Post-operative pin-site infection following external fixation in a tertiary trauma centre: A service evaluation

BackgroundPost-operative pin-site infections remain a common complication of external fixation. Despite the clinical significance of these infections, standardised guidelines for their prevention and management are lacking. This study aimed to evaluate the incidence, risk factors, and microbiological profile of pin-site infections following external fixation in a tertiary trauma centre.MethodsA retrospective service evaluation was conducted on all patients who underwent external fixation between January 1, 2019, and January 1, 2024, at a single UK tertiary trauma centre. Patient demographics, co-morbidities, injury characteristics, surgical indicators, and post-operative care practices were analysed. Univariate and multivariate logistic regression models were used to identify independent predictors of pin-site infection.ResultsA total of 555 patients were included, with a mean age of 43.2 years (±20.4). The overall pin-site infection rate was 16.58% (n=92). Multivariate analysis identified pin-site training as a protective factor (OR = 0.642, p = 0.031), while concurrent acute kidney injury (AKI) was an independent risk factor (OR = 2.134, p = 0.017). Ulna and femur fractures were associated with increased infection risk (OR = 1.14, p = 0.034 and OR = 1.30, p = 0.005, respectively). Antibiotic prophylaxis demonstrated a borderline protective effect (OR = 0.225, p = 0.082) but was not significant after adjustment. Definitive external fixation was associated with higher rates of infection compared to temporary fixation (OR: 4.63, 95% CI [2.90, 7.38], p<0.001).ConclusionsThis study highlights the significant burden of pin-site infection in external fixation and identifies key modifiable and non-modifiable risk factors. Structured pin-site care training was associated with a reduced risk of infection, supporting its routine implementation. The findings also suggest that AKI and anatomical site of fixation may influence infection susceptibility, warranting targeted preventive strategies in high-risk patients. Further research is needed to standardise pin-site care guidelines and evaluate long-term infection outcomes