Intervention Review

You have free access to this content

Pin site care for preventing infections associated with external bone fixators and pins

  1. Anne Lethaby1,*,
  2. Jenny Temple2,
  3. Julie Santy-Tomlinson3

Editorial Group: Cochrane Wounds Group

Published Online: 3 DEC 2013

Assessed as up-to-date: 5 SEP 2013

DOI: 10.1002/14651858.CD004551.pub3


How to Cite

Lethaby A, Temple J, Santy-Tomlinson J. Pin site care for preventing infections associated with external bone fixators and pins. Cochrane Database of Systematic Reviews 2013, Issue 12. Art. No.: CD004551. DOI: 10.1002/14651858.CD004551.pub3.

Author Information

  1. 1

    University of Auckland, Obstetrics and Gynaecology, Auckland, New Zealand

  2. 2

    University of Plymouth, Faculty of Health & Social Work, Drake Circus, Plymouth, UK

  3. 3

    University of Hull, Faculty of Health & Social Care, Hull, East Yorkshire, UK

*Anne Lethaby, Obstetrics and Gynaecology, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand. a.lethaby@auckland.ac.nz.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 3 DEC 2013

SEARCH

References

References to studies included in this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
Camathias 2012 {published data only}
  • Camathias C, Valderrabano V, Oberli H. Routine pin tract care in external fixation is unnecessary: a randomised prospective blinded controlled study. Injury 2012;43:1969-73.
Camilo 2005 {published data only}
  • Camilo AM, Bongiovanni JC. Evaluation of effectiveness of 10% polyvinylpyrrolidone-iodine solution against infections in wire and pin holes for Ilizarov external fixators. Sao Paolo Medical Journal 2005;123(2):58-61.
Cavusoglu 2009 {published data only}
  • Cavusoglu AT, Er MS, Inal S, Ozsoy MH, Dincel VE, Sakaogullari A. Pin site care during circular external fixation using two different protocols. Journal of Orthopaedic Trauma 2009;23(10):724-30.
Chan 2009 {published data only}
  • Chan CK, Kwan MK, Karina R. Diluted povidone-iodine versus saline for dressing metal-skin interfaces in external fixation. Journal of Orthopaedic Surgery 2009;17(1):19-22.
  • Saw A, Chan CK, Penafort R, Sengupta S. A simple practice protocol for care of metal-skin interface of external fixation. Medical Journal of Malaysia 2006;61(Suppl A):61-5.
Egol 2006 {published data only}
  • Egol KA, Klugman J, Puopolo S, Heibert R, Koval K. Pin care following external fixation of the wrist: a prospective randomized trial or three techniques. Orthopaedic Trauma Association Annual Meeting, 2004 October 8-10; Hollywood, Florida. 2004.
  • Egol KA, Nader Pakisma DO, Puopolo S, Klugman J, Heibert R, Koval K. Treatment of external fixation pins about the wrist: a prospective randomized trial. Journal of Bone and Joint Surgery 2006;88-A(2):349-54.
Grant 2005 {published data only}
  • Grant S, Kerr D, Wallis M, Pitchford D. Comparison of povidone-iodine solution and soft white paraffin ointment in the management of skeletal pin-sites: a pilot study. Journal of Orthopaedic Nursing 2005;9:218-25.
Henry 1996 {published data only}
  • Henry C. Pin Sites: Do we need to clean them?. Practice Nursing 1996;7(4):12-7.
Lee 2012 {published data only}
Patterson 2005 {published data only}
W-Dahl 2003 {published data only}
  • W-Dahl A, Toksvig-Larsen S, Lindstrand A. No difference between daily and weekly pin site care. A randomized study of 50 patients with external fixation. Acta Orthopaedica Scandinavia 2003;74(6):704-8.
Yuenyongviwat 2011 {published data only}
  • Yuenyongviwat V, Tangtrakulwanich B. Prevalence of pin-site infection: the comparison between silver sulfadiazine and dry dressing among open tibial fracture patients. Journal of the Medical Association of Thailand  2011;94(5):566-9.

References to studies excluded from this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
Bednar 1996 {published data only}
  • Bednar DA, Raducan V. External spinal skeletal fixation in the management of back pain. Clinical Orthopaedics and Related Research 1996;322:131-9.
Bhattacharya 2006 {published data only}
  • Bhattacharya M, Bradley H. Antibiotics vs an antimicrobial dressing for pin-track infection. Wounds UK 2006;2(2):26-33.
Botte 1989 {published data only}
  • Botte MJ, Byrne TP, Garfin SR. Use of skin incisions in the application of halo skeletal fixator pins. Clinical Orthopaedics and Related Research 1989;246:100-1.
Davies 2005 {published data only}
Hutchinson 2000 {published data only}
  • Hutchinson DT, Bachus KN, Higgenbotham T. External fixation of the distal radius: to predrill or not to predrill. Journal of Hand Surgery 2000;25A(6):1064-8.
Kapoor 2000 {published data only}
  • Kapoor H, Agarwal A, Dhaon BK. Displaced intra-articular fractures of distal radius: a comparative evaluation of results following closed reduction, external fixation and open reduction with internal fixation. Injury 2000;31(2):75-9.
Lagerquist 2012 {published data only}
  • Lagerquist D, Dabrowski M, Dock C, Fox A, Daymond M, Sandau KE, Halm M. Care of external fixator pin sites. American Journal of Critical Care 2012;21(4):288-292.
Masse 2000 {published data only}
Moroni 2001a {published data only}
  • Moroni A, Faldini C, Marchetti S, Manca M, Consoli V, Giannini S. Improvement of the bone-pin interface strength in osteoporotic bone with use of hydrioxyapatite-coated tapered external-fixation pins. Journal of Bone and Joint Surgery 2001;85-A(5):717-21.
Moroni 2001b {published data only}
  • Moroni A, Heikkila J, Magyar G, Toksvig-Larsen S, Giannini S. Fixation strength and pin tract infection of hydroxyapatite-coated tapered pins. Clinical Orthopaedics and Related Research 2001;388:209-17.
Sproles 1985 {published data only}
  • Sproles KJ. Nursing care of skeletal pins: A closer look. Orthopaedic Nursing 1985;4(1):11-9.
Turcic 1998 {published data only}
  • Turcic J, Cavcic J, Smud D, Romic B, Golem AZ, Zupancic B. Conversion of osteosynthesis in war fractures [Osteosynthesenwechsel bei Kriegsfrakturen]. Unfallchirug 1998;101:476-81.
Vossinakis 2002 {published data only}
  • Vossinakis IC, Badras LS. The external fixator compared with the sliding hip screw for pertrochanteric fractures of the femur. Journal of Bone and Joint Surgery. British Volume 2002;84-B(1):23-9.
W-Dahl 2004 {published data only}
  • W-Dahl A, Toksvig-Larsen S. Pin site care in external fixation sodium chloride or chlorhexidine solution as a cleansing agent. Archives of Orthopaedic and Trauma Surgery 2004;124(8):555-8.

Additional references

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
Ahlborg 1999
Begg 1996
Behrens 1988
  • Behrens F. General theory and principles of external fixation. Clinical Orthopaedics and Related Research 1988;241:15-23.
Blaiser 1997
  • Blaiser RD, Aronson J, Tursky EA. External fixation of pediatric femur fractures. Journal of Pediatric Orthopaedics 1997;17(3):342-6.
Checketts 1999
  • Checketts RG, Moran CG, MacEachern AG, Otterburn M. Pin track infection and the principles of pin site care. In: De Bastiani G, Apley GA, Goldberg A editor(s). Orthofix external fixation in trauma and orthopaedics. Vol. 11, London, Berlin, Heidelberg: Springer-Verlag, 1999:97-103.
Deeks 2011
  • Deeks JJ, Higgins JPT, Altman DG, on behalf of the Cochrane Statistical Methods Group and the Cochrane Bias Methods Group (Editors). Chapter 9: Analysing data and undertaking meta-analyses. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org.
Gordon 2000
  • Gordon JE, Kelly-Hahn J, Carpenter C, Schoenecker P. Pin site care during external fixation in children: results of a holistic approach. Journal of Pediatric Orthopaedics 2000;20(2):163-5.
Grant 1992
  • Grant A, Atar D, Lehman W. Pin care using the Ilizarov apparatus: recommended treatment plan in Kurgan, Russia. Bulletin of the Hospital for Joint Diseases 1992;52(1):18-20.
Green 1983
  • Green S. Complications of external skeletal fixation. Clinical Orthopaedics and Related Research 1983;180:109-16.
Green 1984
  • Green S, Ripley M. Chronic osteomyelitis in pin tracts. Journal of Bone and Joint Surgery 1984;66-A(7):1092-8.
Higgins 2003
Higgins 2011
  • Higgins JPT, Altman DG, on behalf of the Cochrane Statistical Methods Group and the Cochrane Bias Methods Group (Editors). Chapter 8:  Assessing risk of bias in included studies. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org.
Holmes 2005
  • Holmes SB, Brown SJ. Skeletal pin site care: National Association of Orthopaedic Nurses guidelines for orthopaedic nursing. Orthopaedic Nursing 2005;24(2):99-107.
Jones-Walton 1991
  • Jones-Walton P. Clinical standards in skeletal traction pin site care. Orthopaedic Nursing 1991;10(2):12-6.
Kroll 1973
  • Kroll JA. The use of the 'Fixateur Externe' in infected fractures. Archivum Chirurgicum Neerlandicum 1973;25(2):137-49.
Lee-Smith 2001
  • Lee-Smith J, Santy J, Davis P, Jester R, Kneale J. Pin site management: toward a consensus, part 1. Journal of Orthopaedic Nursing 2001;5(1):37-42.
Lefebvre 2011
  • Lefebvre C, Manheimer E, Glanville J, on behalf of the Cochrane Information Retrieval Methods Group. Chapter 6: Searching for studies. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org.
Mahan 1991
McKenzie 1999
  • McKenzie LL. In search of a standard for pin site care. Orthopaedic Nursing 1999;18(2):73-8.
Moroni 1998
  • Moroni A, Aspenberg P, Toksvig-Larsen S, Falzarano G, Giannini S. Enhanced fixation with hydroxyapatite coated pins. Clinical Orthopaedics and Related Research 1998;346:171-7.
Saw 2006
  • Saw A, Chan CK, Penafort R, Sengupta S. A simple practical protocol for care of metal-skin interface of external fixation. Medical Journal of Malaysia 2006;61 (suppl A):62-65.
SIGN 2008
  • Scottish Intercollegiate Guidelines Network (SIGN). Search filters. http://www.sign.ac.uk/methodology/filters.html#random (accessed 2 June 2008).
Sims 1996
  • Sims M, Saleh M. Protocols for the care of external fixator pin sites. Professional Nurse 1996;11(4):261-4.
Sisk 1983
  • Sisk TD. External fixation: Historic review, advantages disadvantages, complications and indications. Clinical Orthopaedics and Related Research 1983;180:15-22.
Tolo 1983
Ward 1998
  • Ward P. Care of skeletal pins: a literature review. Nursing Standard 1998;12(39):34-8.
Wissing 1988