Strategies in Trauma and Limb Reconstruction

Register      Login

VOLUME 10 , ISSUE 2 ( August, 2015 ) > List of Articles

Original Article

Efficacy of 1 % silver sulphadiazine dressings in preventing infection of external fixation pin-tracks: a randomized study

Alfred O. Ogbemudia, Ehimwenma J. Ogbemudia, Edwin Edomwonyi

Keywords : 1 % silver sulphadiazine, Pin-skin interface, External fixation, Infection

Citation Information : Ogbemudia AO, Ogbemudia EJ, Edomwonyi E. Efficacy of 1 % silver sulphadiazine dressings in preventing infection of external fixation pin-tracks: a randomized study. 2015; 10 (2):95-99.

DOI: 10.1007/s11751-015-0226-2

License: CC BY-NC-SA 4.0

Published Online: 01-12-2013

Copyright Statement:  Copyright © 2015; The Author(s).


Abstract

Pin-track infection (PTI) is a common complication of external fixation. Antimicrobial dressings of the pin-site interface should reduce the severity and incidence of PTI. This study is aimed at determining the efficacy of 1 % silver sulphadiazine dressings in preventing PTI in external fixation. We compared the incidence of PTI between group A (dry sterile gauze dressing) and group B (1 % silver sulphadiazine impregnated gauze dressing). PTI was diagnosed when there was: (1) redness around any pin-site, (2) tenderness near a pin-site and (3) serous or purulent discharge from the pin-skin interface. With infection, swab was obtained for microscopy, culture and sensitivity. Pin-track infections were diagnosed in 22.5 and 4.1 % of patients in groups A and B, respectively. This difference was statistically significant. The commonest organism isolated from swabs was Staphyloccus aureus. In patients with external fixation, 1 % silver sulphadiazine lowered PTI. This further underlines the need for antimicrobial dressings of pin-sites. We recommend the use of 1 % silver sulphadiazine impregnated ribbon gauze for pin-site dressings. Level of evidence II.


PDF Share
  1. Thakur AJ, Patankar J (1991) Open tibial fractures. Treatment by uniplanar external fixation and early bone grafting. J Bone Jt Surg Br 73:448-451
  2. Ahlborg HG, Josefsson PO (1999) Pin tract complications in external fixation of fractures of the distal radius. Acta Orthop Scand 70:116-118
  3. Parameswaran AD, Roberts CS, Seligson D, Voor M (2003) Pin tract Infection with contemporary external fixation: how much of a problem. J Orthop Trauma 17:503-507
  4. Mostafavi HR, Tornetta P (1997) Open fractures of the humerus treated with external fixation. Clin Orthop Rel Res 337:187-197
  5. Schalamon J, Petnehazy T, Ainoedhofer H, Zwick EB, Singer G, Hoellwarth ME (2007) Pin tract infection with external fixation of pediatric fractures. J Pediatr Surg 42(9):1584-1587
  6. Antoci V, Ono CM, Antoci V, Raney EM (2008) Pin-track infection during limb lengthening using external fixation. Am J Orthop 37(9):E150-E154
  7. Paris LA, Viscarret M, Uban C, Vargas J, Rodriguez-Morales AJ (2008) Pin-site myiasis: a rare complication of a treated open fracture of tibia. Surg Infect 9(3):403-406
  8. Nayagam S (2010) Femoral lengthening with a rail external fixator: tips and tricks. Strat Trauma Limb Reconstr 5(3): 137-144
  9. 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 tract infection in a goat model. J Trauma 50(6):1008-1014
  10. Voos K, Rosenberg B, Fagrhi M, Seligson D (1999) Use of a tobramycin-impregnated polymethyl methacrylate pin sleeve for the prevention of pin tract infection in goats. J Orthop Trauma 13:98-101
  11. Massè A, Bruno A, Bosetti M, Biasibetti A, Cannas M, Gallinaro P (2000) Prevention of pin track infection in external fixation with silver coated pins: clinical and microbiological results. J Biomed Mater Res (Appl Biomater) 53:600-604
  12. Davies R, Holt N, Nayagam S (2005) The care of pin sites with external fixation. J Bone Jt Surg Br 87(5):716-719
  13. Wu SC, Crews RT, Zelen C, Wrobel JS, Armstrong DG (2008) Use of chlorhexidine-impregnated patch at pin site to reduce local morbidity: the ChIPPS pilot trial. Int Wound J 5(3):416-422
  14. Ogbemudia AO, Bafor A, Edomwonyi E, Enemudo R (2010) Prevalence of pin tract infection: the role of combined silver sulphadiazine and chlorhexidine dressing. Niger J Clin Pract 13:268-271
  15. Margaret I, Lui SL, Poon VKM, Lung I, Burd A (2006) Antimicrobial activities of silver dressings: an in vitro comparison. J Med Microbiol 55:59-63
  16. Robb EC, Nathan P (1981) Control of experimental burn wound infections: comparative delivery of the antimicrobial agent (silver sulphadiazine) either from a cream base or from a solid synthetic dressing. J Trauma 21:889-893
  17. Silver S, Phung LT, Silver G (2006) Silver as biocides in burn and wound dressings and bacterial resistance to silver compounds. J Ind Microbiol Biotechnol 33:627-634
  18. Boosalis MG, McCall JT, Ahrenholz DH, Solem LD, McClain CJ (1987) Serum and urinary silver levels in thermal injury patients. Surgery 101:40-43
  19. Zimmerli W (2001) Antibiotic prophylaxis. In: AO principles of fracture management. Stuttgart. Thieme, pp.703-708
  20. Al-Sayyad MJ (2008) Taylor spatial frame in the treatment of open tibial shaft fractures. Indian J Orthop 42(4):431-438
  21. Shapiro JM, Bond EL, Garman JK (1990) Use of chlorhexidine dressing to reduce microbial colonization of epidural catheters. Anaesthesiology 73:625-631
  22. Hanazaki K, Shingu K, Adachi W, Miyazaki T, Amano J (1999) Chlorhexidine dressing for reduction in microbial colonization of the skin with central venous catheters: a prospective randomized controlled trial. J Hosp Infect 42:165-168
  23. Hannan M, Juste RN, Umasanker S, Glendenning A, Nightingale C, Azadian B, Soni N (1999) Antiseptic-bonded central venous catheters and bacterial colonization. Anaesthesia 54:868-872
  24. Dahl AW, Toksvig Larsen S, Lindstrand A (2003) No difference between daily and weekly pin site care: randomized study of 50 patients with external fixation. Acta Orthop Scand 74:704-708
  25. Bhattacharyya M, Bradley H (2006) Antibiotics vs an antimicrobial dressing for pin tract infection. Wounds 2(2):26-33
  26. Saw A, Chan CK, Penafort R, Sengupta S (2006) A simple practical protocol for care of metal-skin interface of external fixation. Med J Malays 61(Suppl A):62-65
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.