Stoffel C, Eltz B, Salles MJ. Role of coatings and materials of external fixation pins on the rates of pin tract infection: A systematic review and meta-analysis. World J Orthop 2021; 12(11): 920-930 [PMID: 34888152 DOI: 10.5312/wjo.v12.i11.920]
Corresponding Author of This Article
Mauro José Salles, MD, MSc, PhD, Assistant Professor, Medical Assistant, Professor, Musculoskeletal Infection Group, Internal Medicine Department, Santa Casa de São Paulo School of Medical Sciences, Rua Dr Cesáreo Mota Jr 112, Paulo 01221-020, Brazil. salles.infecto@gmail.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Meta-Analysis
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Nov 18, 2021; 12(11): 920-930 Published online Nov 18, 2021. doi: 10.5312/wjo.v12.i11.920
Role of coatings and materials of external fixation pins on the rates of pin tract infection: A systematic review and meta-analysis
Cristhopher Stoffel, Bruno Eltz, Mauro José Salles
Cristhopher Stoffel, Department of Orthopedic Surgery, Instituto de Ortopedia e Traumatologia do Rio Grande do Sul, Passo Fundo 99010110, Rio Grande do Sul, Brazil
Bruno Eltz, Department of Orthopedic Surgery, Hospital São Francisco, Concordia 89700-000, Santa Catarina, Brazil
Mauro José Salles, Musculoskeletal Infection Group, Internal Medicine Department, Santa Casa de São Paulo School of Medical Sciences, São Paulo 01221-020, Brazil
Mauro José Salles, Musculoskeletal Infection Group, Division of Infectious Diseases, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 01221-020, Brazil
Author contributions: All authors contributed to the conception or design of the work, or the acquisition, analysis, or interpretation of data for the work; Stoffel C and Salles MJ contributed the drafting the work or revising it critically for important intellectual content, and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved; all authors have read and approved the final manuscript.
Conflict-of-interest statement: All authors declare that they have no competing interests.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mauro José Salles, MD, MSc, PhD, Assistant Professor, Medical Assistant, Professor, Musculoskeletal Infection Group, Internal Medicine Department, Santa Casa de São Paulo School of Medical Sciences, Rua Dr Cesáreo Mota Jr 112, Paulo 01221-020, Brazil. salles.infecto@gmail.com
Received: April 21, 2021 Peer-review started: April 21, 2021 First decision: July 28, 2021 Revised: August 6, 2021 Accepted: October 8, 2021 Article in press: October 8, 2021 Published online: November 18, 2021
Abstract
BACKGROUND
Infection at the pin tract is a frequent and feared complication of external fixators (EF). The type of pin material and coatings have been regarded as possibly influencing infection rates. Over the last 20 years, few prospective clinical studies and systematic reviews addressed the role of coated pins on the rate of pin site infection in human clinical studies.
AIM
To assess the EF literature over the past 20 years on the clinical benefits of pins manufactured from varied materials and coating systems and their possible role in pin tract infection rates.
METHODS
We performed a systematic review according to the PRISMA and PICOS guidelines using four scientific platforms: PubMed, LiLacs, SciELO, and Cochrane. We searched the literature for related publications over the past 20 years.
RESULTS
A literature search yielded 29 articles, among which seven met the inclusion criteria. These studies compared stainless-steel pins and pins coated with hydroxyapatite (HA), titanium and silver. The pin tract infection definitions were arbitrary and not standardized among studies. Most studies included a low number of patients in the analysis and used a short follow-up time. Three meta-analyses were carried out, comparing stainless steel vs silver pins, stainless steel vs HA-coated pins, and titanium vs HA-coated pins. None of this analysis resulted in statistically significant differences in pin tract infection rates.
CONCLUSION
Currently, no clinical evidence supports the advantage of EF pins manufactured with materials other than stainless steel or coated over uncoated pins in reducing the rates of pin tract infections. A standardized definition of pin tract infection in external fixation is still lacking.
Core Tip: There is no consensus in the literature that different materials or pin coatings of external fixators can interfere with the infection rates. This is the first manuscript that evaluates related publications over the last 20 years and develops a meta-analysis evaluating three different types of metallic coatings.
