Pin Tract Inflammation Research Articles

Presentation and outcome of femoral infected non-unions in children and adolescents.

Objectives:To document the presentation of infected non-unions of femur in pediatric and adolescent population and evaluate the outcome of segmental bone transport with the Ilizarov method.Methods:This prospective case series study was carried out over a period of five years, from January 01, 2015 to December 31, 2019. The study included all children and adolescent patients who presented with femoral infected non unions. The study excluded patients above the age of 16 years and those who had pathological fractures secondary to bone pathologies such as cysts, tumors or metabolic bone diseases.Results:Out of 31 patients, 27(87.09%) were males and 4(12.90%) were females. The mean age was 13.48±1.98 years. The underlying mechanisms that lead to the causation of fractures included road traffic accidents (n=23;74.19%), fall from height (n=7;22.58%) and firearm injuries (n=1;3.22%). The bone gaps ranged from 3-5 cm with a mean of 4.00± 0.856 cm. Bone union was achieved among 28(90.32%) patients. Infection was eradicated among 27(87.09%) patients whereas the remaining patients continued to suffer persistent infection. The most common complications included pin tract inflammation/ infection among (n=31;100%) patients and stiffness of knee joint among (n=19;61.29%) patients.Conclusion:Majority of the patients were males, aged 9-16 years. Road traffic accidents were the commonest cause of the fractures. The Ilizarov method of segmental bone transport was effective in treating the majority of infected non-unions.

External Fixation of Intertrochanteric Fractures In High Risk Geriatric Patients Done Under Local Anaesthesia

Objective: The purpose of this study is to evaluate the results of external fixation of intertrochanteric fractures in very highrisk geriatric patients done under local anaesthesia. Design: Prospective clinical study. Settings: Level-1 trauma Centre. Patients: forty eightvery high anaesthetic/surgicalrisk geriatric patients with intertrochanteric fractures. Intervention: Close reduction and external fixation using local anaesthesia supplemented by analgesics. Outcome Measured: Fracture Union, Time To Union, Pin Tract Infection Rate And Return To Daily Activities. Results: Forty eight patients with average age of 79.5 years all high anaesthetic/surgical risk were managed by closed reduction and external fixation under local anaesthesia supplemented by analgesics. Sixteen patients died before fracture union, seven were lost in follow up after removal of fixator and in one patient fixator was removed early after loss of reduction. Remaining twenty four were in regular follow up for at least six months. Pin tract inflammation was the most common complication while shortening andvarus collapse occurred in twelvecases.

Percutaneous transilial pinning for treatment of seventh lumbar vertebral body fracture. A retrospective analysis of 17 cases.

To evaluate outcomes after percutaneous application of transilial pinning in dogs with seventh lumbar vertebral body fracture with concurrent lumbosacral luxation. We reviewed the medical records of dogs with seventh lumbar vertebral body fracture stabilized with percutaneous transilial pinning that were treated at our hospital between January 2000 and March 2014. Radiographic measurements were used for comparing craniocaudal and ventrodorsal displacement pre- and postoperatively. Seventeen dogs met the inclusion criteria. The neurological status of the majority of treated dogs improved quickly, with immediate pain reduction after surgery. Implants were well tolerated throughout the application period and were removed at a mean time of 54.4 ± 9.2 days. One dog experienced a major complication (implant failure) and required surgical revision a week after the initial procedure. Minor complications included pin-tract inflammation, signs of back pain lasting five weeks and acute lameness after implant removal. Postoperative radiographic measurements showed shortening of the vertebral body and residual dorsoventral dislocation. Otherwise, functional recovery was good (5 of 17 dogs) to excellent (10 of 17 dogs) in the majority of the patients. The use of two percutaneous transilial pins can be considered as treatment for the management of seventh lumbar fracture-luxation in dogs. Our modified stabilization technique is relatively easy to perform; less invasive on the soft tissues; and uses implants that are versatile, modifiable, and easily removable.

Complications of Hinged External Fixation Compared With Cross-pinning of the Elbow for Acute and Subacute Instability

Elbows that are unstable after injury or reconstructive surgery often are stabilized using external fixation or cross-pinning of the joint supplemented by cast immobilization. The superiority of one approach or the other remains a matter of debate. We compared patients treated with external fixation or cross-pinning in terms of (1) adverse events, (2) Broberg and Morrey scores, and (3) ROM. Between 1998 and 2010, 19 patients (19 elbows) had hinged external fixation and 10 patients (11 elbows) cross-pinning and casting for subacute or acute posttraumatic elbow instability. Our general indications for both techniques were persistent elbow instability after usual treatment. Initially, we used external fixation for delayed treatment of fracture-dislocations and cross-pinning for simple elbow dislocations in patients who could not tolerate surgery, but more recently we have used cross-pinning for both indications. Adverse events, elbow scores, and ROM were retrospectively evaluated by chart review, with the latter two end points being calculated at a mean of 31 months (range, 5-83 months) and 10 months (range, 5-21 months) after index procedure for the patients treated with external fixation and cross-pinning, respectively. Seven of 19 patients treated with external fixation experienced nine device-related adverse events: three pin tract infections, two nerve problems, one broken pin, one residual subluxation, one suture abscess, and one pin tract fracture of the ulna resulting in a nonunion. Of the 10 patients (11 elbows) treated with cross-pinning, one patient had pin tract inflammation that resolved with pin removal. Mean Broberg and Morrey score was 90 (95% CI, 84-95) after external fixation and 90 (95% CI, 84-96) after cross-pinning (p = 0.88). There were no differences between the external fixation and cross-pinning groups in mean flexion (123° versus 128°, p = 0.49), extension (29° versus 29°, p = 0.97), forearm pronation (68° versus 74°, p = 0.56), and forearm supination (47° versus 68°, p = 0.15). When the elbow remains unstable after reduction and usual treatment for fractures and dislocations or has been out of place for more than 2 weeks, both cross-pinning and external fixation can help maintain elbow alignment while structures heal. Hinged external fixation is associated with more adverse events related to the device, but Broberg and Morrey score and ROM are similar between techniques. Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

A User-Friendly Method of Pin Site Management for External Fixators

Pin tract inflammation and/or infection are common with the use of external fixation devices. Pin sites need to be managed to help prevent complications. There are a variety of regimens proposed for pin care in the literature. The authors present an efficient and simplified approach for addressing pin care protocol using cord locks with the use of compression sponges for external fixation devices. This method obviates the need for extensive bandaging and makes pin care easy for the patient to carry out. A brief review of the current evidence on pin care is presented, and an evidence-based pin care protocol is presented. Therapeutic, Level V.

Enhanced wound healing associated with Sharpey’s fiber-like tissue formation around FGF-2-apatite composite layers on percutaneous titanium screws in rabbits

Pin-tract infections are the most common complications of external fixation. To solve the problem, we developed a fibroblast growth factor-2 (FGF-2)-apatite composite layer for coating titanium screws. The purpose of this study was to elucidate the mechanism of the improvement in infection resistance associated with FGF-2-apatite composite layers. We analyzed FGF-2 release from the FGF-2-apatite composite layer and the mitogenic activity of the FGF-2-apatite composite layer. We evaluated time-dependent development of macroscopic pin-tract infection around uncoated titanium control screws (n = 10). Screws coated with the apatite layer (n = 16) and FGF-2-apatite composite layer (n = 16) were percutaneously implanted for 4 weeks in the medial proximal tibia in rabbits. A FGF-2-apatite composite layer coated on the screws led to the retention of the mitogenic activity of FGF-2. FGF-2 was released from the FGF-2-apatite composite layer in vitro for at least 4 days, which corresponds to a period when 30% of pin-tract infections develop macroscopically in the percutaneous implantation of uncoated titanium control screws. The macroscopic infection rate increased with time, reaching a plateau of 80-90% within 12 days. This value remained unchanged until 4 weeks after implantation. The screws coated with an FGF-2-apatite composite layer showed a significantly higher wound healing rate than those coated with an apatite layer (31.25 vs. 6.25%, p < 0.05). The interfacial soft tissue that bonded to the FGF-2-apatite composite layer is a Sharpey's fiber-like tissue, where collagen fibers are inclined at angles from 30 to 40° to the screw surface. The Sharpey's Wber-like tissue is rich in blood vessels and directly bonds to the FGF-2-apatite composite layer via a thin cell monolayer (0.8-1.7 μm thick). It is suggested that the enhanced wound healing associated with the formation of Sharpey's fiber-like tissue triggered by FGF-2 released from the FGF-2-apatite composite layer leads to the reduction in the pin-tract inflammation rate.

Infections in periarticular fractures of the lower extremity treated with tensioned wire hybrid fixators.

To observe the incidence and clinical presentation of infection in periarticular fractures of the tibia and femur treated with tensioned wire external fixators. Prospective cohort study. Level One Trauma Center in urban community. Single surgeon. One hundred thirty-five patients with 145 fractures: seventy tibial plateau, fifty-six pilon, and nineteen distal femur. Five-year treatment period, 1991 to 1995. The incidence of infection was evaluated. Nineteen of 145 fractures (13 percent) were complicated by infection. Infections presented as pin tract inflammation requiring intravenous antibiotics (seven), deep infection requiring debridement and removal (five), septic arthritis (three), deep fracture infection (three), and necrotizing fasciitis (one). Infection is a common complication of juxtaarticular fractures treated with tensioned wire fixators. Excellent pin care is required. Aggressive management of infections with intravenous antibiotics and debridement will resolve infections occurring in patients treated with tensioned wire fixators. Septic arthritis is associated with wires placed less than one centimeter from the subchondral bone. Deep infection is associated with insidious swelling and excessive proliferative callus. Wire infections increase with prolonged frame time.

External fixation of pediatric femur fractures.

One-hundred and thirty-two children with 139 femur fractures were treated with external fixation from 1984 to 1993. Average age at presentation was 8.97 years. All fractures were followed until union, with an average time of external fixation of 11.4 weeks. There were no nonunions. Of 18 patients with definitive radiographic measurements at 2-year follow-up, 15 patients developed overgrowth (average, 8.7 mm) and three demonstrated shortening (average, 7.7 mm). No patient required treatment for residual leg-length discrepancy. Although pin-tract inflammation was common, pin-tract infection requiring intravenous antibiotics occurred in only six patients (4.5%). No patient developed osteomyelitis. Two fractures (1.4%) were not healed at the time of elective fixator removal, necessitating additional time in the fixator. There were two refractures (1.4%) and one fracture through a healing pin tract after fixator removal (0.7%).

External Fixation of Pediatric Femur Fractures

Summary: One-hundred and thirty-two children with 139 femur fractures were treated with external fixation from 1984 to 1993. Average age at presentation was 8.97 years. All fractures were followed until union, with an average time of external fixation of 11.4 weeks. There were no nonunions. Of 18 patients with definitive radiographic measurements at 2-year follow-up, 15 patients developed overgrowth (average, 8.7 mm) and three demonstrated shortening (average, 7.7 mm). No patient required treatment for residual leg-length discrepancy. Although pin-tract inflammation was common, pin-tract infection requiring intravenous antibiotics occurred in only six patients (4.5%). No patient developed osteomyelitis. Two fractures (1.4%) were not healed at the time of elective fixator removal, necessitating additional time in the fixator. There were two refractures (1.4%) and one fracture through a healing pin tract after fixator removal (0.7%).

External fixation of pediatric femur fractures: Indications and technique for successful results

External fixation of pediatric femur fractures has been successfully used by the authors for the past 10years. The method involves careful attention to technical detail in this select group of patients. Children between the ages of 6 and 10 years who are attending school with both parents working seem to benefit most from this procedure. A modular monolateral external fixation frame using four half-pins is preferred. The most proximal and distal pins are placed first for reduction of the fracture in rotation, length, and varus-valgus. The central two pins are added for reduction of flexion and extension. Manual reduction is accomplished on a radiolucent table using a C-arm.A short hospitalization allows for teaching the caregivers pin care techniques and encouraging the patient to be ambulatory.Monthly clinic visits are also helpful to treat the 1 in 10 patients with pin tract inflammation. Fixator removal is accomplished at 12 weeks under outpatient anesthesia to allow for knee manipulation and debridement of the pin tracts at 12 weeks.Overgrowth has been insignificant at an average of 6 to 8 mm, with a maximum of 10 mm in only one third of the patients. Potential complications of spica cast treatment, including compartment syndrome and skin necrosis, are avoided. The children are active with their peers, ambulatory, and attend school while both parents are able to work. Several important technical aspects of the procedure are described in the following article.