Pin-site Infections

Pin-site infections are the most common problem associated with external fixation treatment. Pin-site infections begin at the level of the skin. If identified early, they are easily treated. If left untreated, they may progress to a more significant infection.

It is important for the patient or family to know the symptoms of a pin-site infection. The most common symptoms are tenderness in an area around a pin site that was not previously tender and increased redness at the pin site. Sometimes the area will have increased warmth, swelling, pain or drainage compared to the other pin sites. Our staff will teach the patient or family more details about these symptoms and proper pin-site care before the patient leaves the hospital. A simple pin-site infection can be compared to a simple ear infection in a toddler. The toddler complains of pain, and the doctor prescribes an antibiotic for 5-10 days, and the ear infection resolves.

When patients with external fixation leave the hospital, the doctor will give them a prescription for oral antibiotics. If patients develop the signs of a pin-site infection, they should fill the prescription and immediately begin to take the oral antibiotics. It is important to start the antibiotics quickly (within 24 hours). The patient/family does not need to call the office to confirm that the patient has a pin-site infection before the patient starts taking the oral antibiotics. Once the antibiotics are started, call us within 24 hours to let us know that you are treating a pin-site infection. The redness, tenderness and drainage should improve within 24 to 48 hours of starting the antibiotics.

The risk of a more serious infection (i.e., toxic shock syndrome or necrotizing fasciitis) that can be life-threatening is extremely rare; in over thirty years of applying thousands of external fixators, we have seen fewer than ten patients who have developed such severe infections (0.002% incidence). The most important thing for patient families to know is that pin-site infections with simultaneous constitutional symptoms (fever, nausea, vomiting, etc.) require immediate attention.

The constitutional signs of a more serious infection are pin-site pain along with one or more of the following symptoms:

• fever
• fatigue
• rashes
• nausea
• vomiting, and/or
• appearing glassy-eyed, pale or flushed.

If the patient has any of these symptoms, we need to know urgently; contact your doctor or the doctor on call. Again, these types of infection are rare; however, if they occur, treatment is straightforward but must be started immediately. The treatment normally requires a trip to an emergency room and a dose of IV antibiotics for 24 hours.