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Meta-Analysis
. 2013 Dec 3;2013(12):CD004551.
doi: 10.1002/14651858.CD004551.pub3.

Pin site care for preventing infections associated with external bone fixators and pins

Anne Lethaby  1 , Jenny Temple, Julie Santy-Tomlinson
Affiliations
Meta-Analysis

Pin site care for preventing infections associated with external bone fixators and pins

Anne Lethaby et al. Cochrane Database Syst Rev. .

Abstract

Background: Metal pins are used to apply skeletal traction or external fixation devices in the management of orthopaedic fractures. These percutaneous pins protrude through the skin, and the way in which they are treated after insertion may affect the incidence of pin site infection. This review set out to summarise the evidence of pin site care on infection rates.

Objectives: To assess the effect on infection rates of different methods of cleansing and dressing orthopaedic percutaneous pin sites.

Search methods: In September 2013, for this third update, we searched the Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL.

Selection criteria: We evaluated all randomised controlled trials (RCTs) that compared the effect on infection and other complication rates of different methods of cleansing or dressing orthopaedic percutaneous pin sites.

Data collection and analysis: Two review authors independently assessed the citations retrieved by the search strategies for reports of relevant RCTs, then independently selected trials that satisfied the inclusion criteria, extracted data and undertook quality assessment.

Main results: A total of eleven trials (572 participants) were eligible for inclusion in the review but not all participants contributed data to each comparison. Three trials compared a cleansing regimen (saline, alcohol, hydrogen peroxide or antibacterial soap) with no cleansing (application of a dry dressing), three trials compared alternative sterile cleansing solutions (saline, alcohol, peroxide, povidone iodine), three trials compared methods of cleansing (one trial compared identical pin site care performed daily or weekly and the two others compared sterile with non sterile techniques), one trial compared daily pin site care with no care and six trials compared different dressings (using different solutions/ointments and dry and impregnated gauze or sponges). One small blinded study of 38 patients found that the risk of pin site infection was significantly reduced with polyhexamethylene biguanide (PHMB) gauze when compared to plain gauze (RR 0.23, 95% CI 0.12 to 0.44) (infection rate of 1% in the PHMB group and 4.5% in the control group) but this study was at high risk of bias as the unit of analysis was observations rather than patients. There were no other statistically significant differences between groups in any of the other trials.

Authors' conclusions: The available trial evidence was not extensive, was very heterogeneous and generally of poor quality, so there was insufficient evidence to be able to identify a strategy of pin site care that minimises infection rates. Adequately-powered randomised trials are required to examine the effects of different pin care regimens, and co-interventions - such as antibiotic use - and other extraneous factors must be controlled in the study designs.

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Conflict of interest statement

None

Figures

1
1
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
2
2
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
1.1
1.1. Analysis
Comparison 1 Cleansing compared with no cleansing, Outcome 1 Infection rates.
2.1
2.1. Analysis
Comparison 2 Sterile antiseptic cleansing solution compared with sterile non‐antiseptic cleansing, Outcome 1 Infection rate.
3.1
3.1. Analysis
Comparison 3 Sterile cleansing method compared with non‐sterile cleansing, Outcome 1 Minor infection.
3.2
3.2. Analysis
Comparison 3 Sterile cleansing method compared with non‐sterile cleansing, Outcome 2 Major infection.
4.1
4.1. Analysis
Comparison 4 Dressing compared with no dressing, Outcome 1 Successful condition of soft tissue interface.
5.1
5.1. Analysis
Comparison 5 Comparisons between different types of dressings, Outcome 1 Antibiotics needed.
5.2
5.2. Analysis
Comparison 5 Comparisons between different types of dressings, Outcome 2 Clinical signs of infection.
5.3
5.3. Analysis
Comparison 5 Comparisons between different types of dressings, Outcome 3 Superficial infection.
5.4
5.4. Analysis
Comparison 5 Comparisons between different types of dressings, Outcome 4 Infection rate xeroform vs gauze or sponge.
5.5
5.5. Analysis
Comparison 5 Comparisons between different types of dressings, Outcome 5 Any infection sulfadiazine vs dry dressing.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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