Reduction of pin tract infections during external fixation using cadexomer iodine

Abstract

Purpose Knee joint distraction (KJD) is a joint-preserving treatment for younger osteoarthritis patients. KJD has shown positive results in regular care, but the external fixation frame often caused pin tract skin infections. Therefore, the use of cadexomer iodine was included in the wound care protocol. The goal of this cross-sectional study was to evaluate whether use of this ointment reduced the number of patients with infections during KJD treatment. Methods Patients treated with KJD in regular care were included if they gave consent for use of their data and completed treatment with the newest distraction device before 2020. All patients followed a wound care protocol, which since March 2019 included using cadexomer iodine ointment. The number of patients experiencing pin tract infections was compared between patients who did (March 2019–December 2019) and did not (November 2017–March 2019) use the ointment. Results Sixty-seven patients were included; 34 patients used cadexomer iodine and 33 patients did not. Patient who did not use cadexomer iodine experienced twice as many infections (64% vs 32%;p = 0.010). There was a significant difference in the number of patients with serious infections, requiring more antibiotics than the standard 7-day oral antibiotics (30% without vs 6% with cadexomer iodine; p = 0.009). Conclusions The use of cadexomer iodine ointment during KJD results in a significant reduction of the number of patients experiencing pin tract infections during treatment. Use of this ointment should be considered standard protocol during KJD treatment and could be of value in general external fixator usage as well.

Joint distraction using a purpose-built device for knee osteoarthritis: a prospective 2-year follow-up

“…Reducing infections remains an important improvement to patient experience, in which care protocols may be effective. 26 Also, while device-related complications occurred in 12% of patients, only in one case (the broken pin) this resulted in patient discomfort, and neither pin tract infections nor device-related complications were shown to affect treatment primary outcomes or physical health.…”

In-vitro external fixation pin-site model proof of concept: A novel approach to studying wound healing in transcutaneous implants

“…Multiple approaches have been attempted to prevent or minimise pin-site infection with varying degrees of success, including compressive dressings or the use of advanced pin materials, coatings or topical ointments. 53–59…”

“…[14][15][16][17][18][19][20] Multiple approaches have been attempted to prevent or minimise pin-site infection with varying degrees of success, including compressive dressings or the use of advanced pin materials, coatings or topical ointments. [53][54][55][56][57][58][59] The majority of these studies have been in vivo or animal studies, which are costly, difficult to control, lack physiological relevant or have ethical implications. The development of a realistic pin-site model would allow for high throughput testing to better understand the mechanisms of pin-site infection and study the efficacy of these treatments on a larger scale.…”

Ankle joint distraction is a promising alternative treatment for patients with severe haemophilic ankle arthropathy

“…35 A recent study by Jansen et al showed that in OA patients treated with KJD the use of cadexomer iodine ointment resulted in a significant reduction of the number of patients suffering from pin tract infections. 41 Incorporating this antimicrobial ointment in future studies involving patients with AJD can improve the experience of the procedure. A specific concern in haemophilia patients is the risk of bleeding.…”