Pin site care during external fixation in children: results of a nihilistic approach.

We prospectively followed 27 consecutive children with tibial circular external fixators applied between July 1, 1995, and June 30, 1997. A simple pin care system with no physical pin cleansing except that provided by daily showers was used. Children with inflamed or infected pin sites were placed on an oral antibiotic (cephalexin) for 10 days. Pin sites were graded according to the system of Dahl et al. on a 0 to 5 scale. A total of 4,473 observations was made. Patients developed 178 pin tract infections (4.0% per observation), with 151 (85%) grade 1 and 27 (15%) grade 2 infections. No pin was removed because of infection. Diaphyseal half pin sites were less commonly infected (1.6%) than periarticular wire or half pin sites (4.5%). We recommend only showering without other physical pin cleaning procedures in children undergoing external fixation procedures.