Prophylactic Postoperative Antibiotics May Not Reduce Pin Site Infections After External Fixation



Pin infection continues to be a nuisance when using definitive external fixation. Prophylactic antibiotic treatment has been proposed in an effort to decrease pin complications.


We performed a prospective, randomized, single-blinded study to answer the following questions: (1) what was the effect of a 10-day course of oral prophylactic antibiotics administered immediately after external fixation surgery on the incidence of a subsequent pin infection, (2) what was the effect on the severity of a subsequent pin infection, and (3) what was the effect on the timing of a subsequent pin infection?


Patients were randomized into antibiotic treatment and control groups, and incidence, severity, and time of onset of pin infection were recorded.


The incidence of pin infection for the entire cohort during the 90-day observation period was 46/58 (79%) without a statistically significant difference (p = 0.106). There was no statistical difference found (p = 0.512) in pin infection severity. There was no significant difference in the time of onset of infection between the two groups from the date of surgery (p = 0.553).


Our randomized data do not suggest that oral antibiotics alter the incidence, timing, or severity of pin infection. This study does not support the use of prophylactic oral antibiotics in healthy patients.

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We would like to thank, Erica Lenihan, RN, for her help with grading and treating pin infection; Lisa Halfen, RPA, for administering antibiotics postoperatively and keeping the treatment team blinded; Joseph T. Nguyen, MPH, for statistical analysis; and Eugene Borst, BS, for assistance with all workflow aspects of this study. You all contributed significantly to the success of this research project.

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Corresponding author

Correspondence to Austin T. Fragomen MD.

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Conflict of Interest

Andy O. Miller, MD, Barry D. Brause, MD, and Vladimir Goldman, MD, have declared that they have no conflict of interest. Austin T. Fragomen, MD, reports, other than Smith and Nephew, personal fees from NuVasive, Synthes, and Stryker, outside the work. S. Robert Rozbruch, MD, reports personal fees from Smith and Nephew, Stryker, and NuVasive, outside the work.

Human/Animal Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

Informed Consent

Informed consent was obtained from all patients for being included in the study.

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Disclosure forms provided by the authors are available with the online version of this article.

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Level of Evidence: Therapeutic Study Level I.

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Fragomen, A.T., Miller, A.O., Brause, B.D. et al. Prophylactic Postoperative Antibiotics May Not Reduce Pin Site Infections After External Fixation. HSS Jrnl 13, 165–170 (2017).

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  • prophylactic antibiotics
  • pin infection
  • external fixation
  • Ilizarov