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Multicenter Study of Pin Site Infections and Skin Complications Following Pinning of Pediatric Supracondylar Humerus
Kristen Combs1, Steven Frick2, Gary Kiebzak2
1Medical Student, University of Central Florida College of Medicine, Orlando, FL.
Insights
The incidence of pin site infection following pediatric humerus fracture surgery is low at 0.81%. Factors like preoperative antibiotics and prolonged pin duration may influence infection risk in pediatric patients.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Infectious Disease
Background:
- Pediatric supracondylar humerus fractures are common elbow injuries in children.
- Surgical fixation with pins is standard for displaced fractures.
- Pin site infections are a potential complication with variable reported rates.
Purpose of the Study:
- To determine the incidence rate of pin site infection after surgical fixation of pediatric humerus fractures.
- To identify pre-, peri-, and postoperative factors associated with pin site infection.
Main Methods:
- Retrospective chart analysis of patients who developed pin site infections over one year.
- Inclusion of a cast care form in electronic medical records to identify infections.
- Detailed chart review recording preoperative antibiotics, pin details, immobilization, dressings, and duration.
Main Results:
- A total of 369 patients underwent operative reduction, pinning, and casting.
- Three patients (0.81%) developed a pin site infection.
- Descriptive statistics were compiled for patients with infections and complications.
Conclusions:
- The incidence of pin site infection is low following this procedure.
- Potential contributing factors include preoperative antibiotic use, duration of pin placement, and cast changes before pin removal.
Introduction:
Pediatric supracondylar humerus fractures are the most common elbow fractures in pediatric patients. Surgical fixation using pins is the primary treatment for displaced fractures. Pin site infections may follow supracondylar humerus fracture fixation; the previously reported incidence rate in the literature is 2.34%, but there is significant variability in reported incidence rates of pin site infection. This study aims to define the incidence rate and determine pre-, peri-, and postoperative factors that may contribute to pin site infection following operative reduction, pinning, and casting.
Methods:
A retrospective chart analysis was performed over a one-year period on patients that developed pin site infection. A cast care form was added to Nemours' electronic medical records (EMR) system (Epic Systems Corp., Verona, WI) to identify pin site infections for retrospective review. The cast care form noted any inflamed or infected pins. Patients with inflamed or infected pin sites underwent a detailed chart review. Preoperative antibiotic use, number and size of pins used, method of postoperative immobilization, pin dressings, whether postoperative immobilization was changed prior to pin removal, and length of time pins were in place was recorded.
Results:
A total of 369 patients underwent operative reduction, pinning, and casting. Three patients developed a pin site infection. The pin site infection incidence rate was 3/369=0.81%. Descriptive statistics were reported for the three patients that developed pin site infections and three patients that developed pin site complications.
Conclusion:
Pin site infection development is low. Factors that may contribute to the development of pin site infection include preoperative antibiotic use, length of time pins are left in, and changing the cast prior to pin removal.
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