Pin tract infection prophylaxis and treatment

Area of Science:

• Orthopedic surgery
• Infectious disease management

Background:

• Pin tract infection is a frequent complication of external fixation (ExFix).
• Infections can lead to implant loosening, osteomyelitis, and loss of fixation.
• Current diagnostic methods for pin tract infection are empirical with low validity.

Purpose of the Study:

• To review the current understanding of pin tract infections in external fixation.
• To explore the infection rates and management strategies following conversion to intramedullary nailing (IMN).
• To highlight the need for better evidence and standardized protocols.

Main Methods:

• Literature review of studies on external fixation pin tract infections.
• Analysis of existing evidence regarding conversion from ExFix to IMN.
• Identification of gaps in current knowledge and practice.

Main Results:

• Distinction between minor (soft tissue) and major (bone involvement) infections is possible.
• Data on infection rates after ExFix to IMN conversion is scarce and of low evidence level (IV or V).
• A two-step regimen for ExFix to IMN conversion is suggested, with an uncertain optimal time interval (potentially within 9 days).

Conclusions:

• There is a lack of consensus on prophylaxis protocols before conversion.
• Further research and the establishment of registries are crucial for better understanding and management of infections.
• Standardized protocols and higher evidence-level studies are needed for pin tract infection management.