Pin Tract Infections in Pediatric Open Long Bone Fractures: Common but Clinically Manageable

TL;DR

Pin tract infections are common in children with open long bone fractures treated with external fixation but are mostly mild and manageable without major complications.

Contribution

This study provides pediatric-specific insights into the frequency, management, and outcomes of pin tract infections in open long bone fractures treated with external fixation.

Findings

16 out of 40 pediatric patients developed pin tract infections, with most cases being mild and resolved with conservative care.

All fractures achieved bony consolidation, and reoperations were not primarily due to pin tract infections.

No cases of osteomyelitis were observed despite the presence of pin tract infections.

Abstract

Background: Pin tract infections (PTIs) are a frequent complication of external fixation, yet pediatric trauma-specific data—particularly for open long bone fractures—remain limited and heterogeneous. This study evaluated the frequency, severity, timing, management, and outcomes of PTIs in children and adolescents treated with external fixation for open long bone fractures. Methods: This retrospective single-center study included patients younger than 18 years with open long bone fractures treated with external fixation between 2002 and 2023. PTIs were graded using the Checketts–Otterburn classification (grades I–VI). Management included antibiotic regimen and surgical interventions. Outcome was reported by time to bony consolidation. Results: In 40 patients, 16 patients exhibited PTIs (mild: eight; moderate: five; severe: three. A higher grade of Gustilo–Anderson (p = 0.47) and evident macroscopic contamination (p = 0.73) did not appear to influence the occurrence of PTIs by similar duration of initial antibiotic regimen (p = 0.3). The median time to PTI onset was 49 days (IQR 22–80), with the majority occurring after completion of initial systemic antibiotic therapy. The management of PTIs was predominantly conservative: all eight mild cases resolved with intensified local pin tract care, while all eight moderate and severe cases were treated with systemic antibiotics and five required pin exchange or premature fixator removal. Overall bony consolidation was achieved in all patients, and reoperations were related to trauma severity rather than PTIs except in one patient. No cases of osteomyelitis were observed. Conclusion: Pin tract infections are frequently identified in pediatric open long bone fractures treated with external fixation. Using strict diagnostic criteria, any documented inflammatory change or local secretion at the pin–skin interface is considered indicative of PTI. However, the majority of these infections were classified as superficial and manageable with conservative measures, and all affected fractures healed radiologically.