Primary closure versus secondary healing of pin sites after the removal of provisional external fixator: a systematic review and meta-analysis Article Swipe
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.
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Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1186/s12891-025-09288-2
- https://bmcmusculoskeletdisord.biomedcentral.com/counter/pdf/10.1186/s12891-025-09288-2
- OA Status
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- 24
- OpenAlex ID
- https://openalex.org/W4416572216
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W4416572216Canonical identifier for this work in OpenAlex
- DOI
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https://doi.org/10.1186/s12891-025-09288-2Digital Object Identifier
- Title
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Primary closure versus secondary healing of pin sites after the removal of provisional external fixator: a systematic review and meta-analysisWork title
- Type
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articleOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2025Year of publication
- Publication date
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2025-11-24Full publication date if available
- Authors
-
Michael D. McKeeList of authors in order
- Landing page
-
https://doi.org/10.1186/s12891-025-09288-2Publisher landing page
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https://bmcmusculoskeletdisord.biomedcentral.com/counter/pdf/10.1186/s12891-025-09288-2Direct link to full text PDF
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YesWhether a free full text is available
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goldOpen access status per OpenAlex
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https://bmcmusculoskeletdisord.biomedcentral.com/counter/pdf/10.1186/s12891-025-09288-2Direct OA link when available
- Cited by
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0Total citation count in OpenAlex
- References (count)
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24Number of works referenced by this work
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| abstract_inverted_index.vs. | 229 |
| abstract_inverted_index.was | 136, 203, 250 |
| abstract_inverted_index.(OR) | 150 |
| abstract_inverted_index.(OR: | 190 |
| abstract_inverted_index.(one | 162 |
| abstract_inverted_index.Data | 122 |
| abstract_inverted_index.Odds | 148 |
| abstract_inverted_index.This | 56, 241 |
| abstract_inverted_index.data | 144 |
| abstract_inverted_index.have | 211, 235 |
| abstract_inverted_index.rate | 138 |
| abstract_inverted_index.risk | 17, 131, 255 |
| abstract_inverted_index.site | 20, 23, 141, 225, 294 |
| abstract_inverted_index.such | 218 |
| abstract_inverted_index.that | 244 |
| abstract_inverted_index.they | 12 |
| abstract_inverted_index.used | 6 |
| abstract_inverted_index.were | 123, 145, 168 |
| abstract_inverted_index.with | 15, 151, 173, 252, 259, 265 |
| abstract_inverted_index.(CI). | 155 |
| abstract_inverted_index.0.0%, | 197 |
| abstract_inverted_index.after | 105 |
| abstract_inverted_index.aimed | 61 |
| abstract_inverted_index.among | 206 |
| abstract_inverted_index.based | 262 |
| abstract_inverted_index.days. | 273 |
| abstract_inverted_index.entry | 69 |
| abstract_inverted_index.lower | 180, 230, 254 |
| abstract_inverted_index.other | 119 |
| abstract_inverted_index.rates | 66, 98, 182 |
| abstract_inverted_index.sites | 70, 249 |
| abstract_inverted_index.terms | 49 |
| abstract_inverted_index.there | 202 |
| abstract_inverted_index.these | 45, 287 |
| abstract_inverted_index.three | 160 |
| abstract_inverted_index.total | 158 |
| abstract_inverted_index.using | 32, 147 |
| abstract_inverted_index.which | 209 |
| abstract_inverted_index.wound | 289 |
| abstract_inverted_index.(upper | 228 |
| abstract_inverted_index.0.375, | 191 |
| abstract_inverted_index.Pooled | 176 |
| abstract_inverted_index.Ratios | 149 |
| abstract_inverted_index.better | 282 |
| abstract_inverted_index.cohort | 116, 166 |
| abstract_inverted_index.either | 33 |
| abstract_inverted_index.future | 275 |
| abstract_inverted_index.impact | 285 |
| abstract_inverted_index.needed | 280 |
| abstract_inverted_index.rates, | 52, 129 |
| abstract_inverted_index.rates. | 239 |
| abstract_inverted_index.remain | 53 |
| abstract_inverted_index.review | 58, 91 |
| abstract_inverted_index.safety | 43 |
| abstract_inverted_index.showed | 178 |
| abstract_inverted_index.trials | 114 |
| abstract_inverted_index.(RCTs), | 115 |
| abstract_inverted_index.0.003). | 200 |
| abstract_inverted_index.Factors | 217 |
| abstract_inverted_index.Methods | 86 |
| abstract_inverted_index.Results | 156 |
| abstract_inverted_index.between | 99 |
| abstract_inverted_index.closure | 35, 81, 101, 185, 246 |
| abstract_inverted_index.complex | 9 |
| abstract_inverted_index.fixator | 27, 107 |
| abstract_inverted_index.healing | 84, 104, 189 |
| abstract_inverted_index.maximum | 267 |
| abstract_inverted_index.outcome | 135 |
| abstract_inverted_index.patient | 126 |
| abstract_inverted_index.primary | 34, 80, 100, 134, 184, 245 |
| abstract_inverted_index.removal | 28, 73 |
| abstract_inverted_index.studies | 95, 110, 161, 264 |
| abstract_inverted_index.Abstract | 0 |
| abstract_inverted_index.Eligible | 109 |
| abstract_inverted_index.External | 2 |
| abstract_inverted_index.However, | 201, 274 |
| abstract_inverted_index.analysis | 177 |
| abstract_inverted_index.commonly | 5 |
| abstract_inverted_index.compared | 186, 258 |
| abstract_inverted_index.duration | 220, 270 |
| abstract_inverted_index.efficacy | 41 |
| abstract_inverted_index.evaluate | 63 |
| abstract_inverted_index.external | 26, 77, 106, 222, 268 |
| abstract_inverted_index.factors. | 132 |
| abstract_inverted_index.fixation | 227, 269 |
| abstract_inverted_index.fixator, | 78 |
| abstract_inverted_index.fixators | 3 |
| abstract_inverted_index.healing, | 261 |
| abstract_inverted_index.healing. | 38 |
| abstract_inverted_index.included | 111, 169 |
| abstract_inverted_index.managing | 8 |
| abstract_inverted_index.methods. | 85 |
| abstract_inverted_index.relative | 40 |
| abstract_inverted_index.removal. | 108 |
| abstract_inverted_index.research | 278 |
| abstract_inverted_index.results. | 216 |
| abstract_inverted_index.studies) | 167 |
| abstract_inverted_index.studies, | 117, 208 |
| abstract_inverted_index.studies. | 121 |
| abstract_inverted_index.Objective | 55 |
| abstract_inverted_index.analysis, | 172 |
| abstract_inverted_index.comparing | 79, 96 |
| abstract_inverted_index.conducted | 88 |
| abstract_inverted_index.extracted | 124 |
| abstract_inverted_index.fixation, | 223 |
| abstract_inverted_index.following | 25, 71 |
| abstract_inverted_index.infection | 51, 65, 97, 128, 181, 238, 257 |
| abstract_inverted_index.intervals | 154 |
| abstract_inverted_index.patients. | 175 |
| abstract_inverted_index.performed | 31 |
| abstract_inverted_index.secondary | 37, 83, 103, 188, 260 |
| abstract_inverted_index.temporary | 76 |
| abstract_inverted_index.Background | 1 |
| abstract_inverted_index.Conclusion | 240 |
| abstract_inverted_index.anatomical | 224 |
| abstract_inverted_index.approaches | 291 |
| abstract_inverted_index.associated | 14, 251 |
| abstract_inverted_index.confidence | 153 |
| abstract_inverted_index.controlled | 113 |
| abstract_inverted_index.fractures, | 10 |
| abstract_inverted_index.infection, | 142 |
| abstract_inverted_index.influenced | 236 |
| abstract_inverted_index.management | 24, 290 |
| abstract_inverted_index.randomized | 112 |
| abstract_inverted_index.systematic | 57, 90 |
| abstract_inverted_index.uncertain. | 54 |
| abstract_inverted_index.understand | 283 |
| abstract_inverted_index.approaches, | 46 |
| abstract_inverted_index.contributed | 212 |
| abstract_inverted_index.extremity), | 231 |
| abstract_inverted_index.homogeneous | 277 |
| abstract_inverted_index.infections. | 21, 295 |
| abstract_inverted_index.synthesized | 146 |
| abstract_inverted_index.considerable | 204 |
| abstract_inverted_index.demonstrated | 243 |
| abstract_inverted_index.inconsistent | 215 |
| abstract_inverted_index.particularly | 47 |
| abstract_inverted_index.comorbidities | 233 |
| abstract_inverted_index.demographics, | 127 |
| abstract_inverted_index.heterogeneity | 205 |
| abstract_inverted_index.meta-analysis | 60, 93, 242 |
| abstract_inverted_index.observational | 120 |
| abstract_inverted_index.significantly | 179 |
| abstract_inverted_index.0.195–0.724; | 194 |
| abstract_inverted_index.well-designed, | 276 |
| cited_by_percentile_year | |
| corresponding_author_ids | https://openalex.org/A5069424342 |
| countries_distinct_count | 1 |
| institutions_distinct_count | 1 |
| corresponding_institution_ids | https://openalex.org/I138006243, https://openalex.org/I176279760 |
| citation_normalized_percentile |