Nice Trick — RCT Says It’s OK to Close Those Ex-Fix Pin Sites

An easy, practical improvement to everyday care for patients with fractures

What’s the Claim

A randomized trial found that pin sites closed substantially faster — two weeks versus six weeks — when surgeons threw a vertical mattress suture to close pin sites after removing temporary external fixation devices rather than letting those pin sites heal by secondary intention (local wound care to the pin sites). Suturing the pin sites was not associated with an increased risk of infection. This study included both patients with upper and lower extremity fractures, but the benefit of suturing was only observed for lower extremity fractures. Calcaneal external fixators were excluded.

How’s It Stack Up?

No other study of which we are aware has evaluated this question, so its only real comparator is “orthopaedic dogma,” which goes back for as long as there have been external fixators. For that reason, it’s obviously nice to have some actual data to inform a real-world treatment that surgeons perform all the time. The study was well done, with each patient serving as a kind of internal control (each patient provided had at least one pin site randomized to each treatment, with alternate pin sites in each patient being either sutured or left open, with the randomization determining that sequence), which helped to minimize bias associated with differences in patients.

What’s Our Take?