Introduction: Pin site infections (PSIs) are frequent complications encountered with the use of circular external fixators. PSIs range in severity, and the numerous factors have been suggested to affect the incidence. We aim to perform a systematic review of all comparative studies including circular external fixation applied to the tibia diaphysis in adult patients and to explore frame and fixation factors that may be associated with the development of PSI. Materials and Methods: We conduct a systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to assess the available data with the specific focus on frame factors that might contribute to the development of PSI. A literature search of major electronic databases was conducted to identify journal articles. A scoping review process was adopted due to the expected broad variation of studies in our research topic using the PRISMA for Scoping Reviews guidelines. Results: The initial electronic database search produced 360 publications. After a review process, only four publications were retained for final analysis. Type of fixation pins and wires, frame fixation configurations, and reconstructive methods were compared in these studies. There are very few clinical studies comparing the different frame and fixation factors that can influence PSI rates in circular external fixation. The available studies reflect a significant degree of bias and confounding, representing a low level of evidence. Conclusion: Further research is needed, and with the present paucity of data, it is not possible to make any firm recommendations. Within the same frame construct, it appears that tensioned wires may carry a lower risk of PSI than half-pins.

Introduction: Dead space management following intramedullary debridement and reaming can be challenging and several alternatives have been described. The main objective of this study was to investigate the clinical outcome and resolution rate in patients treated for fracture-related Cierny and Mader anatomical type 1 intramedullary chronic osteomyelitis by means of continuous irrigation (modified Lautenbach system) as dead space management following intramedullary reaming. Materials and Methods: A consecutive series of thirty patients with Cierny and Mader type 1 chronic osteomyelitis, treated between May 2016 and September 2019, were evaluated retrospectively. Patient history and clinical information, including imaging and laboratory results, were reviewed. Treatment procedures and antibiotic profiles were also recorded. Results: The initial cohort included 30 cases with 18 tibias, 11 femurs, and one humerus. Seven patients were excluded; three patients did not return for follow-up and four patients had <6 months of follow-up. Of the remaining 23 patients, 91% (21/23) achieved resolution of infection over a median follow-up period of 16 months (interquartile range [IQR] 7–21 months). Infecting organisms where isolated in 65% (15/23). The median duration of hospital stay was 6 days (IQR 4–7 days). Postoperative complications were noted in two cases and involved a tibial and femoral refracture, respectively. Both patients however achieved union without recurrence of infection following surgical intervention. Conclusion: Continuous irrigation is a cost-effective single-stage surgical option for dead space management during the treatment of intramedullary chronic osteomyelitis. It provides the advantage of instilling high dose intramedullary antibiotics and negates the need for a second surgical procedure while achieving similar outcomes than other dead space management techniques. Level of Evidence: IV, single-center retrospective study