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Pin site care during external fixation in children: results of a nihilistic approach
J E Gordon1, J Kelly-Hahn, C J Carpenter
1Washington University School of Medicine and Shriners Hospital for Children, St. Louis, Missouri, USA. Gordone@msnotes.wustl.edu
Insights
Showering daily is sufficient pin site care for children with external fixators. This simple method, avoiding physical cleaning, resulted in low infection rates, with no pins removed due to infection.
Area of Science:
- Orthopedics
- Pediatric surgery
- Infectious disease
Background:
- External fixation is common in pediatric orthopedics.
- Pin site care is crucial to prevent infection.
- Current pin care protocols vary.
Purpose of the Study:
- To evaluate the efficacy of a simple pin care system in children with external fixators.
- To determine the infection rate associated with minimal pin site cleansing.
Main Methods:
- Prospective follow-up of 27 children with tibial external fixators.
- Utilized a simple pin care system: daily showers only.
- Graded pin site infections using the Dahl et al. scale (0-5).
- Recorded 4,473 observations over two years.
Main Results:
- 178 pin tract infections occurred (4.0% per observation).
- Most infections were low-grade (151 Grade 1, 27 Grade 2).
- No pins were removed due to infection.
- Diaphyseal half pin sites had lower infection rates (1.6%) than periarticular sites (4.5%).
Conclusions:
- Daily showering alone is an effective pin site care method for pediatric external fixation.
- This approach minimizes complications and avoids the need for extensive pin cleansing.
- Simplifying pin care can reduce the risk of infection and improve patient outcomes.
Abstract:
We prospectively followed 27 consecutive children with tibial circular external fixators applied between July 1, 1995, and June 30, 1997. A simple pin care system with no physical pin cleansing except that provided by daily showers was used. Children with inflamed or infected pin sites were placed on an oral antibiotic (cephalexin) for 10 days. Pin sites were graded according to the system of Dahl et al. on a 0 to 5 scale. A total of 4,473 observations was made. Patients developed 178 pin tract infections (4.0% per observation), with 151 (85%) grade 1 and 27 (15%) grade 2 infections. No pin was removed because of infection. Diaphyseal half pin sites were less commonly infected (1.6%) than periarticular wire or half pin sites (4.5%). We recommend only showering without other physical pin cleaning procedures in children undergoing external fixation procedures.