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Pin site care for preventing infections associated with external bone fixators and pinsLethaby A, Temple J, Santy J
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SummaryPin site care regimens to reduce infection and complications associated with external bone fixators and pinsMetal 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 cared for may affect the frequency of infection. Different solutions are used for cleaning around pins, different dressings can be used, scabs may or may not be removed and massage might be used to drain fluids around the pin. This review found no evidence for the best pin care technique to minimise the chance of infection and other complications.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2008 Issue 3, Copyright © 2008 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This version first published online:
January 26. 2004 AbstractBackgroundMetal pins are used to apply skeletal traction or external fixation devices in the management of orthopaedic fractures. These pins protrude through the skin (described as 'percutaneous') and the way in which they are treated after insertion may affect the incidence of pin site infection. This review set out to summarise the evidence on the effect of pin site care on infection rates. ObjectivesTo assess the effect on infection rates of different methods of cleansing and dressing orthopaedic percutaneous pin sites. Search strategyFor this first update the following electronic databases were searched: the Wounds Group Specialised Trials Register (searched June 2008); CENTRAL (2008, Issue 2); Ovid Medline (1950 to May 2008), Ovid EMBASE (1980 to May 2008) and Ovid CINAHL (1982 to May 2008). In addition, reference lists of review articles and relevant trials were also searched and some handsearching undertaken. Selection criteriaAll randomised controlled trials (RCTs) comparing the effect on infection and other complication rates of different methods of cleansing or dressing orthopaedic percutaneous pin sites were evaluated. Data collection and analysisTwo review authors independently assessed the citations retrieved by the search strategies for reports of relevant RCTs, independently selected trials that satisfied the inclusion criteria, extracted data and undertook quality assessment. Main resultsFor this first update an additional five trials were identified, in total six trials (349 participants) were eligible for inclusion in the review. Three trials compared a cleansing regimen with no cleansing, 2 trials compared cleansing solutions, 1 trial compared identical pin site care performed daily or weekly and 4 trials compared dressings. One of these trials reported that infection rates were lower (9%) with a regimen that included cleansing with half strength hydrogen peroxide and application of Xeroform dressing when compared with other regimens with different cleansing and dressing regimens (rates >26%) but this may be a chance difference. There was no evidence of a difference between groups in any of the other trials. No trials were identified that compared any dressing versus no dressing or different massage regimens. Authors' conclusionsThere is insufficient evidence for a particular strategy of pin site care which minimises infection rates. Adequately powered randomised trials are required to examine the effects of different pin care regimens and co interventions such as antibiotic use and other extraneous factors must be controlled in the study designs. |
