Abstract
BACKGROUND: External fixators are commonly used for managing complex fractures, but they are associated with the risk of pin site infections. Pin site management following external fixator removal can be performed using either primary closure or secondary healing. The relative efficacy and safety of these approaches, particularly in terms of infection rates, remain uncertain. OBJECTIVE: This systematic review and meta-analysis aimed to evaluate the infection rates of pin entry sites following the removal of the temporary external fixator, comparing primary closure and secondary healing methods. METHODS: We conducted a systematic review and meta-analysis of studies comparing infection rates between primary closure and secondary healing after external fixator removal. Eligible studies included randomized controlled trials (RCTs), cohort studies, and other observational studies. Data were extracted on patient demographics, infection rates, and risk factors. The primary outcome was the rate of pin site infection, and data were synthesized using Odds Ratios (OR) with 95% confidence intervals (CI). RESULTS: A total of three studies (one RCT and two cohort studies) were included in the analysis, with 738 patients. Pooled analysis showed significantly lower infection rates in primary closure compared to secondary healing (OR: 0.375, 95% CI: 0.195-0.724; I² = 0.0%, P = 0.003). However, there was considerable heterogeneity among the studies, which may have contributed to the inconsistent results. Factors such as duration of external fixation, anatomical site of fixation (upper vs. lower extremity), and comorbidities may have influenced the infection rates. CONCLUSION: This meta-analysis demonstrated that primary closure of pin sites was associated with a lower risk of infection compared with secondary healing, based on studies with a maximum external fixation duration of 21 days. However, future well-designed, homogeneous research is needed to better understand the impact of these two wound management approaches on pin site infections.