Journal of Health and Medical Research

Pin Site Infection

Pin site infection is the most common local complication of external fixation, so many different care protocols have been used to try to minimise the risks of infection. Pin site infections are usually acquired through healthcare intervention and should be considered as healthcare-associated infections.Pin site infections are a common complication of external fixation that places a significant burden on the patient and healthcare system. Such infections increase the number of clinic visits required during a patient’s course of treatment, can result in the need for additional treatment including antibiotics and surgery, and most importantly can compromise patient outcomes should osteomyelitis or instability result from pin loosening or need for pin or complete construct removal. Factors that may influence the development of pin site infections include patient-specific risk factors, surgical technique, pin design characteristics, use of prophylactic antibiotics, and the post-operative pin care protocol including cleansing, dressing changes, and showering. Despite numerous studies that work to derive evidence-based recommendations for prevention of pin site infections, substantial controversy exists in regard to the optimal protocol. This review comprehensively evaluates the current literature to provide an overview of factors that may influence the incidence of pin site infections in patients undergoing treatment with external fixators, and concludes with a description of the preferred surgical and post-operative pin site protocols employed by the senior authors Not all patients are susceptible to pin site infection due to a combination of factors related to patient health and the external fixator. Patient factors associated with a higher risk of pin site infections include increased patient age and intrinsic medical comorbidities. The immune status and consumed medications are expected to influence the risk of infection; examples include diabetes, rheumatoid arthritis and other collagen vascular diseases, and use of steroids. Smoking has been studied extensively and has been shown to increase post-operative complications including wound infection . Although not studied directly in the context of percutaneous pin and wire infection, smoking has been shown to decrease subcutaneous collagen production . Ceasing to smoke preoperatively has been demonstrated to reduce wound-related complications dramatically in patients undergoing primary hip and knee arthroplasty . Anecdotally, we have observed that excessive patient activity leads to increased pin irritation and infection also and that traumatized skin is less resistant to infection.
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