Abstract
Pin tract infections have been considered a major drawback in the use of external
fixation and can deleteriously affect bone and soft tissue healing. Recognizing the
scope of the problem, a study was designed to evaluate the efficacy of antibiotic-impregnated
polyurethane tubing for the prevention of pin tract infections. Antibiotic-coated
pin sleeves were manufactured by Smith & Nephew, Richards, Memphis, TN and were made
of polyether-based, thermoplastic polyurethane tubing, which is the same material
used in cardiovascular and urological catheters and stents. The interior and exterior
of the tubing were coated with an antibiotic polymer matrix (gentamicin 0.2 to 0.4
mg/cm2) from which the antibiotic was released. 4-mm half-pins were placed in the iliac
crest of goats and randomly assigned pins were then treated with the antibiotic sleeve.
Pins were contaminated with a gentamicin-sensitive strain of Staphylococcus aureus. The antibiotic-loaded pin sleeves were effective in decreasing the number of organism
colony forming units per pin by 4 orders of magnitude (P < 0.005) and increasing the
stability of the external half pins by 24.5 % (P < 0.05).
Key words
Pin tract infection - external fixation - gentamicin antibiotic coated pin sleeves
- osteomyelitis
References
- 1
Anderson L D, Hutchinson W C, Wright P E, Disney J M.
Fractures of the tibia and fibula treated by casts and transfixing pins.
Clin Orthop.
1974;
105
179-191
- 2
Arens S, Schlegel U, Printzen G, Ziegler W J, Perren S M, Hansis M.
Influence of materials for fixation implants on local infection. An experimental study
of steel versus titanium DCP in rabbits.
J Bone Joint Surg [Br].
1996;
78
647-651
- 3
Behrens F.
External skeletal fixation, part H.
Instructional Course Lectures.
1981;
30
170-182
- 4
Behrens F, Searls K.
External fixation of the tibia. Basic concepts and prospective evaluation.
J Bone Joint Surg [Br].
1986;
68
246-254
- 5
Burny F.
Complications liées a l'utilization de l'osteotaxis.
Acta orthopaedic Belg.
1975;
41
103-109
- 6
Caja V L, Moroni A.
Hydroxyapatite coated external fixation pins: an experimental study.
Clin Orthop.
1996;
325
269-275
- 7
Collinge C A, Goll G, Seligson D, Easley K J.
Pin tract infections: silver vs uncoated pins.
Orthopedics.
1994;
17
445-448
- 8
Colmano G, Edwards S S, Barranco S D.
Activated silver coatings for surgical implants.
Va Med.
1979;
106
928-930
- 9
Green S A.
Complications of external fixation.
Clinical Orthopaedics.
1983;
180
109-116
- 10
Lund M E, Hawkinson R W.
Evaluation of the prompt inoculation system for preparation for standardized bacterial
inocula.
J Clin Microbiology.
1983;
18
84-91
- 11
Mahan J, Seligson D, Henry S L, Hynes P, Dobbins J.
Factors in pin tract infections.
Orthopedics.
1991;
14
305-308
- 12
Mathews L S, Green S A, Goldstein S A.
The thermal effects of skeleton fixation-pin insertion into the bone.
J Bone Joint Surg [Am].
1984;
66
1017-1083
- 13
McGraw J M, Lim E V.
Treatment of open tibial-shaft fractures: External fixation and secondary intramedullary
nailing.
J Bone Joint Surg [Am].
1988;
70
900-911
- 14
Moroni A, Aspenberg P, Toksvig-Larsen S, Falzarano G, Giannini S.
Enhanced fixation with hydroxyapatite coated pins.
Clin Orthop.
1998;
346
171-177
- 15
Moroni A, Toksvig-Larsen S, Maltarello M C, Orienti L, Stea S, Giannini S.
A comparison of hydroxyapatite-coated, titanium-coated, and uncoated tapered external-fixation
pins. An in vivo study in sheep.
J Bone Joint Surg [Am].
1998;
80
547-554
- 16
Raiha J, Granholm S, Rinkinen M, Miettinen S, Tormala P.
Effect of slow release antibiotics on pin-tract infection.
Tijdschr Diergeneeskd.
1993;
118 (Suppl 1)
18 S
- 17
Respet P J, Kliemann P G, Meinhard B P.
Pin tract infections: a canine model.
J Orthopaedic Research.
1987;
5
600-603
- 18
Rohan N J, Wallace M E.
Pin tract osteomyelitis.
Southern Medical Journal.
1969;
62
1316-1319
- 19
Steinfeld P H, Cobelli N J, Sadler A H, Szporn M N.
Open tibial fractures treated by anterior half-pin frame fixation.
Clinical Orthopaedics.
1988;
228
208-214
- 20
Voos K, Rosenberg B, Fagrhi M, Seligson D.
The use of a tobramycin-impregnated polymethylmethacrylate pin sleeve for the prevention
of pin tract infection in goats.
J Orthopedic Trauma.
1999;
13
98-101
- 21
Wassall M A, Santin M, Isalberti C, Cannas M, Denyer S P.
Adhesion of bacteria to stainless steel and silver-coated orthopedic external fixation
pins.
J Biomed Mater Res.
1997;
36
325-330
- 22 WHO .Expert Committee on Biological Standardization. WHO Tech Rep Ser 610; 1977
David SeligsonMD, Professor
Department of Orthopaedics · University of Louisville
550 South Jackson St. 3rd Floor Bridge
Louisville, KY 40202
USA
Phone: Phone: +1/5 02-8 52-09 23
Fax: +1/5 02-8 52-89 51
Email: Seligson@louisville.edu; Josh.madsen@louisville.edu