Department of Orthopaedics and Physical Performance, University of Rochester Medical Center, Rochester, NY.
J Orthop Trauma. 2024 Aug 1;38(8):e288-e294. doi: 10.1097/BOT.0000000000002823.
To determine if rates of pin site infection and surgical site infection among patients managed with primary closure after external fixator removal were similar to those allowed to heal secondarily.
Retrospective cohort.
Urban/Suburban Academic Level I Trauma Center.
Patients who had received a lower extremity external fixator for provisional management before definitive fixation of lower extremity fractures were included with pin site wounds closed primarily or allowed to heal by secondary intention.
The rate of pin tract infection and surgical site infection following primary closure of external fixator pin sites relative to patients whose pin sites were allowed to heal through secondary intention.
In total, 256 patients were evaluated: 143 patients (406 pin sites) in the primary closure group and 113 patients (340 in sites) in the secondary closure group. The average age was 49 ± 16 years. Sixty-five percent of included patients were male. There was no difference in pin tract infections between cohorts (primary = 0.5%, secondary = 1.5%, P = 0.26). External fixator duration in the primary closure group was 11.5 ± 8.4 days and 13.0 ± 8.1 days in the secondary closure group (P = 0.15). There was a greater rate of surgical site infections in the secondary intention cohort (15.9% vs. 7.7%, P = 0.047).
There was no difference in pin site infection rate after primary pin site closure relative to patients who were allowed to heal through secondary intention. Furthermore, there was a lower rate of surgical site infection after primary closure. These results challenge the dogma of secondary closure for ex fix pin sites, suggesting that debridement and primary closure is a safe option for management of external fixator pin sites and may impart benefit in decreasing infection risk.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
确定接受外固定器去除后一期缝合的患者与二期愈合的患者相比，针道感染和手术部位感染的发生率是否相似。
回顾性队列研究。
城市/郊区一级创伤中心。
接受下肢外固定器临时固定后，行确定性固定治疗下肢骨折的患者，其针道伤口一期缝合或二期愈合。
一期缝合外固定器针道与二期愈合患者的针道感染和手术部位感染率。
共评估了 256 例患者：一期缝合组 143 例（406 个针道），二期愈合组 113 例（340 个针道）。平均年龄为 49±16 岁。65%的患者为男性。两组针道感染率无差异（一期：0.5%，二期：1.5%，P=0.26）。一期缝合组外固定器使用时间为 11.5±8.4 天，二期愈合组为 13.0±8.1 天（P=0.15）。二期愈合组的手术部位感染率较高（15.9%比 7.7%，P=0.047）。
一期缝合针道与允许二期愈合的患者相比，针道感染率无差异。此外，一期缝合后手术部位感染率较低。这些结果对外固定器针道的二期愈合原则提出了挑战，表明清创和一期缝合是管理外固定器针道的安全选择，并可能降低感染风险。
治疗性 III 级。欲了解完整的证据分级说明，请参见作者须知。
