Effect of frame and fixation factors on the incidence of pin site infections in circular external fixation of the tibia: A systematic review of comparative studies

Abstract

Introduction: Pin site infections (PSIs) are frequent complications encountered with the use of circular external fixators. PSIs range in severity, and the numerous factors have been suggested to affect the incidence. We aim to perform a systematic review of all comparative studies including circular external fixation applied to the tibia diaphysis in adult patients and to explore frame and fixation factors that may be associated with the development of PSI. Materials and Methods: We conduct a systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to assess the available data with the specific focus on frame factors that might contribute to the development of PSI. A literature search of major electronic databases was conducted to identify journal articles. A scoping review process was adopted due to the expected broad variation of studies in our research topic using the PRISMA for Scoping Reviews guidelines. Results: The initial electronic database search produced 360 publications. After a review process, only four publications were retained for final analysis. Type of fixation pins and wires, frame fixation configurations, and reconstructive methods were compared in these studies. There are very few clinical studies comparing the different frame and fixation factors that can influence PSI rates in circular external fixation. The available studies reflect a significant degree of bias and confounding, representing a low level of evidence. Conclusion: Further research is needed, and with the present paucity of data, it is not possible to make any firm recommendations. Within the same frame construct, it appears that tensioned wires may carry a lower risk of PSI than half-pins.