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 (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.

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

For 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.

All 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.

Two 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.

For 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.

There 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.