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. 2025 Apr 28:18:1455-1465.
doi: 10.2147/RMHP.S509406. eCollection 2025.

Managing Pin Tracts in Open Tibial Fractures: The Role of Medical Waste Rubber Bung

Yi Hu  1 , Yu Peng  1 , Kaihu Li  2 , Jun Zhang  1
Affiliations

Managing Pin Tracts in Open Tibial Fractures: The Role of Medical Waste Rubber Bung

Yi Hu et al. Risk Manag Healthc Policy. .

Abstract

Objective: This study aims to assess the effect of using medical waste rubber bung (MWRB) for pin-tract management in patients with open tibial fractures treated with external fixators (EFs).

Methods: A retrospective analysis of 91 patients with open tibial fractures admitted to our hospital over a three-year period was conducted to compare and statistically characterize overall PTI incidence, PTI rate across five different pin-tract locations, time (days) to the first occurrence of infection, and Checketts-Otterburn classification.

Results: Among the enrolled 91 patients, 88 met the criteria. After excluding deaths and losses to follow-up, they were divided into two study groups, with no significant difference in overall PTI incidence. Group A exhibited a significantly lower rate of severe infection and prolonged time to initial infection compared to Group B (both P < 0.05). Group A also had a significantly lower rate of PTI at the tibial telangiectasia than Group B.

Conclusion: The study underscores that compression in EF management is necessary to significantly reduce the incidence of severe PTIs, especially in the tibial metaphysis, and to delay the onset of initial infection among patients with open tibial fractures.

Keywords: compression; external fixator; medical waste rubber bung; open tibial fracture; pin site infection; pin-tract infection.

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Conflict of interest statement

The authors declare no competing interests in this work.

Figures

Figure 1
Figure 1
The MWRB. (a) Longitudinal plane. (b) Transverse plane.
Figure 2
Figure 2
The operational procedures of using MWRB are demonstrated by these pictures right here. (a) Piercing the skin at a diameter equivalent to that of the pin. (b) Inserting the pin to a precisely determined location. (c) Puncturing the MWRB. (d) Advancing the MWRB onto the pin and securing it at the designated level on the connecting rod. (e) Mounting the connecting rods applying clamps. (f and g) Tending to the pin tract and encircling the pin with sterile pre-cut gauze segments. (h) Lowering the rubber bung to apply mild compression and securing it with sterile gauze.
Figure 3
Figure 3
Distribution of study subjects from enrollment to the end of the study.
Figure 4
Figure 4
Representative images of pin-tract infection in our cases. a-c Minor infection. (a) Grade 1: Slight redness, little discharge. (b) Grade 2: Redness of the skin, discharge, pain and tenderness in the soft tissue. (c) Grade 3: Grade 2 but not improved with antibiotics. (d and e) Major infection. (d) Grade 4: Severe soft tissue infection involving several pins, sometimes with associated loosening of the pin. (e) Grade 5: Grade 4 but also involvement of the bone; also visible in radiographs. External fixation must be abandoned.
See this image and copyright information in PMC

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