A Randomized Clinical Trial on the Use of Antiseptic Solutions for the Pin-Site Care of External Fixators: Chlorhexidine–Alcohol Versus Povidone–Iodine

Abstract

Pin-site infections remain a common clinical complication in patients with external fixators. Pin-site care is commonly performed with either chlorhexidine–alcohol solution or povidone–iodine solution. This study aimed to investigate the superiority of chlorhexidine–alcohol solution versus povidone–iodine solution for external fixator pin-site care in pin-site infection. This prospective randomized clinical trial using an open, parallel-group design was conducted in a single Spanish hospital. Eligible consenting patients from November 2018 to May 2019 who underwent placement of an external fixator were included. Patients were randomly assigned to receive pin-site care using either a 2% chlorhexidine–alcohol solution or a 10% povidone–iodine solution. The primary endpoint was the development of a pin-site infection. In total, 568 pins were analyzed (128 patients, with a mean of 4.3 pins per patient). No significant differences were found between groups. However, statistically significant differences were found regarding time and infection variables. The longer the person had the fixator, the higher the risk of infection, t(x) = 5.49, p = .002. Both chlorhexidine–alcohol and povidone–iodine solutions are equally effective antiseptic agents for the prevention of infections in external fixators.

Osteomyelitis of proximal tibia 27 yr after skeletal traction: a case report

“…14 Even if placement of skeletal traction through metallic pins becomes necessary, proper antiseptic measures should be taken to prevent pin-tracks infection and delayed osteomyelitis. 15 Courvoisier et al 11 and Hamahashi et al 12 have reported cases of delayed osteomyelitis in pin tracks previously (Table 1). There are not many cases in literature, especially with such a delayed presentation.…”

“…Skin traction must be favored in cases where traction is needed for lower-extremity trauma 14. Even if placement of skeletal traction through metallic pins becomes necessary, proper antiseptic measures should be taken to prevent pin-tracks infection and delayed osteomyelitis 15…”

Pin-site Infection: A Systematic Review of Prevention Strategies

“…Jalon 19 randomised 128 patients and 568 pins to compare iodine and chlorhexidine for pin-site care in patients undergoing external fixation for clean or contaminated surgeries. Ultimately, they reported a 62% per-patient PSI in the chlorhexidine group vs a 68% PSI in the iodine group declaring no statistical difference.…”