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Management of pin tract infection in pediatric supracondylar humerus fractures: a comparative study of three methods
1From Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuanxi Road, Wenzhou, 325000, China.
Insights
Daily, every other day, or weekly pin care for pediatric supracondylar humerus fractures showed no difference in pin tract infection rates. However, daily care increased patient pain and parental anxiety.
Area of Science:
- Orthopedic surgery
- Pediatric trauma care
- Infection control in fractures
Background:
- Pin site infection is a common complication following fracture fixation with percutaneous pins.
- Closed reduction and percutaneous K-wire fixation are standard treatments for pediatric supracondylar humeral fractures.
Purpose of the Study:
- To prospectively compare the incidence of pin tract infection in pediatric supracondylar humerus fractures based on pin care frequency.
- To evaluate the effectiveness of daily, every other day, and weekly pin care regimens.
Main Methods:
- 135 pediatric patients with supracondylar humerus fractures were randomized into three groups for postoperative pin care: daily, every other day, or weekly.
- Data collected included pin retention time, union time, and pin tract infection rates using the Checketts-Otterburns classification.
- Patient demographics and intraoperative variables were comparable across groups.
Main Results:
- No significant differences in union time or pin fixation time were observed between the groups.
- Overall, 35.6% of patients experienced pin tract infection (28.9% Grade I, 6.7% Grade II).
- No statistically significant differences in the frequency or severity of pin tract infections were found among the three pin care groups (P > 0.05).
Conclusions:
- All three pin care frequencies (daily, every other day, weekly) are effective in managing pin site infections in pediatric supracondylar humerus fractures.
- Daily pin care, while effective, was associated with increased patient pain and parental anxiety.
- Less frequent pin care may be preferable to minimize patient and parental distress without compromising infection control.
Abstract:
The objective of this study was to prospectively compare the incidence of pin tract infection in pediatric supracondylar humerus fractures managed with pin care daily or every other day or weekly. We hypothesized that there were some differences between these three methods. From June 2012 to May 2015, 135 children with supracondylar humerus fractures were randomized to postoperative pin care by cleaning pin tracts daily (group A, 45 cases) or cleaning every 2 days (group B, 45 cases) or cleaning weekly (group C, 45 cases). The three groups were comparable with respect to age, gender, affected side, body mass index (BMI), fracture type, injury to surgery time, number of intraoperative percutaneous pinning, and follow-up time. We collected data on pin retention time, union time, and pin tract infection. The average follow-up time of group A was 4.5 ± 1.3 and 4.2 ± 1.6 months in group B and 4.3 ± 1.4 months in group C. The patient demographics and intraoperative variables of three groups were comparable. No significant difference between these three groups was found in union time and pin fixation time. Of the 135 children, 48 (35.6%) cases had pin tract infection. Grade I infections (Checketts-Otterburns classification) occurred around 28.9% of 270 pin and grade II around 6.7%. We found no differences between three groups as regards frequency and severity of pin tract infections (both P > 0.05). However, complain of pain was more frequent in group A than other two groups (P < 0.05).
Conclusions:
All of the three methods were effective for the management of pin site infection in pediatric supracondylar humerus fractures. However, excessive frequent care as well as pin care daily had the disadvantages of child's fear and parental anxiety. What is Known: • Pin site infection is a common complication after fracture fixation and bone lengthening using percutaneous pins or wires. • Closed reduction and percutaneous K-wires fixation are the mainstay of treatment in pediatric supracondylar humeral fractures. What is New: • All of the three methods were effective for the management of pin site infection. • Excessive frequent care as well as pin care daily has the disadvantages of child's fear and parental anxiety.
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