Background: Pin-track infection remains one of the most troublesome
complications of external fixation, in some cases compromising otherwise
successful fracture treatment.
Methods: One hundred and eighteen patients (120 wrists) who had been
managed with the placement of an external fixation device for the treatment of
a displaced, unstable, distal radial fracture were randomized into one of
three treatment groups: (1) weekly dry dressing changes without pin-site care;
(2) daily pin-site care with a solution of one-half normal saline solution and
one-half hydrogen peroxide; and (3) treatment with the placement of
chlorhexidine-impregnated discs (Biopatch) around the pins, with weekly
changes of the discs by the treating surgeon. The patients were followed at
weekly intervals until the external fixator was removed. Radiographs were made
biweekly. The patients were evaluated with regard to (1) erythema, (2)
cellulitis, (3) drainage, (4) clinical or radiographic evidence of
pin-loosening, (5) the need for antibiotics, and (6) the need for pin removal
before fracture-healing due to infection. Differences in complication rates
among the three groups, with adjustment for patient age, gender, and the
performance of an associated open procedure, were evaluated.
Results: The average age of the patients was fifty-four years.
Forty-seven wrists had an open procedure (either bone-grafting or open
reduction and internal fixation) in addition to treatment with the external
fixator. The fixators remained in place for an average of 5.9 weeks.
Twenty-three patients (19%) had a complication related to the pin track, with
twelve of these patients requiring oral antibiotics for the treatment of a
pin-track infection. There were no significant differences among the three
groups with regard to the prevalence of pin-site complications. The age of the
patient was found to be significantly associated with an increased risk of
postoperative pin-track complications (p = 0.04).
Conclusions: We found a high rate of local wound complications
around external fixation pin sites; however, most complications were minor and
could be observed or treated with oral antibiotics. The prevalence of these
complications was not decreased in association with the use of hydrogen
peroxide wound care or chlorhexidine-impregnated dressings. On the basis of
these results, we do not recommend additional wound care beyond the use of
dry, sterile dressings for pin-track care after external fixation for the
treatment of distal radial fractures.
Level of Evidence: Therapeutic Level II. See Instructions
to Authors for a complete description of levels of evidence.