Highlights
- •Four arm Randomised Control Superiority Trial.
- •Comparison of effectiveness of three antiseptics against control in routine pin site care in Ilizarov external fixators.
- •Daily and weekly pin site care regimens within each group.
- •No superiority of any antiseptic over control in reducing the burden of pin site infection.
- •Daily pin site care not superior to weekly pin site care.
Abstract
Introduction
Pin site infection is the commonest complication of Ilizarov external fixation. The
aim of the study was to examine if use of antiseptics was superior over control and
further if daily dressing was superior to weekly dressing in regular pin site care
in reducing the burden of pin site infection in Ilizarov fixators.
Patients and methods
A total of 114 patients (2363 pin sites) were randomised to receive regular pin site
care alone (30 patients, 638 pin sites) or with additional application of povidone
iodine (27 patients, 561 pin sites), silver sulfadiazine (27 patients, 570 pin sites)
and chlorhexidine (30 patients, 594 pin sites). The pin tracts were sub-randomised
to receive daily (1212 pin sites) or weekly (1151 pin sites) dressings. The primary
outcome was pin site infection days rate across all four groups. The secondary outcomes
were - mean duration to first episode of infection, differences between daily and
weekly dressing groups, mean duration of antibiotic therapy and incidence of re-interventions
and sequelae. We also recorded frequency of bacterial pathogens in all microbiological
samples submitted. Block randomization using computer-generated random numbers was
used. The assessor of outcome was blinded.
Results
All patients completed the study. Pin site infection rate days per 1000 pin site days
observed was marginally less in chlorhexidine group, but was not statistically significant
compared to other antiseptics and control group (Absolute value in control, povidone
iodine, silver sulphadiazine and chlorhexidine groups were respectively 2.04 ± 4.27,
2.04 ± 3.65, 1.85 ± 3.37, 1.37 ± 2.35, p value 0.92). Daily dressing category showed
slightly less pin site infection days rate within each group and overall, but this
was also not statistically significant (1.56 ± 3.99 versus 2.10 ± 5.1, p value 0.35).
There was no statistically significant difference among the groups with regard to
other secondary outcomes. Methicillin Sensitive Staphylococcus aureus was the most common bacterial pathogen isolated.
Conclusion
Use of antiseptics does not offer any advantage in regular pin site care in Ilizarov
external fixation and daily pin site care is not superior to weekly pin site care.
Empirical therapy in early and low grade pin site infections must be targeted against
Staphylococcus.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to InjuryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Pin site care for preventing infections associated with external bone fixators and pins.Cochrane Database Syst Rev. 2013; 12 (CD004551)
- A systematic review of incidence of pin track infections associated with external fixation.J Limb Lengthening Reconstr. 2016; 2: 6-16
- A fresh consensus for pin site care in the UK.Int J Orthop Trauma Nurs. 2013; 17: 19-28
- Care of pin sites.Nurs Stand. 2008; 22: 44
- Routine pin tract care in external fixation is unnecessary: a randomized, prospective, blinded controlled study.Injury. 2012; 43: 1969-1973
- Comparison of povidone-iodine solution and soft white paraffin ointment in the management of skeletal pin-sites: a pilot study.J Orthop Nurs. 2005; 9: 218-225
- Antimicrobial gauze as a dressing reduces pin site infection: a randomized controlled trial.Clin Orthop Relat Res. 2012; 470: 610-615
- Multicenter pin care study.Orthop Nurs. 2005; 24: 349-360
- Pin site care in external fixation sodium chloride or chlorhexidine solution as a cleansing agent.Arch Orthop Trauma Surg. 2004; 124: 555-558
- Evaluation of effectiveness of 10% polyvinylpyrrolidone-iodine solution against infections in wire and pin holes for Ilizarov external fixators.Sao Paulo Med J. 2005; 123: 58-61
- Pin site care during circular external fixation using two different protocols.J Orthop Trauma. 2009; 23: 724-730
- Diluted povidone-iodine versus saline for dressing metal-skin interfaces in external fixation.J Orthop Surg (Hong Kong). 2009; 17: 19-22
- Treatment of external fixation pins about the wrist: a prospective, randomized trial.J Bone Joint Surg Am. 2006; 88: 349-354
- Efficacy of 1% silver sulphadiazine dressings in preventing infection of external fixation pin-tracks: a randomized study.Strategies Trauma Limb Reconstr. 2015; 10: 95-99
- Prevalence of pin-site infection: the comparison between silver sulfadiazine and dry dressing among open tibial fracture patients.J Med Assoc Thai. 2011; 94: 566-569
- No difference between daily and weekly pin site care A randomized study of 50 patients with external fixation.Acta Orthop Scand. 2003; 74: 704-708
- Care of external fixator pin sites.Am J Crit Care. 2012; 21: 288-292
- Prevention of pin site infection in external fixation: a review of the literature.Strategies Trauma Limb Reconstr. 2016; 11: 75-85
- From prevention of pin-tract infection to treatment of osteomyelitis during paediatric external fixation.Journal of child orthop. 2016; 10: 605-612
- Power (sample size) calculators. Sealed envelope.2018 (date last accessed 23 september 2018)
- Complications of limb lengthening. A learning curve.Clin Orthop Relat Res. 1994; 301: 10-18
Article info
Publication history
Published online: January 23, 2019
Accepted:
January 23,
2019
Footnotes
☆The work was done at Dept of Orthopaedics, Sri Sathya Sai Institute of Higher Medical Sciences - Prashanthigram, Puttaparthi, Andhra Pradesh, India – 515134.
Identification
Copyright
© 2019 Elsevier Ltd. All rights reserved.
