Routine pin tract care in external fixation is unnecessary: A randomised, prospective, blinded controlled study Carlo Camathias a, *, Victor Valderrabano b , Hermann Oberli c a UKBB, University Childrens Hospital Basel, Department of Orthopaedics, Spitalstrasse 33, 4056 Basel, Switzerland b University Hospital Basel, Department of Orthopaedics, Spitalstrasse 21, 4031 Basel, Switzerland c National Referral Hospital, Honiara, Solomon Islands, Dorfmatt 7, 3286 Muntelier, Switzerland Introduction The external fixator (ExFix) is a simple device for fast and inexpensive stabilisation of a bone segment or a joint. It has been in use for over 100 years and is an accepted part of the armamentari- um for orthopaedic surgeons. In over a million cases per year worldwide, the ExFix is used in the fields of limb reconstruction, for surgical treatment of deformities and acute trauma. Complications associated with these devices include wound infection, non-union, neurovascular injury, and premature consolidation. 1–3 However these complications are relatively rare when compared to pin tract infection which is an accepted, common finding when managing patients with these devices. This circumstance can lead to loosening of the pins, osteomyelitis and loss of fixation. 4 The pin site is a crucial part of the construct as it represents an interruption in the natural skin barrier to infection. 5,6 Ahlborg showed a complication rate of 27% overall with ex fix treatment with 21% of the overall rate being pin tract infections. 7 Others have shown up to 42% rate of inflammatory changes in the skin around the pin site. 4 Despite being used for decades, there is no consensus in the literature as to the appropriate regimen for pin tract care and infection prevention. Regimens vary widely in the cleaning fluid used (from sterile water to dilute detergent), how the crusts are managed (removed or left), where the care is carried out (sterile area or clean), whether a cream is applied to the pin tract, the person who carries out the care (specialist nurse, district nurse, doctor), and the rate of pin cleaning and wound debridement (daily, weekly, monthly, never). 8,9 There are now some low powered preliminary studies suggesting that regular cleaning or pin site care of any kind may not be necessary or improve the outcome in terms of number of pin tract infections. 10–14 This study is the first intra-subject, randomised, prospective controlled trial comparing daily pin tract care to no pin tract care at Injury, Int. J. Care Injured 43 (2012) 1969–1973 A R T I C L E I N F O Article history: Accepted 31 July 2012 Keywords: External fixation Infection Pin tract infection Pin tract care A B S T R A C T Introduction: Pin site infections are seen in up to 40% of external fixators (ExFix) and are therefore the most common complication with this device. There is no consensus in the literature as to the appropriate regimen for pin tract care and infection prevention. This study is the first intra-subject, randomised, prospective controlled trial comparing daily pin tract care to no pin tract care at all. Method: Consecutive patients series (56 patients, 16 female, age 4–68y, mean 24y, in total 204 pins) recruited in the National Referral Hospital in Honiara in the Solomon Islands over a 2 year period. Exclusion criteria were application of ExFix for less than two weeks or a non-standard ExFix. Pin treatment was allocated into groups anatomically, proximal and distal. Randomisation was intra- subject and intra-group: 101 pins had daily pin site care and 103 had no treatment at all. Endpoints: Soft-tissue interface, stability of the pins, torsional stability as determined with a torque metre, osteolysis and pain. Assessment of pin sites blinded. Statistical analysis using the paired t test for parametric data and the Wilcoxon rank test for non-parametric data (Stat View). Results: No significant difference between the two groups. Soft-tissue interface 36% vs. 35% (granulation/ secretion), stability 20 vs 25 pins with loosening. No significant osteolysis (7 vs. 6 pins). Torque: mean 0.75 Nm, max.: 3.05 Nm vs. 0.60 Nm, max.: 3.55 Nm, no significant difference. No differences in demographics (age, localisation, sex, time of fixation). Conclusion: This study shows that routine pin tract care is unnecessary in external fixation treatment of injuries. ß 2012 Elsevier Ltd. All rights reserved. * Corresponding author. Tel.: +41 61 365 55 37. E-mail addresses: carlo.camathias@ukbb.ch, camathias.carlo@gmail.com (C. Camathias), vvalderrabano@uhbs.ch (V. Valderrabano), puletaufao@gmail.com (H. Oberli). Contents lists available at SciVerse ScienceDirect Injury jo ur n al ho m epag e: ww w.els evier .c om /lo cat e/inju r y 0020–1383/$ – see front matter ß 2012 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.injury.2012.08.010