Evaluation of effectiveness of 10% polyvinylpyrrolidone-iodine solution against infections in wire and pin holes for Ilizarov external fixators

Abstract

CONTEXT AND OBJECTIVE: Superficial infection at wire and pin insertions in the skin is a frequent disorder among patients utilizing the Ilizarov method. The objective of this study was to evaluate the effectiveness of daily topical application of 10% polyvinylpyrrolidone-iodine solution against infections of the holes for Kirschner wires and Schanz pins among patients using Ilizarov external fixators, in comparison with cleaning these holes only with 0.9% sterile physiological saline solution. DESIGN AND SETTING: Controlled randomized clinical trial, in the Orthopedics and Traumatology Outpatient Clinic, Hospital São Paulo, and Orthopedics and Traumatology Center of Jundiaí. METHODS: 30 patients were treated using the Ilizarov technique: 15 were instructed to apply 0.9% physiological saline dressing on the wire and pin insertions and 15 to apply 0.9% physiological saline plus 10% polyvinylpyrrolidone-iodine. Patients were evaluated at outpatient return visits for identification of signs and symptoms of superficial infection at wire and pin insertion sites. Samples were collected from cases of purulent exudate secretion, for culturing and clinical tests. RESULTS: The chi-squared and Fischer exact tests were applied, but no statistically significant association between the intervention of topical polyvinylpyrrolidone-iodine solution and the prevention of infections at wire and pin insertions could be found. CONCLUSIONS: Topical 10% polyvinylpyrrolidone-iodine solution applied daily to Kirschner wire and Schanz pin insertions did not reduce the incidence of superficial infection at these holes, in comparison with mechanical removal of dirt using 0.9% physiological saline solution.

Assessment of an implant-skin interface scoring system for external skeletal fixation of dogs

“…The development of a validated scoring system of inflammation at an ISI is an essential step for allowing clinicians to reach evidence-based conclusions about outcomes and complications in clinical studies involving ESF for factors ranging from care of the pin site to coatings of implants. Several scoring systems of the ISI have been used for clinical studies [19][20][21][22][23][24][25][26] in human medicine. The primary limitations of those scoring systems are a lack of validation and inconsistency in scoring systems among studies, which prevents meaningful comparisons.…”

“…The lack of a validated scoring system weakens the conclusions of previous clinical studies in which investigators evaluated the skin response to external fixators. [19][20][21][22][23][24][25][26] To our knowledge, no scoring system for inflammation at the ISI has been fully validated for human or veterinary medicine. Full validation involves face validity, intraobserver repeatability, interobserver agreement, and criterion validation.…”

“…A standard method for the development of an instrument to assess a subjective state was used to develop an ISI inflammation score on the basis of nonvalidated ISI scoring systems used previously for humans. [19][20][21][22][23][24][25][26] Six metrics were defined: erythema, discharge amount, discharge type, swelling, hair loss or lack of hair regrowth, and granulation tissue. A scale from 1 to 10 (higher scores indicated greater severity of each of the assessed metrics of inflammation) was selected on the basis of ease of use, compared with ease of use for a visual analogue scale.…”

A web‐based survey to identify current practice in skeletal pin site management

“…19 The increasing number of trials investigating the effects of different dressings on PSI is encouraging, although small study populations and heterogeneous designs make comparison of data challenging. 23,24,[30][31][32][33][34] Current results highlight a clear lack of consensus regarding dressing of pin sites.…”

A survey of current practice in skeletal pin site management

“…One issue of note is the use of gauze dressings that may shed fibres into an open wound and these act as an irritant and source of infection. A recent Brazilian study (Camilo and Bongiovanni, 2005) demonstrated no significant reduction in the infection rates that occurred when iodine soaked gauze is used to dress the pin sites in comparison to gauze soaked with normal saline. This survey shows that a number of dressing products are currently in use across the UK, especially in the immediate post-operative period.…”