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Primary Suture Closure of External Fixation Pin Sites After Removal Has a Lower Risk of Infection Compared With Pin
Molly Sekar1, Jackson Woodrow1, Lindsey Lamb2
1Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, AZ.
Closing external fixation pin sites after removal reduces surgical site infection (SSI) risk compared to leaving them open. This finding can improve patient outcomes and decrease infection rates following external fixation procedures.
Area of Science:
- Orthopedic surgery
- Infectious disease control
- Biomedical engineering
Background:
- External fixation is a common orthopedic procedure for extremity fractures.
- Pin site care after external fixation removal is crucial for preventing surgical site infections (SSI).
- Current practices for pin site management after external fixator removal vary, necessitating evidence-based guidelines.
Purpose of the Study:
- To compare the incidence of surgical site infections (SSI) after external fixation removal.
- To evaluate infection rates between primarily closed pin sites and those left open to heal by secondary intention.
- To identify risk factors associated with pin site SSI after external fixator removal.
Main Methods:
- Retrospective, multi-center study involving 412 adult patients undergoing external fixator removal for extremity fractures.
- Patients were stratified into two groups: primarily closed pin sites and pin sites left open for secondary intention healing.
- Surgical site infection (SSI) rates were compared between the two cohorts, with follow-up of at least 30 days.
Main Results:
- Leaving pin sites open after external fixator removal was associated with a significantly increased odds of SSI (OR=3.2; p<0.01).
- Tibial plateau fractures were also identified as an independent risk factor for pin site SSI (OR=4.45; p<0.001).
- The median duration of external fixator use was shorter in the closed pin site group (11 days) compared to the open group (19 days).
Conclusions:
- Primary closure of external fixator pin sites after removal is associated with a lower risk of SSI compared to secondary intention healing.
- These findings suggest that adopting primary closure for pin sites can help reduce SSI rates in patients undergoing external fixation.
- Implementing evidence-based pin site closure protocols can enhance patient safety and decrease the incidence of SSIs in orthopedic trauma care.
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