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Pin site care for preventing infections associated with external bone fixators and pins

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Abstract

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Background

Metal pins are used to apply skeletal traction or external fixation devices in the management of orthopaedic fractures. These percutaneous pins protrude through the skin, and the way in which they are treated after insertion may affect the incidence of pin site infection. This review set out to summarise the evidence of pin site care on infection rates.

Objectives

To assess the effect on infection rates of different methods of cleansing and dressing orthopaedic percutaneous pin sites.

Search methods

For this update we searched the Cochrane Wounds Group Specialised Register (searched 22 June 2011); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 2); Ovid MEDLINE (2008 to June Week 2 2011); Ovid MEDLINE (In‐Process & Other Non‐Indexed Citations June 21, 2011); Ovid EMBASE (2008 to 2011 Week 24); and EBSCO CINAHL (2008 to 17 June 2011).

Selection criteria

We evaluated all randomised controlled trials (RCTs) that compared the effect on infection and other complication rates of different methods of cleansing or dressing orthopaedic percutaneous pin sites.

Data collection and analysis

Two review authors independently assessed the citations retrieved by the search strategies for reports of relevant RCTs, then independently selected trials that satisfied the inclusion criteria, extracted data and undertook quality assessment.

Main results

A total of eight trials (448 participants) were eligible for inclusion in the review. Three trials compared a cleansing regimen with no cleansing, three trials compared alternative cleansing solutions, two trials compared methods of cleansing, one trial compared identical pin site care performed daily or weekly and four trials compared different dressings. There were no statistically significant differences between groups for any of these comparisons. No trials were identified that compared any dressing versus no dressing or different massage regimens.

Authors' conclusions

The available trial evidence was not extensive, was very heterogeneous and generally of poor quality, so there was insufficient evidence to be able to identify a strategy of pin site care that minimises infection rates. Adequately‐powered randomised trials are required to examine the effects of different pin care regimens, and co‐interventions ‐ such as antibiotic use ‐ and other extraneous factors must be controlled in the study designs.

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Plain language summary

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Methods of pin site care for reducing infection and complications associated with external bone fixators and pins

Metal pins are sometimes used to apply traction or to attach other external fixation devices into broken arms or legs. These pins pierce through the skin. The way they are cared for may affect the frequency of infection. Different solutions are used for cleaning around pins, different dressings can be used, scabs may or may not be removed and massage might be used to drain fluids around them. Few clinical trials have investigated this area, and they were of poor quality. As a result, this review found no strong evidence that one pin care technique was better than any other for reducing the chance of infection and other complications.