The Incidence of Pin Tract Infections and Septic Arthritis in Percutaneous Distal Femur Pinning

Murgai, Rajan; Compton, Edward; Illingworth, Kenneth D.; Kay, Robert M.

doi:10.1097/bpo.0000000000001346

Cited by 7 publications

(10 citation statements)

References 13 publications

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“…In addition, surgical disruption of the joint capsule facilitates communication between the inside and outside of the knee joint. Intra-articular pins can increase the risk of septic arthritis owing to communication with the joint 15. Mamoya et al reported a case of synovial fistula after femoral tension band plating for genu valgum correction 16.…”

Section: Discussionmentioning

confidence: 99%

Distal Femur Growth Modification Surgery Is Associated With Higher Surgical Wound Complication Rate

Hsu

Lee

Kao

et al. 2022

Journal of Pediatric Orthopaedics

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Background: Orthopaedic wound complications are often associated with extensive surgeries and patient medical conditions. However, we noticed wound complications in minor growth modification surgeries in children, including guided growth and epiphysiodesis. Herein, we report the complication rate and risk factors associated with pediatric growth modification surgeries. Methods: This retrospective study reviewed surgical wound complications in 622 pediatric orthopaedic patients who underwent growth modification surgeries (418 children) or osteotomies (204 children) in the lower extremities in a single center between 2007 and 2019. The grades II and III complications assessed using the modified Clavien-Dindo-Sink complication classification system were compared between growth modification and osteotomy. Risk factors for complications, including the type of surgery, age, body mass index, neuromuscular disease, operation time, surgical sites per patient, surgical location, and implant types, were analyzed using the logistic regression. Results: The complication rate was 6.9% per patient and 3.6% per surgical site (29 sites in 29 patients comprising 21 grade II and 8 grade III) in the growth modification group, which was > 1.0% per patient and 0.6% per site in the osteotomy group (2 sites in 2 patients comprising 2 grade III infections; P = 0.001). Among 418 patients with 797 surgical sites in the growth modification group, wound complications were associated with surgical location (5.2% at distal femur vs. 1.0% at proximal tibia, P = 0.002) and implant type (0.5% using transphyseal screw vs. 4.3-10.5% using plates or staples, P = 0.011). Conclusion: Surgical wound complication was associated with growth modification surgeries using plates or staples at the distal femur. Our results alert orthopaedic surgeons to this minor but unneglectable problem. Transphyseal screws may be the implant of choice for guided growth and epiphysiodesis at the distal femur in older children, considering the lower risks of wound complication.

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Section: Discussionmentioning

confidence: 99%

Distal Femur Growth Modification Surgery Is Associated With Higher Surgical Wound Complication Rate

Hsu

Lee

Kao

et al. 2022

Journal of Pediatric Orthopaedics

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“…The phenomenon of exposure to occupational factors for PTI is also not negligible, especially for agricultural practitioners in developing areas. The workload of heavy physical strength, the working environment of complex species of microorganisms, and work-related high-pressure psychological state may be associated with a high incidence of infectious diseases [ 12 , 29 , 33 , 34 ]. In this study, the rate of PTI was 35.4% in patients working in agriculture approximately.…”

Section: Discussionmentioning

confidence: 99%

“…And a retrospective study of 163 patients who underwent retrograde percutaneous pinning of the distal femur for osteotomy or physeal fracture was conducted by Murgai e al. [ 12 ] and reported the incidence of PTI was 6.7%. The previous studies commonly focused on the treatments of PTI and percentages of patients with complications, concentrated on the risk factors less.…”

Section: Introductionmentioning

confidence: 99%

Risk factors of pin tract infection during bone transport using unilateral external fixator in the treatment of bone defects

Abulaiti

Liu

et al. 2021

BMC Surg

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Background The bone transport using the unilateral external fixator, one of the Ilizarov techniques, is widely practiced in lower limb reconstructive surgery. Pin tract infection (PTI), one of most common complication, has become the important postoperative problems which plague clinicians gradually. Methods A group of 130 patients who received bone transport surgery for tibia or femur defects using the unilateral external fixation (Orthofix limb reconstruction system, Verona, Italy) and met the inclusion criteria were selected for the study from 2015 to 2019. Regular pin tract care was performed twice a day, and the conditions of the pin tract were evaluated by the same observer using clinical appearance criteria. The Saw’s classification of PTI was used to assess the condition around screws. After the data were significant by the T-test or Pearson’s Chi-square test analyzed, odds ratios were calculated using logistic regression tests to describe factors associated with the diagnosis of PTI. Results Ninety-one males and thirty-nine females with a mean age of 43 years (range 28–58 years) were included in this cohort. 7816 observations were documented from 12 to 36 months, and 58 cases (44.6%) of PTI (thirty-nine cases in grade 1, 17 cases in grade 2, and 2 cases in grade 3). The top five risk factors were agricultural work (OR 1.86, CI 0.94–2.39), non-urban living (OR 1.75, CI 1.24–3.26), male (OR 1.71, CI 1.02–2.31), smoking (OR 1.53, CI 0.76–1.89), and diabetes (OR 1.26, CI 1.12–2.64). No long-term sequelae were observed at the latest clinical visit. Conclusion Occupation, gender, living environment (non-urban), smoking, and diabetes were the top five significant risk factors for PTI in the period of bone transport using unilateral external fixation. Awareness of predictable risk factors of PTI is beneficial to avoid or early detect the severe complications which can affect the effectiveness.

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“…When Steinmann pin fixation was selected, retrograde insertion was preferred with the majority electing to not bury the pins under the skin. Despite historical concerns of septic arthritis stemming from intra-articular pins, this appears extremely uncommon; however, localized pin site infection is not infrequent [19].…”

Section: Discussionmentioning

confidence: 99%

Management of Salter-Harris II distal femur fractures – what is the state of practice? A survey of Pediatric Orthopaedic Society of North America membership

Weltsch

Williams

Gohel

et al. 2021

Journal of Pediatric Orthopaedics B

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Appropriate treatment of Salter-Harris (SH) II distal femoral physeal fractures is crucial due to risks of growth arrest and angular deformity. Low incidence renders sufficiently powered, prospective research difficult. This study aimed to assess the current state of management of these fractures on the basis of the Pediatric Orthopaedic Society of North America (POSNA) membership experience. POSNA members were surveyed via an emailed REDCAP survey. Questions included respondent demographics, experience, practice environment and clinical questions regarding preferred treatment and postoperative management based, in part, on an illustrative case of a nighttime presentation of a displaced SH-II distal femur fracture. Descriptive statistics were performed to summarize the preferred management among POSNA members. Twenty-eight percent (376/1344) of contacted POSNA members responded to the survey meeting sample size criteria of membership representation. Respondents' median years in practice were 17 . Surgical management of the presented case was preferred by most (96.3%) respondents. If no vascular compromise was present (ABI >0.9), most (86.6%) felt it was appropriate to wait for intervention on the following day. One-third (32.7%) of respondents considered every SH-II as an indication for surgical treatment. Screw fixation is the most common implant selection for operatively managed injuries, with the majority choosing not to electively remove screws. Those who opted for pin fixation tended to remove pins by 3-4 weeks postoperatively. For immediate postoperative immobilization, long leg casting (44.4%) was selected more commonly than splinting or knee immobilizers. Nearly all (99.7%) respondents preferred follow-up until skeletal maturity. In cases of suspected growth arrest, 76% felt MRI was necessary for further evaluation. Operative management of SH-II distal femur fractures is preferred among POSNA members, particularly in cases of displaced fractures or when closed reduction had failed. Except for immediate postoperative immobilization preferences, pediatric orthopedic surgeons appear to have a majority consensus regarding treatment practices, postoperative management and indications and timing of hardware removal.

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The Incidence of Pin Tract Infections and Septic Arthritis in Percutaneous Distal Femur Pinning

Cited by 7 publications

References 13 publications

Distal Femur Growth Modification Surgery Is Associated With Higher Surgical Wound Complication Rate

Distal Femur Growth Modification Surgery Is Associated With Higher Surgical Wound Complication Rate

Risk factors of pin tract infection during bone transport using unilateral external fixator in the treatment of bone defects

Management of Salter-Harris II distal femur fractures – what is the state of practice? A survey of Pediatric Orthopaedic Society of North America membership

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