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. 2024 Aug 1;38(8):e288-e294.
doi: 10.1097/BOT.0000000000002823.

Primary Closure of External Fixator Pin Sites Is Safe After Orthopaedic Trauma Surgery

James D Brodell Jr  1 , Brittany Haws, Jeffrey B Shroff, Steven T Karnyski, Samantha Hoffman, Sandeep P Soin, Catherine A Humphrey, John T Gorczyca, John P Ketz
Affiliations

Primary Closure of External Fixator Pin Sites Is Safe After Orthopaedic Trauma Surgery

James D Brodell Jr et al. J Orthop Trauma. .

Abstract

Objectives: To determine if rates of pin site infection and surgical site infection among patients managed with primary closure after external fixator removal were similar to those allowed to heal secondarily.

Design: Retrospective cohort.

Setting: Urban/Suburban Academic Level I Trauma Center.

Patient selection criteria: Patients who had received a lower extremity external fixator for provisional management before definitive fixation of lower extremity fractures were included with pin site wounds closed primarily or allowed to heal by secondary intention.

Outcome measures and comparisons: The rate of pin tract infection and surgical site infection following primary closure of external fixator pin sites relative to patients whose pin sites were allowed to heal through secondary intention.

Results: In total, 256 patients were evaluated: 143 patients (406 pin sites) in the primary closure group and 113 patients (340 in sites) in the secondary closure group. The average age was 49 ± 16 years. Sixty-five percent of included patients were male. There was no difference in pin tract infections between cohorts (primary = 0.5%, secondary = 1.5%, P = 0.26). External fixator duration in the primary closure group was 11.5 ± 8.4 days and 13.0 ± 8.1 days in the secondary closure group (P = 0.15). There was a greater rate of surgical site infections in the secondary intention cohort (15.9% vs. 7.7%, P = 0.047).

Conclusions: There was no difference in pin site infection rate after primary pin site closure relative to patients who were allowed to heal through secondary intention. Furthermore, there was a lower rate of surgical site infection after primary closure. These results challenge the dogma of secondary closure for ex fix pin sites, suggesting that debridement and primary closure is a safe option for management of external fixator pin sites and may impart benefit in decreasing infection risk.

Level of evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Conflict of interest statement

The authors report no conflict of interest.

References

    1. Bible JE, Mir HR. External fixation: principles and applications. J Am Acad Orthop Surg. 2015;23(11):683–690.
    1. Roth F, Cagienard F, Link BC, et al. Primary or secondary wound healing of the pin sites after removal of the external fixator: study protocol for a prospective, randomized controlled, monocenter trial. Trials. 2020;21:205–209.
    1. Jennison T, McNally M, Pandit H. Prevention of infection in external fixator pin sites. Acta Biomater. 2014;10:595–603.
    1. W-Dahl A, Toksvig-Larsen S, Lindstrand A. No difference between daily and weekly pin site care: a randomized study of 50 patients with external fixation. Acta Orthop Scand. 2003;74:704–708.
    1. Potter JM, van der Vliet QMJ, Esposito JG, et al. Is the proximity of external fixator pins to eventual definitive fixation implants related to the risk of deep infection in the staged management of tibial pilon fractures?. Injury. 2019;50:2103–2107.

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