Prospective Cohort Study on Incidence and Risk factors of Pin Tract Infection after External Fixation of Fracture at AaBET Hospital, 2022G.C.

Abstract

Abstract Introduction: Pin site infection (PTI) is by far the most common complication that arise after external fixation (Ex-Fix) that puts a significant burden on the patient and healthcare system. This infection may require more number of clinic visits required during a patient’s course of treatment, requires additional treatment such as antibiotics and surgery, and most importantly can compromise patient outcomes should osteomyelitis or instability result from pin loosening, or need for pin or complete construct removal. There is no study that determined the magnitude of incidence of PTI locally, neither is there a study that looked into risk factors for these infections. Objectives: To determine incidence and risk factors of PTI among patients who have undergone Ex-Fix of fracture at Addis Ababa Burn Emergency and Trauma (AaBET) Hospital. Methods: This was a prospective cohort study design that was done in AaBET Hospital. Study population including all orthopedic and traumatology patients for whom Ex-Fix was done from February–April 2022 for fracture treatment. The sample size was 40 patients for whom Ex-Fix was done during study period which was selected by consecutive sampling technique. Data on PTI and risk factors was collected and analyzed by Statically Package for the Social Sciences (SPSS) v. 26. Graphs, tables and descriptive method of data were utilized to discuss the results. Fisher’s exact test and logistic regression analysis were performed to assess association. Odds ratio (OR) was used to assess strength of association. Result: An incidence rate of PTI was 65.0% (26 out of 40 patients). All PTI were minor infections, grade 1-grade 3 of Checketts-Outterburn grade. Grade 2 was seen in 17 patients (45.9%). Skin tension around pin site was seen in 26 (65.0%), of these 21 (52.5%) patients with skin tension around pin site developed PTI. Skin tension around pin site was risk factor for PTI with Fisher’s Exact test=0.04, crude odds ratio (COR) =7.56, 95% CI: 1.75, 32.72, p<0.01 and adjusted odds ratio (AOR): 5.04, 95% CI: 1.13, 22.50; p<0.05. Conclusion: PTI incidence rate is around 2/3 after Ex-Fix done for fracture which is significant problem. All PTI are minor infections, Grade 1-3. Grade 2 PTI is most commonly observed PTI grade. Skin tension around pin sites found is risk factor for PTI. Recommendation: Proper surgical technique to relieve skin tension around pin sites is needed to reduce PTI. Further large and longstanding study on identification of risk factors and prevention of PTI are recommended for proper pin site care and PTI prevention. Key Words: EX-Fix, incidence, pin tract infection, risk factors, fracture, AaBET Hospital