:10.5580/28c0
  6. Cavusoglu AT, Er MS, Inal S, Ozsoy MH, Dincel VE, Sakaogullari A (2009) Pin site care during circular external fixation using two different protocols. J Orthop Trauma 23:724-730
  7. Schalamon J, Petnehazy T, Ainoedhofer H, Zwick EB, Singer G, Hoellwarth ME (2007) Pin track infection with external fixation of pediatric fractures. J Ped Surg 42:1584-1587
  8. Mostafavi HR, Tornetta P III (1997) Open fractures of the humerus treated with external fixation. Clin Orthop Relat Res 337:187-197
  9. Piza G, Caja VL, Gonzalez-Veijo MZ, Navarro A (2004) Hydroxyapatite-coated external-fixation pins. The effect on pin loosening and pin-track infection in leg lengthening for short stature. J Bone Joint Surg [Br] 86-B:892-897
  10. Davies R, Holt N, Nayagam S (2005) The care of pin sites with external fixation. J Bone Joint Surg [Br] 87-B:716-719
  11. DeJong ES, DeBerardino TM, Brooks DE, Nelson BJ, Campbell AA, Bottoni CR, Pusateri AE, Walton RS, Guymon CH, McManus AT (2001) Antimicrobial efficacy of external fixator pins coated with a lipid stabilized hydroxyapatite/chlorhexidine complex to prevent pin track infection in a goat model. J Trauma 50:1008-1014
  12. Watson MA, Mathias KJ, Maffulli N (2000) External ring fixators: an overview. Proc Inst Mech Eng 214:459-470
  13. Chao EYS, Aro HT (1991) Biomechanics of fracture repair and fracture fixation. In: Mow VC, Hayes WC (eds) Basic orthopaedic biomechanics. Raven Press, New York, pp 293-336
  14. Erhan Y, Oktay B, Lokman K, Nurettin A, Erhan S (2003) Mechanical performance of hybrid Ilizarov external fixator in comparison with Ilizarov circular external fixator. Clin Biomech 18:518-522
  15. Moroni A, Heikkila J, Magyar G, Toksvig-Larsen S, Giannini S (2001) Fixation strength and pin track infection of hydroxyapatite- coated tapered pins. Clin Orthop Relat Res 388:209-217
  16. Moroni A, Vannini F, Mosca M, Giannini S (2002) Techniques to avoid pin loosening and infection in external fixation. J Orthop Trauma 16:189-195
  17. Moroni A, Toksvig-Larsen S, Maltarello MC et al (1998) A comparison of hydroxyapatite coated, titanium coated and uncoated tapered external fixation pins. J Bone Joint Surg [Am] 80:547-554
  18. Moroni A, Orienti L, Stea S et al (1996) Improvement of the pinbone interface with hydroxyapatite coating. An in vivo long-term experimental study. J Orthop Trauma 10:236-242
  19. Moroni A, Aspenberg P, Toksvig-Larsen S, Falzarano G, Giannini S (1998) Enhanced fixation with hydroxyapatite coated pins. Clin Orthop Relat Res 346:171-177
  20. Moroni A, Cadossi M, Romagnoli M, Faldini C, Giannini S (2008) A biomechanical and histological analysis of standard versus hydroxyapatite-coated pins for external fixation. J Biomed Mater Res 86B:417-421
  21. Harding AK, Toksvig-Larsen S, Tagil M, W-Dahl A (2010) A single dose zolendronic acid enhances pin fixation in high tibial osteotomy using the hemicallotasis technique. A double-blind controlled randomized study in 46 patients. Bone 46:649-654
  22. Moroni A, Caja VL, Maltarello MC et al (1997) Biomechanical, scanning electron microscopy, and microhardness analyses of the bone pin interface in hydroxyapatite coated versus uncoated pins. J Orthop Trauma 11:154-161
  23. Magyar G, Toksvig-Larsen S, Moroni A (1997) Hydroxyapatite coating of threaded pins enhances fixation. J Bone Joint Surg [Br] 79:487-489
  24. Moroni A, Vannini F, Faldini C, Pegreffi F, Giannini S (2004) Cast vs external fixation: a comparative study in elderly osteoporotic distal radial fracture patients. Scand J Surg 93:64-67
  25. Sanden B, Olerud C, Johansson C, Larsson S (2001) Improved bonescrew interface with hydroxyapatite coating. Spine 26:2673-2678
  26. Santy J, Vincent M, Duffield B (2009) The principles of caring for patients with Ilizarov external fixation. Nurs Stand 23:50-55
  27. Holmes SH, Brown SJ (2005) Skeletal pin site care. Orthop Nurs 24(2):99-107
  28. Lee-Smith J, Santy J, Davis P, Jester R, Kneale J (2001) Pin site management. Towards a consensus: part 1. J Orthop Nurs 5:37-42
  29. Gordon JE, Kelly-Hahn J, Carpenter C, Schoenecker PL (2000) Pin site care during external fixation in children: results of a nihilistic approach. J Pediatr Orthop 20:163-165
  30. W-Dahl A, Toksvig-Larsen S (2004) Pin site care in external fixation sodium chloride or chlorhexidine solution as a cleansing agent. Arch Orthop Trauma Surg 124:555-558
  31. W-Dahl A, Toksvig-Larsen S (2009) Undisturbed theatre dressing during the first postoperative week. A benefit in the treatment by external fixation: a cohort study. Strat Traum Limb Recon 4:7-12
  32. Timms A, Vincent M, Santy-Tomlinson J, Hertz K (2011) Guidance on pin site care. Report on recommendation from the 2010 consensus project on pin site care. Royal College of Nursing, pp 1-30
  33. Timms A, Pugh H (2010) From British consensus to Russian protocol: how we justified our journey. Int J Orthop Trauma Nurs 14:109-115
  34. Lee CK, Chua YP, Saw A (2012) Antimicrobial gauze as a dressing reduces pin site infection. Clin Orthop Relat Res 470:610-615
  35. Checketts RG, MacEachern AG, Otterburn M (2000) Pin track infection and the principles of pin site care. In: Goldberg A, De Bastiani A, Graham Apley A (eds) Orthofix external fixation in trauma and orthopeadics. Springer, Berlin, pp 97-103
  36. Bhattacharyya M, Bradley H (2006) Antibiotics vs an antimicrobial dressing for pin-track infection. Wounds 2:26-33
  37. Morgan-Jones RL, Burgert S, Richardson JB (1998) Arthroscopic debridement of external fixator pin tracks. Injury 29:41-42
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.