Clinical Outcome following Management of Severe Osteomyelitis due to Pin Site Infection

Florian A Frank; Eoghan Pomeroy; Andrew J Hotchen; David Stubbs; Jamie Y Ferguson; Martin McNally

doi:10.5005/jp-journals-10080-1607

Clinical Outcome following Management of Severe Osteomyelitis due to Pin Site Infection

Strategies Trauma Limb Reconstr. 2024 Jan-Apr;19(1):21-25. doi: 10.5005/jp-journals-10080-1607.

Authors

Florian A Frank¹, Eoghan Pomeroy², Andrew J Hotchen², David Stubbs², Jamie Y Ferguson², Martin McNally²

Affiliations

¹ Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, United Kingdom; Musculoskeletal Infections Centre (ZMSI), Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Switzerland.
² Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, United Kingdom.

Abstract

Aim: This study has investigated cases of pin site infection (PSI) which required surgery for persistent osteomyelitis (OM) despite pin removal.

Materials and methods: Patients requiring surgery for OM after PSI between 2011 and 2021 were included in this retrospective cohort study. Single-stage surgery was performed in accordance with a protocol at one institution. This involved deep sampling, debridement, implantation of local antibiotics, culture-specific systemic antibiotics and soft tissue closure. A successful outcome was defined as an infection-free interval of at least 24 months following surgery.

Results: Twenty-seven patients were identified (the sites were 22 tibias, 2 humeri, 2 calcanei, 1 radius); about 85% of them were males with a median age of 53.9 years. The majority of infections (21/27) followed fracture treatment. Fifteen patients were classified as BACH uncomplicated and 12 were BACH complex. Staphylococci were the most common pathogens, polymicrobial infections were detected in five cases (19%). Seven patients required flap coverage which was performed in the same operation.After a median of 3.99 years (2.00-8.05) follow-up, all patients remained infection free at the site of the former OM. Wound leakage after local antibiotic treatment was seen in 3/27 (11.1%) cases but did not require further treatment.

Conclusion: Osteomyelitis after PSI is uncommon but has major implications for the patient as 7 patients needed flap coverage. This reinforces the need for careful pin placement and pin site care to prevent deep infection. These infections were treated in accordance with a protocol and were not managed simply by curettage. All patients treated in this manner remained infection-free after a minimum follow-up of 2 years suggesting that this protocol is effective.

Clinical significance: Pin site infection is a very common complication in external fixation. The sequela of a chronic pin site OM is rare but the implications to the patient are huge. In this series, more than a quarter of patients required flap coverage as part of the treatment of the deep infection.

How to cite this article: Frank FA, Pomeroy E, Hotchen AJ, et al. Clinical Outcome following Management of Severe Osteomyelitis due to Pin Site Infection. Strategies Trauma Limb Reconstr 2024;19(1):21-25.

Keywords: Local antibiotics; One-stage surgery; Osteomyelitis; Pin site infection; Retrospective cohort study.