Archives of Orthopaedic and Trauma Surgery

, Volume 124, Issue 8, pp 555–558 | Cite as

Pin site care in external fixation sodium chloride or chlorhexidine solution as a cleansing agent

Original Article



Pin site infection is the most common complication using external fixators. This study investigated the differences in pin site infections, antibiotic use, pain, and complications using sodium chloride and chlorhexidine solution as cleansing agent in patients operated on by the hemicallotasis technique for knee deformities.

Materials and methods

The prospective study included 49 consecutive patients: 2 mg/ml chlorhexidine solution was used as cleansing agent in 30 patients (120 pins) and 9 mg/ml sodium chloride in 19 patients (76 pins). We evaluated the status of the pin sites, pain (VAS), uses of antibiotic and analgesic agents, and any complications (infections were graded according to the Checketts-Otterburns classification). Bacterial cultures were performed from each pin site at 1, 6, and 10 weeks and from the pins at removal.


Grade 1 infection was found in 14% of the sodium chloride group and in 8.5% of the chlorhexidine group, and grade 2 infection in and 3% and 0.5%, respectively. With sodium chloride there was a significantly higher relative risk for positive cultures (1.7) and for the presence of Staphylococcus aureus (3.3). The chlorhexidine group required significantly fewer antibotics reported significantly less pain at weeks 6 and 10.


Chlorhexidine solution (2 mg/ml) as cleansing agent in pin site care is preferable to sodium chloride in patients operated on by the hemicallotasis technique.


External fixators Infection control Agents cleansing Sodium chloride Chlorhexidine 


  1. 1.
    Checketts RG, MacEachern AG, Otterburn M (2000) Pin track infection and the principles of pin site care. In: De Bastiani A, Graham Apley A, Goldberg A (eds) Orthofix external fixation in trauma and orthopeadics. Springer, Berlin Heidelberg New York, pp 97–103Google Scholar
  2. 2.
    DeJong ES, DeBerardino TM, Brooks DE (2001) Antmicrobial effecacy of external fixator pin coated with a lipid stabilizer hydroxyapatite/chlorhexidine complex to prevent pin tract infection in a goat model. J Trauma 50:1008–1014PubMedGoogle Scholar
  3. 3.
    EARSS (2002) EARSS Newsletter. Management Team, National Institute of Public Health and Environment. RIVM, The NetherlandsGoogle Scholar
  4. 4.
    Gordon JE, Kelly-Hahn J, Carpenter CJ, Schoenecker PL (2000) Pin site care during external fixation in children: results of a nihilistic approach. J Pediatr Orthop 20:163–165CrossRefPubMedGoogle Scholar
  5. 5.
    Hedner T, Währborg P (2000) Smärtmätning och andra test inom smärtdiagostik. In: Hedner T, Währborg P (eds) Smärtmanual. Health Profile, Gothenburg, pp 61–64Google Scholar
  6. 6.
    Magyar G, Toksvig-Larsen S, Lindstrand A (1998) Open wedge tibial osteotomy by callus distraction in gonarthrosis. Operative technique and early results in 36 patients. Acta Orthop Scand 69:147–151PubMedGoogle Scholar
  7. 7.
    Magyar G, Toksvig-Larsen S, Lindstrand A (1999) Hemicallotasis open-wedge osteotomy for osteoarthritis of the knee. Complications in 308 operations. J Bone Joint Surg Br 81:449–451CrossRefPubMedGoogle Scholar
  8. 8.
    Mahan J, Seligson D, Henry SL, Hynes P, Dobbins J (1991) Factors in pin tract infections. Orthopedics 14:305–308PubMedGoogle Scholar
  9. 9.
    Olson RS (1996) Halo skeletal traction pin site care: toward developing a standard of care. Rehabil Nurs 21:243–246PubMedGoogle Scholar
  10. 10.
    Sims M, Saleh M (2000) External fixation—the incidence of pin site infection: a prospective audit. J Orthop Nurs 4:59–63CrossRefGoogle Scholar
  11. 11.
    W-Dahl A, Toksvig-Larsen S, Lindstrand A (2003) No difference between daily and weekly pin site care: a randomized study of 50 patients with external fixation. Acta Orthop Scand 74:6 704–708CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  1. 1.Department of OrthopedicsUniversity HospitalLundSweden

Personalised recommendations