Do pin site cleaning techniques and solutions affect pin site infection rate in external fixation? A systematic review of randomized and nonrandomized trials

Abstract

Introduction: Infection at the pin site connecting an external fixator to the limb is a common and potentially serious complication of frame treatment. Impacted by many patient and injury factors, further variables exist in terms of the way in which pin sites are cared for. Timing and techniques used to clean pin sites vary substantially and are an attractive domain in which to intervene to decrease infection due to the extent of the associated complications and number of patients involved. Through this review, we explore the impact of cleaning techniques and solutions on pin site infection. Methodology: A systematic literature review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, MEDLINE, Cochrane Controlled Trials Register (1996–2022), and EMBASE (1974–2022) were searched in January 2022. Results: Thirty-two articles were identified and following eligibility criteria application 14 studies were analyzed. Nine hundred and fourteen adult and child patients undergoing external fixation treatment 2003–2021 in 12 countries were included. Nine studies used an outcome measure and of these, five different outcome measures were used. The literature was graded as having either some or high concerns of bias. No pooling of data was enabled. Discussion: The literature investigating variables impacting on pin site care in terms of solutions used, technique, and timing of care is poor. Variance in methodology, populations compared, interventions, and outcomes preclude meaningful analysis or conclusions. In particular, the lack of consensus on diagnosis and classification compromises studies relating to this question. Conclusions: Pin site infection is a significant issue in patients undergoing external fixation. The available literature cannot be used to guide care. We strongly recommend a consensus is derived on methodology for studies investigating pin site care. A well-designed randomized controlled trial would carry huge value due to the numbers of patients whose care could be improved through a reduction in pin site infection. Objective: To estimate the impact of pin site cleaning techniques and solutions in preventing pin site infection in patients treated with external fixation. The question which this systematic review address is: “Does pin site cleaning techniques and solutions affect pin site infection rate in external fixation?”