The Control of Pin Tract Colonization with Antibiotic Coated Sleeves: A Prospective Study of External Fixation of Distal Radius Fractures

Abstract

Objective: The purpose of this study was to assess the efficacy of antibiotic coated pin sleeves to reduce pin site colonization and subsequent infection with external fixation of the distal radius.
Study Design/Methods: A prospective, randomized, investigation of gentamicin coated sleeves for use with external fixation was performed after approval was obtained from the Institutional Review Board (IRB) involving informed consent of 28 patients with distal radius fractures treated with external fixation. Patients were enrolled in the study and randomized into two groups: group one (gentamicin 0.2 to 0.4 mg/cm² polyether-based, thermoplastic tubing antibiotic coated sleeves covering 3 mm half-pins) and group two (3 mm half-pins without antibiotic coated sleeves). All other fixateur configurations and treatments were the same. Prophylactic, perioperative antibiotics were administered in all cases intravenously. No additional antibiotics were given post-operatively. Clinical follow-up was performed at 2, 4, and 6 weeks, 3 months and 6 months post-operatively. The Fracture Service Attending, the Trauma Fellow, and 2 orthopaedic residents were responsible for the placement of the external fixateur and subsequent follow-up in the orthopaedic clinic.
Results: Of the 28 patients enrolled in the study, two patients were disqualified. One patient had antibiotics given in an emergency room visit for unrelated injuries and one patient asked to be withdrawn from the study. Twenty-six patients completed the study. Thirty-eight percent (10/26) were randomly fitted with antibiotic coated sleeves and sixty-one percent (16/26) did not have antibiotic coated sleeves. In the 10 patients with antibiotic sleeves, 42 total pins were used. The pins were sent for lab culture when the external fixateur was removed. Twenty-nine percent (12/42) of the half-pins cultured positive with 4/12 (33 %) positive for yeast and 8/12 (66 %) positive for S. epidermis. Of the 16 patients that did not receive the antibiotic coated sleeves, 34 of the 64 (53 %) total pins used were cultured positive for infection. Sixty-eight (23/34) were positive for S. aureus, 8/34 (24 %) were positive for S. epidermis, and 3/34 (8 %) were positive for S. intermedius. There were no late infections at the three and six month follow-up appointment. These differences were significant because S. aureus and S. intermedius were only cultured on the pins without antibiotic sleeves.
Conclusion: Antibiotic coated sleeves placed over half-pins used in external fixation of fractures are efficacious in reducing the incidence of pin tract colonization and in changing the spectrum of organisms recovered to less virulent organisms.

Key words

Antibiotic coated sleeves - gentamicin - pin sleeve - distal radius fracture - external fixation - osteomyelitis

References

• 1 Becker P L, Smith R A, Williams R S, Dutkowsky J P. Comparison of antibiotic release from polymethylmethacrylate beads and sponge collagen.  J Orthop Res. 1994;  12 737-741
• 2 Calhoun J H, Mader J T. Treatment of osteomyelitis with a biodegradable antibiotic implant.  Clin Orthop Rel Res. 1997;  341 206-214
• 3 Grzybowski J, Kolodziej W, Trafny E A, Struzyna J. A new anti-infective collagen dressing containing antibiotics.  J Biomed Mater Res. 1997;  36 163-166
• 4 Humphrey J S, Mehta S, Seaber A V, Parker Vail T. Pharmacokinetics of a degradable drug delivery system in bone.  Clin Orthop Rel Res. 1998;  349 218-224
• 5 Lindsey R W, Probe R, Miclau T, Alexander J W, Perren S M. The effects of antibiotic-impregnated autogeneic cancellous bone graft on bone healing.  Clin Orthop Rel Res. 1993;  291 102-111
• 6 Mahan J, Seligson D, Henry S L, Hynes P, Dobbins J. Factors in the pin tract infections.  Orthopedics. 1991;  14 305-308
• 7 Masri B A, Duncan C P, Beauchamp C P, Paris N J, Arntorp J. Effect of varying surface patterns on antibiotic elution from antibiotic-loaded bone cement.  J Arthroplasty. 1995;  10 453-459
• 8 Mehta S, Humphrey S J, Schenkman D I, Seaber A V, Parker Vail T. Gentamicin distribution from a collagen carrier.  J Orthop Res. 1996;  14 749-754
• 9 Merkli A, Heller J, Tabatabay C, Gurny R. Purity and stability assessment of a semi-solid poly (ortho ester) used in drug delivery systems.  Biomaterials. 1996;  17 897-902
• 10 Moroni A, Faldini C, Marchetti S, Manca M, Consoli V, Giannini S. Improvement of the bone-pin interface strength in osteoporotic bone with use of hydroxyapatite-coated tapered external-fixation pins. A prospective, randomized clinical study of wrist fractures.  J Bone Joint Surg [Am]. 2001;  83 717-721
• 11 Otsuka M, Sawada M, Matsuda Y, Nakamura T, Kokubo T. Antibiotic delivery system using bioactive bone cement consisting of bis-GMA/TEGDMA resin and bioactive glass ceramics.  Biomaterials. 1997;  18 1559-1664
• 12 Penner M J, Masri B A, Duncan C P. Elution characteristics of vancomycin and tobramycin combined in acrylic bone-cement.  J Arthroplasty. 1996;  11 939-944
• 13 Roskos K V, Fritzinger B K, Rao S S, Armitage G C, Heller J. Development of a drug delivery system for the treatment of periodontal disease based on bioerodible poly(ortho esters).  Biomaterials. 1995;  16 313-317
• 14 Takechi M, Miyamoto Y, Ishikawa K, Nagayama M, Kon M, Asaoka K, Suzuki K. Effects of added antibiotics on the basic properties of anti-washout-type fast-setting calcium phosphate cement.  J Biomed Mater Res. 1998;  39 308-316
• 15 Wachol-Drewek Z, Pfeiffer M, Scholl E. Comparative investigation of drug delivery collagen implants saturated in antibiotic solutions and a sponge containing gentamicin.  Biomaterials. 1996;  17 1733-1738
• 16 Walenkamp G H. Chronic osteomylitis.  Acta Orthop Scan. 1997;  68 497-506
• 17 Webber W L, Lago F, Thanos C, Mathiowitz E. Characterization of soluble, salt-loaded, degradable PLGA films and their release of tetracycline.  J Biomed Mater Res. 1998;  41 18-29