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Children's Orthopaedics: R. Davies, N. Holt, and S. Nayagam The care of pin sites with external fixation J Bone Joint Surg Br 2005; 87-B: 716-719 [Abstract] [Full text] [PDF]

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Letter from Sian, Britten and Duffield

Parmjit S. Sian, Simon Britten and Beverley Duffield.   (18 August 2005)

Letter from Sian, Britten and Duffield 18 August 2005
Parmjit S. Sian, Senior SHO in Trauma and Orthopaedics St James's University Hospital, Beckett Street, Leeds, West Yorkshire, LS9 7TF, Simon Britten and Beverley Duffield. Send letter to journal: Re: Letter from Sian, Britten and Duffield parmjitsian{at}hotmail.com Parmjit S. Sian, et al.	Sir, We read this paper with interest. It compares the British consensus method with the Russian method of pin site care. In our unit we compared pin site infection data collected retrospectively for the British consensus method (group A) and prospectively for a modified version of the Russian method (group B). We also emphasised total pin site care from insertion (no touch technique, pulse drilling etc) to post-operative management (clean weekly with alcoholic chlorhexidine and keep covered). Our modification was to use plastic clips and Allevyn foam squares (Smith & Nephew Healthcare, Hull, UK) in place of rubber stoppers and alcohol soaked gauze. The numbers of patients with pin site infection during the lifetime of their frame are shown in Table I. All patients in group A had an infection requiring oral antibiotics, compared with only 23/44 in group B (chi-squared test, p = 0.001). In group A, 10/16 required hospitalisation for IV antibiotics, pin site abscess drainage or wire change; while in group B significantly fewer patients (only 3/44 required hospitalisation (p < 0.001). Our results were similar to those of Davies, Nayagam and Holt. This suggests that the method of total pin site care (no touch technique, pulse drilling with irrigation, cleaning weekly with alcoholic chlorhexidine and keeping covered) is paramount in reducing pin site infection, rather than simply the materials used. In our opinion, plastic clips and Allevyn foam squares are easier to use (and a forgotten clip can always be applied after the wire has been attached and tensioned). Since the instigation of the Russian method of total pin site care in our unit there has been a dramatic reduction in infections requiring inpatient hospital care from 63% to 7%. It would be interesting to see what view ethics committees take on randomised, controlled trials in this field, given the vast difference in serious infections recorded for the two methods. Meanwhile, the Ilizarov method is no longer synonymous with inevitable serious pin site infection. P. S. SIAN S. BRITTEN B. DUFFIELD St James's University Hospital, Leeds, UK. We would like to acknowledge the following for their guidance in pin site care. The staff of the Royal Liverpool Children’s Hospital; Bristol Royal Infirmary; and the Russian Ilizarov Scientific Centre for Restorative Orthopaedics and Traumatology, Kurgan, Russia. 1. Davies R, Holt N, Nayagam S. The care of pin sites with external fixation. J Bone Joint Surg [Br] 2005;87-B:716-19.   Table I Presence of Infection Group A Group B No 0(0) 21(0.477) Yes 16(1) 23(0.523) Total 16 44