What is the recommended approach for pin site care of external fixators to prevent infection?

From the Guidelines

The standard for pin site care of external fixators involves daily cleaning with chlorhexidine solution or normal saline, followed by application of an antimicrobial ointment, without the use of silver-coated dressings, as they do not improve outcomes or decrease pin site infections 1.

Pin Site Care Approach

The approach to pin site care should prioritize evidence-based methods to prevent infection. Key components include:

• Daily cleaning with chlorhexidine solution (0.5-2%) or normal saline
• Application of an antimicrobial ointment such as mupirocin or bacitracin zinc after cleaning
• Cleaning should begin 24-48 hours after fixator placement and continue until removal
• The technique involves gently removing crusts and debris around each pin with sterile gauze soaked in the cleaning solution

Importance of Pin Site Care

Pin site care is crucial because the metal pins create a direct pathway from the external environment to bone, making infection a common complication. Proper care reduces bacterial colonization at the skin-pin interface, minimizes tissue irritation from pin movement, and promotes tissue adherence to the pin, creating a natural barrier against bacterial migration. Patients should be instructed to monitor for signs of infection including increased redness, warmth, pain, swelling, or drainage around pin sites. The use of silver-coated dressings is not recommended as they do not improve outcomes or decrease pin site infections, as stated in the AAOS clinical practice guideline summary 1.

From the Research

Pin Site Care for External Fixators

The standard for pin site care of external fixators (ex-fix) is crucial to prevent infection. According to the available evidence:

• Pin site infections are a significant problem, with incidences between 3% and 80% reported in the literature 2.
• The most commonly implicated organisms are Staphylococcus aureus and Staphylococcus epidermidis 2.
• Techniques to prevent infection must prevent bacterial adhesion, allow good osteointegration, and have a low toxicity 2.

Recommended Approaches

Some recommended approaches for pin site care include:

• Using antiseptic solutions such as chlorhexidine-alcohol or povidone-iodine solution 3.
• Applying a dry dressing or using a cleansing regimen with saline, alcohol, or antibacterial soap 4.
• Using polyhexamethylene biguanide (PHMB) gauze, which has been shown to reduce the risk of pin site infection 4.
• Implementing a simplified approach for addressing pin care protocol using cord locks with compression sponges 5.

Key Considerations

Key considerations for pin site care include:

• Effective assessment, monitoring, and cleaning of the pin site to prevent infections 6.
• Controlling co-interventions, such as antibiotic use, and other extraneous factors in study designs 4.
• The need for adequately-powered randomized trials to examine the effects of different pin care regimens 4.