This Article Full Text Full Text (PDF) CME: Take the activities for this article: Hand Test 6: Fall 2006 (publication date November 15, 2006; expiration date... CME 1: January, February, March 2006 Trauma Test 11: Spring 2006 (publication date May 15, 2006; expiration date... [Supplementary Material] Letters to the Editor: Submit a response Letters to the Editor: View responses Alert me when this article is cited Alert me when Letters to the Editor are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Egol, K. A. Articles by Koval, K. J. Search for Related Content PubMed PubMed Citation Articles by Egol, K. A. Articles by Koval, K. J. Related Collections Hand/Wrist Social Bookmarking                   What's this?

Treatment of External Fixation Pins About the Wrist: A Prospective, Randomized Trial

¹ Department of Orthopaedic Surgery, New York University—Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003. E-mail address for K.A. Egol: ljegol{at}att.net
² Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756

Investigation performed at the Department of Orthopaedic Surgery, New York University—Hospital for Joint Diseases, New York, NY

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

The authors did not receive grants or outside funding in support of their research for or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Methods: One hundred and eighteen patients (120 wrists) who had been managed with the placement of an external fixation device for the treatment of a displaced, unstable, distal radial fracture were randomized into one of three treatment groups: (1) weekly dry dressing changes without pin-site care; (2) daily pin-site care with a solution of one-half normal saline solution and one-half hydrogen peroxide; and (3) treatment with the placement of chlorhexidine-impregnated discs (Biopatch) around the pins, with weekly changes of the discs by the treating surgeon. The patients were followed at weekly intervals until the external fixator was removed. Radiographs were made biweekly. The patients were evaluated with regard to (1) erythema, (2) cellulitis, (3) drainage, (4) clinical or radiographic evidence of pin-loosening, (5) the need for antibiotics, and (6) the need for pin removal before fracture-healing due to infection. Differences in complication rates among the three groups, with adjustment for patient age, gender, and the performance of an associated open procedure, were evaluated.

Results: The average age of the patients was fifty-four years. Forty-seven wrists had an open procedure (either bone-grafting or open reduction and internal fixation) in addition to treatment with the external fixator. The fixators remained in place for an average of 5.9 weeks. Twenty-three patients (19%) had a complication related to the pin track, with twelve of these patients requiring oral antibiotics for the treatment of a pin-track infection. There were no significant differences among the three groups with regard to the prevalence of pin-site complications. The age of the patient was found to be significantly associated with an increased risk of postoperative pin-track complications (p = 0.04).

Conclusions: We found a high rate of local wound complications around external fixation pin sites; however, most complications were minor and could be observed or treated with oral antibiotics. The prevalence of these complications was not decreased in association with the use of hydrogen peroxide wound care or chlorhexidine-impregnated dressings. On the basis of these results, we do not recommend additional wound care beyond the use of dry, sterile dressings for pin-track care after external fixation for the treatment of distal radial fractures.

Level of Evidence: Therapeutic Level II. See Instructions to Authors for a complete description of levels of evidence.

CiteULike    Connotea    Del.icio.us    Facebook    Technorati    Twitter    What's this?

This article has been cited by other articles:

				J. K. ANDERSEN, A. HOGH, J. GANTOV, M. T. VAeSEL, and T. B. HANSEN Colles' Fracture Treated with Non-Bridging External Fixation: A 1-Year Follow-Up J Hand Surg Eur Vol., August 1, 2009; 34(4): 475 - 478. [Abstract] [Full Text] [PDF]

Letters to the Editor:

Stanford University Libraries' HighWire Press (TM) assists in the publication of JBJS Online.
Copyright © 2006 by The Journal of Bone and Joint Surgery, Inc. Online ISSN: 1535-1386.
The Journal of Bone and Joint Surgery®, JBJS®, JB&JS®, and eJBJS® are registered in the U.S. Patent and Trademark Office.