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Pin Tract Infections in Pediatric Open Long Bone Fractures: Common but Clinically Manageable
Britta Chocholka1,2, Lara Marie Bogensperger1,2, Vanessa Groß1,2
1University Clinic of Orthopedics and Trauma Surgery, Department of Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
Insights
Pin tract infections (PTIs) are common in pediatric open long bone fractures treated with external fixation. Most PTIs are superficial and successfully managed with conservative care, leading to good fracture healing.
Area of Science:
- Orthopedic surgery
- Pediatric trauma care
- Infectious disease management
Background:
- Pin tract infections (PTIs) are a frequent complication of external fixation in pediatric patients.
- Limited data exists on pediatric-specific PTIs, especially for open long bone fractures.
Purpose of the Study:
- To evaluate the frequency, severity, timing, management, and outcomes of PTIs in children and adolescents with open long bone fractures treated with external fixation.
Main Methods:
- Retrospective single-center study of patients under 18 years with open long bone fractures treated with external fixation (2002-2023).
- PTIs graded using the Checketts-Otterburn classification.
- Management strategies and time to bony consolidation were analyzed.
Main Results:
- 16 out of 40 patients developed PTIs, with most being mild.
- The median time to PTI onset was 49 days, often after initial antibiotic therapy.
- Conservative management was effective for mild PTIs; moderate/severe cases required antibiotics and sometimes hardware intervention. No osteomyelitis was observed.
Conclusions:
- Pin tract infections are common in pediatric open long bone fractures managed with external fixation.
- The majority of PTIs are superficial and manageable with conservative measures.
- All fractures achieved radiological consolidation, with reoperations primarily linked to trauma severity.
Abstract:
Background: Pin tract infections (PTIs) are a frequent complication of external fixation, yet pediatric trauma-specific data-particularly for open long bone fractures-remain limited and heterogeneous. This study evaluated the frequency, severity, timing, management, and outcomes of PTIs in children and adolescents treated with external fixation for open long bone fractures. Methods: This retrospective single-center study included patients younger than 18 years with open long bone fractures treated with external fixation between 2002 and 2023. PTIs were graded using the Checketts-Otterburn classification (grades I-VI). Management included antibiotic regimen and surgical interventions. Outcome was reported by time to bony consolidation. Results: In 40 patients, 16 patients exhibited PTIs (mild: eight; moderate: five; severe: three. A higher grade of Gustilo-Anderson (p = 0.47) and evident macroscopic contamination (p = 0.73) did not appear to influence the occurrence of PTIs by similar duration of initial antibiotic regimen (p = 0.3). The median time to PTI onset was 49 days (IQR 22-80), with the majority occurring after completion of initial systemic antibiotic therapy. The management of PTIs was predominantly conservative: all eight mild cases resolved with intensified local pin tract care, while all eight moderate and severe cases were treated with systemic antibiotics and five required pin exchange or premature fixator removal. Overall bony consolidation was achieved in all patients, and reoperations were related to trauma severity rather than PTIs except in one patient. No cases of osteomyelitis were observed. Conclusion: Pin tract infections are frequently identified in pediatric open long bone fractures treated with external fixation. Using strict diagnostic criteria, any documented inflammatory change or local secretion at the pin-skin interface is considered indicative of PTI. However, the majority of these infections were classified as superficial and manageable with conservative measures, and all affected fractures healed radiologically.
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