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

  • Review
  • Intervention

Authors

  • J Temple,

  • J Santy


Jenny Temple, Senior Lecturer, Institute of Health Studies, University of Plymouth, Room C 414 Portland Square, Drake Circus, Plymouth, Devon, PL4 8AA, UK. j.temple@plymouth.ac.uk.

Abstract

Background

Metal pins are used to apply skeletal traction or external fixation devices in the management of orthopaedic fractures. These pins protrude through the skin and are therefore described as 'percutaneous' and much has been written on the management of the associated skin wound. The way in which percutaneous pins are treated may affect the incidence of pin site infection. Recommendations for care are not necessarily evidence based. This review set out to summarise the research evidence on the effect of pin site care on infection rates.

Objectives

To assess the effect on infection rates of different methods of cleansing and dressing orthopaedic percutaneous pin sites.

Search strategy

The following electronic databases were searched: Medline (from 1966), the Cochrane Central Register of Controlled Trials (2003 issue 1) and the Wounds Group Specialised Trials Register (March 2003). In addition reference lists of review articles and relevant trials were also searched and some handsearching undertaken.

Selection criteria

All randomised controlled trials (RCTs) in people comparing the effect on infection rates of different methods of cleansing or dressing orthopaedic percutaneous pin sites were evaluated.

Data collection and analysis

Two reviewers independently assessed the citations retrieved by the search strategies for reports of relevant RCTs.

Main results

Only one trial was eligible for inclusion in the review. Henry (1996) compared cleansing with 0.9% saline, cleansing with 70% alcohol and no cleansing and found significantly fewer infections in pin sites which had not been cleansed.

Authors' conclusions

There is very little evidence as to which pin site care regimen best reduces infection rates. Clearly there is a need for large RCTs to determine the best method of pin site management.

Plain language summary

Plain language summary

No strong evidence about insertion, care and removal techniques for pins used for attaching traction or other fixation devices into broken arms and legs

Metal pins are sometimes used to apply traction or other external fixation devices into broken arms or legs. These pins pierce through the skin. The way they are inserted, cared for and removed may affect the frequency of infection. Different solutions are used for cleaning around pins, scabs may or may not be removed and massage might be used to drain fluids around the pin. There are different kinds of pins, loosening regimes and removal techniques. However, the review of trials found that there is little strong evidence to show which pin care techniques have the best outcomes.

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