Incidence Of Pin Tract Infection Research Articles

Tibial fractures treated with mono-lateral fixation: Principles of design and application.

This paper presents the outcome of a data review of patients treated with the IOS external fixation system at the Royal Stoke University Hospital: a fixation designed to meet four requirements for external fixation proposed in this paper. Demographic data and outcome were collected and assessed. From 69 initial patients, 64 patients (55 males and 9 females) had an average age of 35.9 years. The mean time to union was 127 days. There were no incidences of malunion, or refracture post fixation removal attributable to the treatment method. In addition, in this cohort, there was no incidence of pin tract infection resulting in osteomyelitis. Of all the factors assessed the only factor to have any significant effect on healing was smoking: an average delay of 31 days. An examination of RUST (radiographic union score tibia) and modified RUST scores illustrated a potential false negative of up to 80%. Hence, this study cannot support the use of either scoring system to diagnose fracture healing. IOS external fixation was shown to be an effective method for the treatment of unstable tibial fractures. The reduction at fixation removal was shown to be very good. There was no incidence of osteomyelitis. It is, therefore, suggested that appropriately used external fixation is a viable alternative to intramedullary nailing if designed and surgically applied using four design principles outlined in this paper. Furthermore, it is proposed that external fixation be designed and applied to meet these four principles.

Hemilateral bone longitudinal transport technique for the treatment of hemilateral defects of long bones of lower limbs

To explore clinical efficacy of Ilizarov hemilateral bone longitudinal transport technique in treating hemilateral bone defects associated with chronic osteomyelitis of lower extremity long bones. Clinical data of 13 patients with hemilateral bone defects caused by chronic osteomyelitis of lower extremity long bones and treated by Ilizarov hemilateral bone longitudinal transport technique were retrospective analyzed, including 10 males and 3 female, aged from 14 to 55 years old;4 patients occurred femoral and 9 patients occurred tibial;10 patients were diagnosed as traumatic osteomyelitis and 3 patients as hematogenous osteomyelitis. The anatomical classification of Cierny-Mader in 13 patients was type Ⅲ. Bone and wound healing, postopertaive complication, and bony and functional results were observed by Paley evaluation standard. After removing external fixator, all patients were followed up from 6 to 70 months. Transporting time ranged from 54 to 158 d. And the time in external fixation ranged from 6.8 to 19.5 months. External fixation index (EFI) ranged from 1.23 to 1.6 months/cm. According to Paley's evaluation criteria, bony results were excellent in 13 patients;functional results showed excellent in 12 patients and good in 1 patient. Two patients occurred poor union on the docking sites and healed with autogenous iliac bone graft. The callus at the extended area was poorly mineralized and improved significantly when treated with low-intensity pulsed ultrasound in one patient. All patients had good wound healing without recurrence of osteomyelitis and refracture. There was no vascular and nerve injury and axial deviation in all patients and they were satisfied with the appearance and function of lower limbs. The range of motion of knee and ankle joint before operation was 120 ° to 150 ° and 35 °to 80 ° respectively, and at the latest follow-up was 110 ° to 140 ° and 30 ° to 75 ° . Ilizarov hemilateral bone longitudinal transport technique is effective in treating infective hemilateral bone defects of lower extremity long bones, which could not only simplify architecture of external fixation, but also reduce the number of fixation pins, shorten the time in external fixator and decrease the incidence of pin tract infection. However, this technique is highly demanding, and the growth of callus in extended region and healing of bone apposition should be noticed.

Microbiological Profile of Pin Tract Infections due to External Fixators

Introduction: Pin tract infections are complications associated with external fixators. Proper diagnosis and treatment can prevent further complications related to the infection. There are limited numbers of studies on this infection and thus treatment is usually based on individual’s experience. Therefore, this study was undertaken to have a better understanding of pin tract infections and to help us establish a treatment protocol in the hospital. Aim: To determine the incidence of pin tract infections among all patients who have external fixators, to identify the causative agents and study their antibiotic sensitivity pattern. Materials and Methods: The present study was a cross-sectional study which was conducted in a tertiary hospital for patients who had external fixators. After obtaining ethical clearance and informed consent from the patient, all patients were monitored and if there was clinical suspicion of infection, discharge/pus was collected from the infection site and processed in the microbiology laboratory as per standard laboratory protocol to isolate and identify the causative agent. Antimicrobial susceptibility using Kirby Bauer’s disc diffusion method. Statistical analysis was done by using Microsoft excel 2010. Results: It was found that out of the 30 patients included in the study, six patients showed clinical evidence of pin tract infections with male preponderance. The most common isolate was Acinetobacter baumanii followed by Pseudomonas aeruginosa, Citrobacter koseri with variable antibiotic susceptibility pattern. Conclusion: Pin tract infection occurred in 20% of the patients. Early diagnosis and treatment prevents complications which further reduces the cost of treatment and the number of days of hospital stay.

To asses the union time and pin track infection rate in ilizarov fixator using the Russian and rancho hybrid fixation technique

Introduction: The treatment of complex proximal tibial fractures with ilizarov external fixators is slowly gaining more popularity and acceptability in traumatology, complex tibial plateau fractures pose a significant risk of soft tissue problems, edema and compartment syndrome, its management throws a great challenge. These fractures were treated with ilizarov external fixators. Materials and Methods: The prospective study was conducted in JSS Medical College and Hospital over a period of April 2016 to September 2017. A total of 30 patients who were treated with ilizarov ring external fixator for schatzkers type V and VI tibial plateau fractures were included in the study, each patients were randomly assigned to be treated with two methods, the Russian technique and the Rancho hybrid fixation technique, these patients were followed up and their data with regard to fracture union time and pin tract infections were collected in a Microsoft excel and the results were scrutinised. Results: There was a predominantly male population and the road traffic accidents was the most common followed by self-fall, The mean union time was 18.27+_1.79 weeks in the Russian technique and 23.47+_2.72 weeks in the rancho hybrid system the union time was assessed using the RUST criteria and The Rancho technique pin tract infection rate was 20% and it was 26.67% in the Russian technique, the incidence of pin tract infection was even though a little higher in the Russian technique the difference was not statistically significant (OR1.45(0.26-8.1)p0.5) the pin track infection was graded using the checkers and buns. Conclusion: the ilizarov Russian technique fares over the rancho hybrid fixation technique in achieving union earlier by enhancing the micromotion at the fracture site being a less rigid construct. Keywords: Ilizarov fixator, Russian technique, Rancho technique, Schatzkers type V and VI fractures, Union time, Pin tract infections.

Ilizarov ring fixator for management of Schatzker type v and vi fractures of proximal tibia: A study of 30 cases

Introduction: Bicondylar tibia fractures are mostly treated by ORIF in a staged manner and involve lot of periosteal stripping and soft tissue disruption with potential complications of infection, hardware failures, compartment syndrome and delayed ambulation. Trans-osseous osteosynthesis using Ilizarov ring fixator seems to be a better emerging option for treating such fractures with minimal complications and better clinical and functional outcome. The aim of this study is to evaluate the role of Ilizarov ring fixator in Schatzker type V and VI fractures of proximal tibia. Methods: 30 patients with these injuries were included in the study after careful inclusion and exclusion criteria. All underwent standard Ilizarov ring fixation method with trans- fixation of knee in type VI fractures, which was removed at around 3 - 4 weeks and knee mobilization was started. Early weight bearing was encouraged in all cases except two with humerus fracture. Clinical followup was done at monthly intervals along with radiological evaluation. Pin site care was repeatedly stressed for and taught. Final follow up was done at six months post frame removal and Karlstrom-Olerud scoring system was used to analyze the final outcome. Results: There was no incidence of superficial or deep infection. All the fractures healed in time. Incidence of pin tract infection was 26.6% but it resolved with proper dressings and antibiotics. Average union time was around 17.46 weeks. There was no incidence of deep vein thrombosis or compartment syndrome or peroneal nerve injury. Overall result was Excellent in 12 cases, Good in 11 cases, Fair in 4 cases and Poor in 3 cases. Conclusion: Ilizarov fixator is a good, reliable and easily reproducible method of treating such fractures with early return to pre-injury levels in most of the cases.

A comparative study of the anatomical and functional outcome between Joshi’s External Stabilization System and Kirschner wire fixation technique for Extra-articular Metacarpal fracture

A comparative study of the anatomical and functional outcome between Joshi’s External Stabilization System and Kirschner wire fixation technique for Extra-articular Metacarpal fracture - IJOS- Print ISSN No: - 2395-1354 Online ISSN No:- 2395-1362 Article DOI No:- 10.18231/j.ijos.2020.002, Indian Journal of Orthopaedi

The Incidence of Pin Tract Infections and Septic Arthritis in Percutaneous Distal Femur Pinning.

Retrograde percutaneous pinning often involves intra-articular pin placement. Classic teaching has cautioned about the risk of septic arthritis with intra-articular pins, although an incidence has not been reported for this complication. The purpose of this study was to determine the incidence of pin tract infections and septic arthritis following retrograde percutaneous pinning of the distal femur. A retrospective review identified patients who underwent retrograde percutaneous pinning of the distal femur for osteotomy or physeal fracture fixation at a tertiary pediatric hospital from 2006 to 2017 and had at least 3 months follow-up. The incidence of pin site infections and septic arthritis was determined. In total, 163 patients met criteria, 142 patients with osteotomies and 21 with physeal fractures. The mean pin duration was 33.2±9.0 days (range: 18 to 68 d). Pin duration of ≥30 days was associated with an increased rate of pin tract infections (11.2% vs. 1.4%, P=0.01). The incidence of pin tract infections was 6.7% (11/163), including 9.5% (2/21) in those with fractures and 6.3% (9/142) following osteotomy (P=0.64). There were no cases of septic arthritis. Of the 11 patients with pin tract infections, 9 were treated successfully with oral antibiotics and 2 patients (1.2%) underwent surgical intervention for infection. Treatment of pin infections with oral antibiotics alone was successful in all 7 patients whose pins were removed within 35 days of surgery, but in only 2 of 4 whose pins were removed later (P=0.11). Of the 2 patients who required irrigation and debridement, one had a superficial pin site infection and retained subcutaneous pin and the other had a pin tract abscess and osteomyelitis at the osteotomy site. Of 163 patients who underwent retrograde percutaneous pinning of the distal femur, no patient developed septic arthritis and the incidence of pin site infections was 6.7% (11/163). Intra-articular retrograde percutaneous pinning of the distal femur is a safe technique with a low risk of septic arthritis. Level III-case-control study.

Effectiveness of minimally invasive osteotomy Ilizarov technique combined with intramedullary nail for femoral lengthening

To explore the effectiveness of minimally invasive osteotomy Ilizarov technique combined with intramedullary nail for femoral lengthening. Seventy-one patients with femoral shortening deformity who met the selection criteria between January 2013 and June 2016 were randomly divided into trial group (36 cases were treated with minimally invasive osteotomy Ilizarov technique combined with intramedullary nail for femoral lengthening) and control group (35 cases were treated with simple Ilizarov technique for femoral lengthening). There was no significant difference in age, gender, causes of femoral shortening, length of femoral shortening, rate of femoral deformity between the two groups ( P>0.05). The operation duration, intraoperative blood loss, lengthening rate, external fixation duration, frequency of pin tract infection, osteotomy healing time, and range of motion (ROM) of knee at 1 year after operation were recorded and compared between the two groups. The patients of two groups were followed up 12-60 months (mean, 31 months). Pin tract infection occured in 8 cases (10 pins), including 1 case (1 pin) in the trial group and 7 cases (9 pins) in the control group. There was significant difference in the incidence of pin tract infection between the two groups ( χ2=5.265, P=0.022). All patients were cured by replacing the fixation pins, changing dressing actively, application of antibiotics, and adequate postoperative care. The operation duration, intraoperative blood loss, external fixation duration, osteotomy healing time, and ROM of knee at 1 year after operation of the trial group were superior to those of the control group, showing significant differences ( P<0.05). There was no significant difference in the lengthening rate between the two groups ( t=-1.581, P=0.153). The minimally invasive osteotomy Ilizarov technique combined with intramedullary nail in femoral lengthening increases the operation time, but the external fixation duration and incidence of pin tract infection are significantly reduced and the function of knee is significantly improved.

Pin tract infection after uniplanar external fixation of open fractures at a national, teaching and referral hospital

Background: Pin tract infection is the most common complication of external fixation accounting for 43% of complications. The presence of a pin tract infection leads to subsequent pin loosening and fixation failure. It also delays conversion of an external fixator to internal fixation until clearance of the infection is achieved. The incidence of pin tract infections in our setting is not known. This study was aimed at determining the incidence and microbe profile of pin tract infection in patients who have undergone uniplanar external fixation following open fractures at Kenyatta National Hospital.Methods: Consecutive sampling of patients who had undergone uniplanar external fixation at Kenyatta National Hospital (KNH) was done between September 2016 and December 2016. 73 patients were recruited. Data concerning presence of pin tract infection was collected. Patients with discharging sinuses had a culture and sensitivity done while those with major pin tract infection had immediate x-rays done to rule out radiological changes.Results: Incidence of pin tract infection was 87.7% (64 of 73 patients). Staphylococcus aureus (30.2%) and coagulase negative staphylococci (16.3%) were the commonest causative organisms.Conclusion: The incidence of pin tract infection after uniplanar external fixation is high. Better surgical technique and pin-site care is recommended. Staphylococcus aureus is the leading cause of pin site infection.

Use of recycled external fixators in management of compound injuries

ABSTRACTBackground: Compound fractures form a bulk of Orthopaedic Trauma cases in a developing country like India. External Fixation devices are the mainstays of treatment of these open fractures. They are generally used as a one use disposable device and add a great burden to the health care costs, especially in a developing country. In our study we evaluated the efficacy and complication rate of recycled external fixators with that of new external fixators.Materials and methods: This was a prospective randomised interventional study conducted in a tertiary care teaching hospital of a developing country. Patients who fulfilled the inclusion criteria were entered into the trial of new vs. recycled external fixators. Outcome indicators used were pin tract infections, loss of fixation and loosening of components.Results: Patients were evaluated at the time of removal of fixator components for outcome indicators. Of the 95 patients in our study (49 new frames and 46 recycled frames) no significant difference was found in the incidence of pin tract infection (8.16% in new vs. 8.69% in recycled), loss of fixation (10.2% in new vs. 13.04% in recycled) and loosening of components (6.12% in new vs. 8.69% in recycled).Conclusion: Around 17% of consentable patients did not want to have an external fixator system with recycled components. Our study concluded that recycling of external fixator components is safe and equally effective, with sizable cost saving.

Bridging external fixation versus non-bridging external fixation for unstable distal radius fractures: A systematic review and meta-analysis

ObjectiveA systematic review and meta-analysis was conducted to compare the relative effectiveness of bridging external fixation and non-bridging external fixation for distal radius fractures treatment. MethodRelevant literature were comprehensively searched using the PubMed, Springer Link, Karger Medical and Scientific Publishers, Chinese Biomedical Database (CBM) and Chinese National Knowledge Infrastructure (CNKI) databases without any language restrictions. STATA Version 12.0 software and Comprehensive Meta-analysis 2.0 were applied. ResultsA total of 905 patients with distal radius fracture from six eligible cohort studies were selected for statistical analysis. Our meta-analysis results indicate that the non-bridging cases had a higher risk of pin track infection, rupture of the extensor pollicis longus and nerve injury than the bridging cases. Subgroup analysis stratified by country indicated non-bridging patients showed evidence of an increased risk of pin track infection and higher risk of rupture of the extensor pollicis longus compared with the patients treated with bridging external fixation in the UK population. The follow-up results showed flexion degree of patients treated with non-bridging external fixation was slightly better than that of patients treated with bridging external fixation (P < 0.05). ConclusionThere is evidence in our systematic review and meta-analysis to support that bridging external fixation can reduce the incidence of pin tract infections and nerve injury compared to non-bridging external fixation, but have no significant difference in other complications and the recovery of wrist joint function. Bridging external fixation could therefore be a better choice in patients with distal radius fractures.

Percutaneous K-wire fixation of distal radius fractures: Our results of leaving the wire outside

Background: Distal radius fracture is one of the common injuries seen in casualty often managed by closed reduction and percutaneous pinning. Aim: The purpose of this prospective study is to determine the incidence of infection following percutaneous wire fixation of distal radius fractures and it's bearing on the outcome in the management of distal radius fractures. Materials and Methods: We studied eighty-eight cases of closed distal end radius fractures managed with closed reduction and percutaneous Kirschner wires (K-wires) fixation with splinting for pintract infection. Results: Out of the 88 cases included in the study, 14 cases had pintract infections that were mild to moderate in nature. In 6 cases of early K-wire removal due to pintract infection, shortening of radius, malunion, reduced finger grip and poor functional outcome was noticed. Pintract infections resulted in extended hospital stay, early pin removal, decreased functional outcome, malunion of distal radius and requirement of second surgery to correct the deformity and to improve functional outcome. However, percutaneous K-wire fixation with keeping the wire outside has been advocated and routinely performed, though incidence of pintract infection and complications arising from early removal of K-wires cannot be ignored. Conclusion: Therefore, our study proposes to bury the pin ends under the skin to reduce complications and to achieve better functional outcomes.

Does Lengthening and Then Plating (LAP) Shorten Duration of External Fixation?

Classic bone lengthening requires patients wear external fixation for the distraction and consolidation phases and there is fracture risk after frame removal. Our technique of lengthening with the Taylor Spatial Frame(TM) and then insertion of a locked plate allows earlier removal of the external fixator during consolidation. Plate insertion is accomplished through a clean pin-free zone avoiding contamination and before frame removal maintaining bone position. We asked (1) whether lengthening and then plating (LAP) decrease the time for external fixation (2) how alignment and complications compare with those of the classic method. We performed a retrospective case-matched comparison between LAP and the classic technique with 27 extremities in each group. We compared time wearing the frame, bone healing index, external fixation index, joint ROM, alignment, and complications. The time wearing the frame and external fixation index were lower in the LAP group (4.5 versus 6.2months and 1.5 versus 2months/cm). Deviation from normal alignment was observed in seven and six patients in the LAP and classic group, respectively. Varus malalignment in two patients in the LAP group was associated with plate breakage. The incidence of pin-tract infection was greater in the classic group (12 versus two). No deep infections occurred in the LAP group. The LAP technique shortened the time patients wore the external fixator but was associated with a high incidence of varus deformity. Stronger plates may help prevent deformity and allow earlier removal of the frame. Level III, therapeutic study (retrospective study). See the Guidelines for Authors for a complete description of levels of evidence.

Pin site care with the Ilizarov circular fixator

Objective: To determine the incidence of pin tract infections in patients who have undergone femoral and tibial lengthening with the Ilizarov fixator.Method: A retrospective study was undertaken of 21 patients who were treated with the Ilizarov method for limb length discrepancies in the lower limbs, between 2001 and 2009. All patients received the same protocol for pin site care. The following information was recorded for each infected pin site: location, whether the implant or the wire or half-pin, time of onset of the first pin site infection in each patient and treatment.Results: Of the 21 patients, 11 were males and 10 were females with an average of 19.7 years (range 2�48 years). Sixty-two wires and 95 half-pins were studied. Half-pin infection site was 6.3%; wire site infection was 18.7%. Total pin site infection was 25%. Periarticular pin site infections accounted for 13.6% and diaphyseal infections 1.36%. Of the 21 patients studied, 19 had pin tract infections.Conclusion: Pin tract infections are common with external fixation. The consequences of pin tract infections can range from trivial to severe. Most pin site infections respond well to local pin care and oral antibiotics.

Prevention of pin tract infection with titanium‐copper alloys

The most frequent complication in external fixation is pin tract infection. To reduce the incidence of implant-associated infection, many published reports have looked at preventing bacterial adhesion by treating the pin surface. This study aimed to evaluate the antibacterial activity of a Titanium-Copper (Ti-Cu) alloy on implant infection, and to determine the potential use of the Ti-Cu alloy as a biomaterial. Two forms of Ti-Cu alloys were synthesized: one with 1% Cu and the other with 5% Cu. For analyzing infectious behavior, the implants were exposed to Staphylococcus aureus and Escherichia coli. The reaction of pathogens to the Ti-Cu alloys was compared with their reaction to stainless steel and pure titanium as controls. Both Ti-Cu alloys evidently inhibited colonization by both bacteria. Conversely, cytocompatibility studies were performed using fibroblasts and colony formation on the metals was assessed by counting the number of colonies. Ti-1% Cu alloy showed no difference in the number of colonies compared with the control. External fixator pins made of Ti-Cu alloys were evaluated in a rabbit model. The tissue-implant interactions were analyzed for the presence of infection, inflammatory changes and osteoid-formation. Ti-1% Cu alloy significantly inhibited inflammation and infection, and had excellent osteoid-formation. Copper blood levels were measured before surgery and at 14 days postoperatively. Preoperative and postoperative blood copper values were not statistically different. Overall, it was concluded that Ti-Cu alloys have antimicrobial activity and substantially reduce the incidence of pin tract infection. Ti-1% Cu alloy shows particular promise as a biomaterial.

Use of chlorhexidine‐impregnated patch at pin site to reduce local morbidity: the ChIPPS Pilot Trial

Pin tract infection is one of the most common complications associated with the use of external fixation. While some studies have identified the potential benefit of chlorhexidine gluconate-impregnated polyurethane dressings to reduce the incidence of catheter-related bloodstream infections, we are unaware of any published studies that evaluate the effectiveness of similar technologies in reducing the risk for external-fixation-related pin tract infections. Therefore, the purpose of this study was to evaluate the effectiveness of chlorhexidine gluconate-impregnated polyurethane dressing in reducing percutaneous-device-related skin colonisation and local infections. In this initial retrospective cohort, data were abstracted for two groups of consecutive patients undergoing surgery involving external fixation at an interdisciplinary foot and ankle surgical unit. All patients received surgical treatment of their foot/ankle pathology along with application of a hybrid external fixator. Twenty patients (45% male, age 54.5 +/- 3.69 years) received chlorhexidine gluconate-impregnated polyurethane dressing and twenty (55% male, age 55.8 +/- 3.22 years) received standard pin care. There was a significantly higher rate of pin tract infection in patients who received standard pin care compared with those who received chlorhexidine gluconate-impregnated polyurethane dressings (25% versus 0%, P = 0.047). There was no significant difference in any of the descriptive study characteristics (age, gender, diabetes and presence of neuropathy). The results of this initial study suggest that chlorhexidine gluconate-impregnated polyurethane dressing may be effective to reduce the incidence of pin tract infections and help decrease morbidity associated with external fixation.

Reuse of External Fixation Components: A Randomized Trial

External fixation devices are sold in the United States as single-use devices and can be costly. Approved processes for refurbishment of nonimplantable components are available. We evaluated one such program for safety, efficacy, and fiscal ramifications. Randomized clinical trial Single center, Level I trauma center During the 30-month enrollment period (November 16, 2001 to May 16, 2004), 41 patients (13%) of 315 patients were not able to consent and were excluded. A total of 178 (65%) of the 274 eligible patients who were offered entry into a randomized trial of new versus refurbished external fixation components for their injury refused to participate, leaving 96 (35%) of the 274 eligible patients entered into the study. Consented patients were entered into a trial of new versus refurbished nonimplantable external fixation components for their injury (all pins were new). The frames were evaluated at the time of removal for efficacy and the complications of pin tract infections, loss of fixation, or loosening of components. A total of 48 distal radius fractures, 29 pilon fractures, and 19 tibial plateau fractures were entered into the study. With the 96 fractures treated in our study (50 new frames, 46 reused frames), we found no statistical differences in the incidence of pin tract infections (46% versus 52%, P=0.32), loss of fixation (4% versus 4%, P=0.70), or loosening of the components (1% versus 1%, P=1.0). Sixty-five percent of consentable patients did not wish to have an external fixation frame with refurbished clamps. Our study demonstrated that this type of program is safe and effective with an actual cost savings of $65,452. The potential savings of such a program is 25% of the cost of all new frames.

Prevention of halo pin complications in post-cranioplasty patients

Distraction Osteogenesis has been successfully implemented in the treatment of maxillary hypoplasia. By using the Rigid External Distraction device (RED) the maxilla can be advanced without the need for bone grafts, providing more stability to the repositioned maxilla. The introduction of the RED system in craniofacial surgery has given rise to previously unseen problems. To provide a set of protocol improvements that might prevent the intracranial pin migration seen at the removal of a RED-II in one patient. Although the RED device has been shown to achieve good clinical results, there are some disadvantages to the system. There is a high incidence of pin tract infections - leading to loosening of the pins and loss of rigidity. Also, the external ring is prone to traumatic injury. Furthermore, the positioning of the pins can be difficult in thin bone. The improvements used in our protocol might prevent this complication.

Bactericidal activity of antimicrobial coated polyurethane sleeves for external fixation pins

This study was conducted to assess the potential of gentamicin coated polyurethane sleeves to inhibit bacterial colonization on external fixation pins and wires. These antimicrobial sleeves have been designed to be fitted over the pins and wires, at the time of surgery, as a prophylactic approach to combat the major complication of external fixation treatment, pin tract infection. Elution testing was conducted to estimate the amount of gentamicin released into the pin tract. These gentamicin concentrations were compared to the gentamicin minimal inhibitory concentration (MIC) level for common pin tract pathogens. Elution testing revealed that the gentamicin coated polyurethane sleeves released significant quantities of the antibiotic for up to 26 weeks. The initial bolus release was characterized by predicted pin tract gentamicin concentrations of >80 μg/ml at the 2 h and 1 day elution time points. These amounts of gentamicin, delivered directly to the pin tract, are far beyond those that could be achieved via oral or intravenous administration. Furthermore, the expected concentration of gentamicin in the pin tract remained above the National Committee for Clinical Laboratory Standards (NCCLS) MIC breakpoint of 4 μg/ml, [Performance standards for antimicrobial susceptibility testing: twelfth informational supplement M100-S12, NCCLS, Wayne, PA, 2002], for at least 20 weeks. Data from the SENTRY antimicrobial surveillance program (1997–2002) established a high level of bactericidal activity for gentamicin, with 83.1% of the common pin tract pathogen isolates found to be susceptible to the antibiotic. The initial burst and subsequent long-term sustained local delivery of effective amounts of gentamicin from the antimicrobial sleeves would be expected to inhibit bacterial colonization on external fixation pins and wires. This inhibition of bacterial colonization should substantially reduce the incidence of pin tract infection, and improve the overall outcome and cost effectiveness of external fixation fracture management.

Pin tract infection with contemporary external fixation: how much of a problem?

To determine the incidence of pin tract infection.DESIGN Retrospective chart review. Level 1 trauma center in an urban community. A total of 285 patients with 285 fractures over a 4-year period (1997-2001). External fixation. Incidence of pin tract infection. Of 285 fractures, 32 (11.2%) were complicated by infection. The incidence of infection according to montage was 3.9% (3/77) for ring fixators, which was significantly different (P < 0.04) from the 12.9% incidence (23/178) for unilateral fixators and the 20.0% incidence (6/30) for hybrid fixators (P = 0.004). The incidences of pin tract infection for the unilateral fixator group and the hybrid fixator group were not significantly different. Patients with hybrid external fixators had a similar risk of pin tract infection as patients who had unilateral fixators. The infection rate in the ring fixator group was significantly lower than the hybrid external and unilateral fixator groups.