Long-term bactericidal properties of a gentamicin-coated antimicrobial external fixation pin sleeve.

Abstract

External fixation is a versatile method of fracture treatment. However, pin-track infections remain a major complication. Despite the routine use of antibiotics, pin-track infections occur in 57% to 75% of cases1,2. One factor contributing to the high prevalence of infection is the access that the pin track provides to bacteria and the ability of bacteria to colonize the metal surface of the pin or wire. The OrthoGuard AB antimicrobial sleeve (Smith and Nephew, Memphis, Tennessee) inhibits bacterial colonization on external fixation pins and wires by providing sustained local delivery of gentamicin to the pin or wire site. In order for local antibiotic delivery to be bactericidal, (1) the antibiotic must be effective against pathogens common to pin-track infections and (2) the sleeve must deliver an effective dose into the pin track in a sustained manner. The purpose of the present study was to evaluate the results of in vitro testing in order to establish the long-term bactericidal properties of the OrthoGuard AB antimicrobial sleeve. The OrthoGuard AB sleeve consists of polyurethane tubing that has a thin gentamicin-loaded coating on its inner and outer surfaces. After insertion of the fixation pin or wire, the sleeve is placed over the pin or wire and is manually pushed through the subcutaneous tissue up to the point of contact with the bone (Fig. 1). The sleeve is measured and cut before placement so that at least 1 cm of the sleeve is protruding from the skin surface in order to allow for …