Seasonal Temperature and Pin Site Care Regimen Affect the Incidence of Pin Site Infection in Pediatric Supracondylar Humeral Fractures

Abstract

Pin site infection is a common complication after fracture fixation and bone lengthening, and daily pin site care is recommended. Weather is a strong environmental factor of infection, but few articles studied the issue of weather and pin site infection. We performed a prospective comparative study of 61 children with supracondylar humeral fractures treated by closed reduction and percutaneous pinning. The patients were divided into high-temperature season or low-temperature season by the months they received surgery. The patients within each season were further allocated to 2 groups by the different postoperative pin site care methods of daily care or noncare. The infection rate per patient was significantly higher in the high-temperature season compared to low-temperature season (45% versus 19%, P = 0.045). In the high-temperature season, the infection rate per patient was significantly higher in the daily care group versus the noncare group (70% versus 20%, P = 0.001). In the low-temperature season, the infection rate per patient was not significantly different in the daily care group versus the noncare group (10% versus 27.3%, P = 0.33). We recommend that careful monitoring of infection signs, rather than pin site cleaning, would be appropriate in the treatment of pediatric supracondylar humeral fractures, especially during the summer months.

Association between higher ambient temperature and orthopaedic infection rates: a systematic review and meta‐analysis

“…Our search identified 2191 unique documents. Eighteen studies met all criteria and were included in this review . Figure represents the process of inclusion and exclusion.…”

“…with 9128 infections . Sixteen (89%) studies directly stated the number of infection cases while case number was obtained from the authors for one manuscript (7%) and could not be derived for one study . Most research was carried out in the USA (14 studies, 78%) while one study each was conducted in Taiwan, Japan, Australia and Switzerland .…”

“…The mean study length was 77.3 months (interquartile range 36–96). Six (33%) studies utilized national databases, nine (50%) used data from a single site and three (17%) were multi‐site . Spinal surgery patients were the most commonly studied population (7 papers, 39%) followed by arthroplasty patients (4 papers, 22%) .…”

Humidity a potential risk factor for prosthetic joint infection in a tropical Australian hospital

“…Staphylococcus aureus and coagulase-negative staphylococci are the primary infecting organisms following orthopaedic surgery and these too display seasonality based on meteorological and calendar patterns. [13][14][15] Humidity has also been implicated in the severity of acute haematogenous osteomyelitis, 16,17 suggesting that in addition to temperature other features such as moisture, rainfall and air quality also influence the pathogenicity of commensal skin flora in orthopaedic patients. [13][14][15] Humidity has also been implicated in the severity of acute haematogenous osteomyelitis, 16,17 suggesting that in addition to temperature other features such as moisture, rainfall and air quality also influence the pathogenicity of commensal skin flora in orthopaedic patients.…”

“…6,7 Prior epidemiological studies in orthopaedics have placed particular emphasis on the role that higher ambient temperatures might have on surgical site infection with increased risk identified in spinal surgery, 8,9 lower limb joint replacement [10][11][12] and fracture fixation. [13][14][15] Humidity has also been implicated in the severity of acute haematogenous osteomyelitis, 16,17 suggesting that in addition to temperature other features such as moisture, rainfall and air quality also influence the pathogenicity of commensal skin flora in orthopaedic patients.…”