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

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.

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

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.

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.

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

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.

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.