Multicenter Study of Pin Site Infections and Skin Complications Following Pinning of Pediatric Supracondylar Humerus Fractures

Combs, Kristen; Frick, Steven L.; Kiebzak, Gary M.

doi:10.7759/cureus.911

Cited by 11 publications

(14 citation statements)

References 13 publications

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“…Over the last 10 years, the rate of documented infections at our hospital was 18/3386 (0.53%). This is similar to the recent study by Laxdal et al10 (0.29%) and lower than the infection rate in recent studies by Aubret et al1 (1.9%), Tosti et al3 (1.4%), and Combs et al5 (2.34%). Infection rates have historically been reported at 0.5% to 2% 2…”

Section: Discussionsupporting

confidence: 90%

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Early Postoperative Infections After Closed Reduction and Percutaneous Pinning in Type II and Type III Pediatric Supracondylar Humerus Fractures

Ezeokoli

Borici

Serrano

et al. 2022

Journal of Pediatric Orthopaedics

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Background: Supracondylar humerus fractures (SCHF) are the most common elbow fracture type in children, and one of the most common pediatric fracture types overall. Excellent outcomes are generally reported with closed reduction and pinning (CRPP), but the technique involves leaving the pins outside the skin. External pins can act as a nidus for infection. We characterize the infection complications from SCHF treatment at a single-centre tertiary children’s hospital over 10 years. This is the largest series on infectious outcomes after CRPP of SCHF reported to date. Methods: Pediatric patients undergoing CRPP for a type II or type III SCHF from 2011 to 2021 with postsurgical infections within 90 days were identified. Demographic and clinical data were retrieved from medical records. Descriptive statistics were estimated and reported as means or medians with range values or counts with percentages. Results: A total of 18 patients met inclusion criteria, 10 and 8 with type II and III SCHF, respectively. The average age at diagnosis of fracture was 4.7 (2 to 9) years. The average operating time for the index surgery was 29 minutes (12 to 42). The average number of postoperative days until pin removal was 29.8 (18 to 52), and the average number of postoperative days until readmission or visit with symptoms was 38.9 (18 to 77). There was a documented history of a wet cast in 6 patients (33%). Ten (56%) patients presented with fever, and the most common positive culture was methicillin-sensitive Staphylococcus aureus (9, 50%). Thirteen (72%) patients returned to the operating room for incision and drainage. There were no cases with continued complications after the original infection after a median follow-up of 63 days (8 to 559). Infection after CRPP of SCHF is a rare adverse event. In our series, it was most often associated with common pathogens and wet casts. The necessity of return to the operating room will vary with the presentation, but if efficaciously treated afterwards with oral antibiotics, there is a low chance of recurrence or subsequent complications. Patients should be carefully instructed in cast care and demonstrate understanding of risks and complications, and to contact their orthopaedist if their cast demonstrates lack of integrity. Level of Evidence: Prognostic level IV.

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Section: Discussionsupporting

confidence: 90%

“…Excellent outcomes are generally reported for fracture stabilization with pins 3. However, infections as a sequela of these treatments are known to occur, although at a relatively low rate, between 0.5% and 2% in most studies 4,5. Most infections are not severe and resolve with oral antibiotics and local wound care.…”

mentioning

confidence: 99%

Early Postoperative Infections After Closed Reduction and Percutaneous Pinning in Type II and Type III Pediatric Supracondylar Humerus Fractures

Ezeokoli

Borici

Serrano

et al. 2022

Journal of Pediatric Orthopaedics

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“…Over a 1-year period, a hospital system identified several factors that may lead to pin-site infection, include the length of time pins were left in, inappropriate cast care, cast changes before pin removal as well as the use of preoperative antibiotics. 35 In a retrospective study by Iobst et, there were no pin-site infections out of 304 patients who underwent CRPP using a semisterile technique. Of these, 207 did not receive prophylactic antibiotics.…”

Section: Discussionmentioning

confidence: 95%

Hold the Antibiotics: Are Preoperative Antibiotics Unnecessary in the Treatment of Pediatric Supracondylar Humerus Fractures?

Bloomer

Coe

Brandt

et al. 2022

Journal of Pediatric Orthopaedics

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Background: Supracondylar humerus (SCH) fracture is the most common elbow injury in children and often treated with closed reduction and percutaneous pinning (CRPP). There is little published evidence supporting or refuting the use of perioperative prophylactic antibiotics for SCH CRPP in the pediatric population. The purpose of this study is to evaluate the rate of surgical site infection for patients with and without preoperative antibiotics. Methods: A retrospective chart review was conducted of patients less than or equal to 16 years from 2012 to 2018 who underwent primary CRPP. Open fractures, multilimbed polytraumas, and immunodeficient patients were excluded. Infection rates were compared using a noninferiority test assuming a 3% infection rate and a predefined noninferiority margin of 4%. A total of 255 patients were needed to adequately power the study. Results: Of the 1253 cases identified, 845 met eligibility criteria. A total of 337 received antibiotics, and 508 did not. Preoperative nerve injury (P = 0.0244) and sterilization technique (P < 0.0001) were associated with antibiotic use: 4 patients developed an infection; there were successfully treated superficial infections, and 1 was a deep infection requiring a formal debridement. There were 8 patients that had a recorded mal-union, and 6 patients required additional procedures; 1 patient had a postoperative compartment syndrome on postoperation day 1. The infection rates among patients treated with and without antibiotics were 0.60% and 0.40%, respectively. The absence of antibiotics was not clinically inferior to using antibiotics (P = 0.003). Conclusions: Infection remains a rare complication following CRPP of SCH fractures. According to our current data, not giving perioperative antibiotics was not inferior to using perioperative antibiotics for preventing superficial or deep infection in patients undergoing CRPP of SCH fractures. With the increase in attention to antibiotic stewardship, it is important to eliminate unnecessary antibiotic use while continuing to maintain a low rate of surgical site infection.Level of Evidence: Level IV-case series. This is a therapeutic study that investigates the results from a case series.

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“…9 A 2016 study of 369 children estimates the rate of pin site infection in supracondylar fractures to be 0.81%. 10 If purulence is noted at pin sites, a pin site infection should be suspected. 11 Most pin site infections are superficial and can be treated with removal of the pins, oral antibiotics, and local wound care.…”

Section: Risks Of Pin Fixation and Management Of Complicationsmentioning

confidence: 99%

The Pin: An Orthopaedic Transformation

Lindsay¹,

Holmes²,

Owen³

et al. 2022

Journal of the Pediatric Orthopaedic Society of North America

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The stainless-steel pin has become an important part of operative orthopaedics over the last several decades. It is used in all subspecialties as tool to localize a lesion or to effectuate reduction, as a conduit for implant placement (screw or blade plate), as a guide for making an osteotomy, and as an implant that can stabilize bone whether it is placed in an open or percutaneous manner. While simple and ubiquitous to the craft of orthopaedics, it has revolutionized the care of children with orthopaedic conditions. This review highlights the history and the applications of the simple pin that can assist in obtaining good results in common problems.

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Multicenter Study of Pin Site Infections and Skin Complications Following Pinning of Pediatric Supracondylar Humerus Fractures

Cited by 11 publications

References 13 publications

Early Postoperative Infections After Closed Reduction and Percutaneous Pinning in Type II and Type III Pediatric Supracondylar Humerus Fractures

Early Postoperative Infections After Closed Reduction and Percutaneous Pinning in Type II and Type III Pediatric Supracondylar Humerus Fractures

Hold the Antibiotics: Are Preoperative Antibiotics Unnecessary in the Treatment of Pediatric Supracondylar Humerus Fractures?

The Pin: An Orthopaedic Transformation

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