Study ID

N

Participants

Interventions

Infection rate

Definition of infection

Duration

Antibiotic prophylaxis

Camilo 2005

30

Ilizarov external fixators; no infection.

(1) Daily: shower, cleanse with saline, gauze dressing soaked with polyvinylpyrrolidone‐iodine;

(2) Daily: shower, cleanse with saline; dry dressing

(1) 66.7%; (2) 46.7%; NS

Defined as purulent secretion.

Follow‐up for time external fixator in place, mean = 273 days (95‐726 days)

Not reported.

Egol 2006

118

Adults; displaced, unstable, distal radial fracture

(1) Daily: cleansing with 1/2 saline/1/2 hydrogen peroxide;

(2) Biopatch dressing changed weekly;

(3) No pin site care; dry dressing changed weekly.

(1) 22.5%; (2) 5%;
(3) 2.5%.

Defined as requiring antibiotics.

Follow‐up for mean of 5.9 weeks (4‐8 weeks). External fixator removed at 6 weeks and patients followed‐up for 6 months.

Standard prophylaxis given to all patients: before and immediately after surgery.

Grant 2005

20

18+ years

(1) Daily: saline cleansing, soft white paraffin ointment;

(2) Twice daily: saline cleansing, 10% povidone‐iodine.

(1) 34.1%; (2) 18.1% (pin sites, not participants).

Defined as redness, induration, haemo‐serous ooze and pain.

Follow‐up until clinical infection or removal of pin.

Intraoperative or postoperative period: 83%.

Henry 1996

30

Aged 11‐18 years

(1) Daily: cleansing with 0.9% sodium chloride;

(2) Daily: cleansing with 70% alcohol;

(3) Daily: no cleansing.

All groups had pin site care consisting of sterile gauze covering, ease of crusting; massage, dry povidone‐iodine spray.

(1) 25%;

(2) 17.5%;

(3) 7.5%. NS

Defined as pain, redness and swelling and when a significant number of pathogenic bacteria cultured.

Pin in place for mean of 150 days (56‐244 days)

Not reported.

Patterson 2005

101

All ages (3‐80 years); 65% male; no inclusion criteria reported.

(1) Twice daily: 1/2 strength peroxide, rinse with saline, apply stable gauze/sponge;

(2) Same cleansing; apply Xeroform/Xeroflo dressing;

(3) Twice daily; saline cleansing, apply stable gauze/sponge;

(4) Same cleansing; apply Xeroform/Xeroflo dressing;

(5) Twice daily: antibacterial soap and water cleansing, apply stable gauze/sponge;

(6) Same cleansing; apply Xeroform/Xeroflo;

(7) No cleansing, apply gauze/sponge (change only if wet/soiled).

(1) 46%;

(2) 9%;

(3) 33%;

(4) 27%;

(5) 39%;

(6) 50%;

(7) 36%. NS

Rating scale that measured redness, swelling, discomfort, tenting, loosening of pins, crusting and drainage. Stage II infection defined as score >3 and requiring treatment with antibiotics; stage III infection defined as score > 7, treatment with IV antibiotics and/or removal of pin.

6‐week follow‐up.

Not reported.

W‐Dahl 2003

50

Surgery for gonarthrosis by hemicallotosis technique; mean age 54 years; inclusion criteria not reported.

(1) Daily: pin site care: cleansing with 0.9% sodium chloride, sterile compress fixed with soft dressing;

(2) Weekly; same pin site care protocol.

Grade 1:
(1) 7.4%;

(2) 12%.

Grade II:
(1) 2.8%;

(2) 0%. NS

Checketts‐Otterburns classification of pin site infections.

10‐week follow‐up

Prophylaxis with IV antibiotics during surgery and 2 doses within 24 hours post operatively followed by 14 days of oral prophylaxis.

Cavusoglu 2009

39

Mean age 50 and 47 years in two groups; 65% and 53% male; no inclusion criteria reported.

(1) Daily showering; cleaning crusts with sterile gauze with iodine solution;

(2) Daily showering; brushing pin sites with soap and water.

Minor infection:

(1) 44%;

(2) 51%.

Major infection:

(1) 4%;

(2) 4%.

Minor infection: Grade 1 and 2 on a modification of the Dahl system by Gordon ‐ not requiring any extra pin site care. Major infection: Grade 3 and above ‐ requiring treatment with oral antibiotics.

Pin site inspection on 5th, 10th, 15th, 30th, 45th, 60th, 75th, 90th, 120th and 150th days of follow‐up until fixator removal.

Prophylaxis for closed fractures: preoperative and postoperative single dose intravenous cephazolin sodium (1 g); open fractures: preoperative 1 day and postoperative 4 day intravenous cephazolin sodium (1 g 3 X day), intravenous gentamicin (160 mg/day) and oral ornidazole (500 mg 2 X day).

Chan 2009

62

Distraction osteogenesis using Ilizarov fixators; age ranged from 1‐76 years; 37% < 14 years; no inclusion criteria reported.

(1) Daily povidone‐iodine cleansing solution;

(2) Saline cleansing solution.

Any grade of Infection:

(1) 19%;

(2) 17%.

Three point grading of infections by system developed in Department of Orthopaedic Surgery in University of Malaya Medical Centre.

Every 2 weeks for 6 months.

Antibiotics only prescribed for patients with grade 2 or 3 infections.