No difference between daily and weekly pin site careA randomized study of 50 patients with external fixation

Abstract

Introduction We investigated whether there were any differences in the frequency and severity of pin site infections by performing pin site care daily or once a week. We studied patients operated on for gonarthrosis by the hemicallotasis technique, using hydroxyapatite-coated pins in the metaphyseal bone and standard pins in the diaphyseal bone. Patients and methods 50 patients were prospectively randomized to daily (n = 27) or weekly (n = 23) pin site care. We evaluated pin sites, the occurrence of pain (VAS), the use of antibiotics and analgesics and complications every week. Bacterial cultures were taken from each pin site at 1, 6 and 10 weeks and from the pins on removal. Results We found no differences between daily or weekly pin site care as regards the frequency and severity of pin site infections, pain, or the use of antibiotics and analgesics. Grade I infections (Checketts-Otterburns classification) occurred around 11% of the pins and grade II infections around 4%. 70% of the bacterial cultures were negative. The most frequent bacteria were coagulase negative staphylococcus and corynebacterium. Antibiotics were given an average of 47 days. More problems occurred around the proximal pins. 5/200 (all proximal) pins were clinically loose on removal. Interpretation Pin site care once a week seems appropriate.

Pin tract infection with external fixation of pediatric fractures

“…Several authors discussed different strategies. Whereas Dahl et al [20] found no difference between daily and weekly pin site care, Davies et al [21] had a favorable outcome in a group of patients with weekly pin site care and the local application of alcoholic antiseptic and occlusive pressure dressings compared with a group with daily pin site care. Gordon et al [22] presented a successful "nihilistic approach" with daily showers without physical pin cleansing.…”

A survey of current practice in skeletal pin site management

“…A recent study by W-Dahl et al (2003) suggests that there is no difference in the rate of infection when daily pin site cleansing is compared to weekly cleansing. Some practitioners assert that pin sites should only be cleansed when there is debris such as dried blood or crust (crystallised serous fluid) to be removed as frequent disturbance of the pin sites is more likely to lead to infection.…”

“…This dearth of evidence is also highlighted in a recent review by the National Association of Orthopaedic Nurses in the USA (Baird Holmes and Brown, 2005). Four recent studies help to illuminate the situation (Davies et al, 2005;Patterson, 2005;W-Dahl et al, 2003;W-Dahl and Toksvig-Larsen, 2004) but these studies have been conducted using small samples and/or contain a number of methodological weaknesses such as a lack of randomisation and poor control of variables. As a consequence of this situation, pin site wound care practice has been based on ritualistic practice rather than evidence.…”

A fresh consensus for pin site care in the UK

“…Of these complications, pin site infection is reported to be the most common (Ahlborg and Josefsson, 1999;Antoci et al, 2008;Baird-Holmes and Brown, 2005;Dahl et al, 1994;W-Dahl et al, 2003;W-Dahl and Toksvig-Larsen, 2008;Santy, 2010). These wound infections are costly and cause pain and discomfort, complicated and delayed recovery and sometimes death.…”

“…It was agreed that pin site dressings should be changed once weekly unless there is an infection or copious discharge/soaked dressing reflecting the work of W- Dahl et al (2003). In such cases the dressings should be changed when saturated.…”