Future directions in the prevention of pin-site infection: A scoping review

Abstract

Context: Pin-site infections are a common complication associated with the use of external fixators. While many different pin-site care protocols have been described, there is no universally accepted and effective method to eliminate this issue. Further research in this area is necessary. Aims: This scoping review evaluates published research dedicated to investigating potential new methods of pin-site infection prevention. Settings and Design: A scoping review was performed with a structured search of MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature (EBSCO platform), Scopus, Web of Science, and the Cochrane Library using a range of terms related to pin-site infection. Methods: A qualified librarian carried out the search between February 7, 2021, and September 7, 2021. Studies involving human and animal experiments as well as in vivo and in vitro experiments that evaluated modifications to the pin–skin and bone–pin interface, as well as pin surface morphology, were included. Studies based on the type of intervention and the reported outcomes of infection prevention were evaluated. Results: Four thousand six hundred and twenty-two studies using this search strategy were identified. Following screening and full-text review, 33 studies fit the criteria and were included in this review. Thirty studies involved research that evaluated integration at the bone–pin interface and three studies assessed the pin–skin interface. Conclusions: The review identified a very diverse group of modalities. The majority of the research focused on coating with compounds that possess antibacterial properties or modifications to surface morphology to improve the integration of the pin or wire at the bone–pin interface. While most of the researches did not involve human trials, this review highlights the future directions of pin- and wire-site management in an effort to eliminate or minimize the risk of pin-site infections.