You will be provided with the titles and abstracts of a collection of medical RCT reports studying a clinical question -- for instance, the efficacy of an intervention on some medical outcome. Please write a few sentences synthesizing the findings of these reports, which could serve as a conclusion section for a systematic review article. Your response should not include any other text. The RCT reports are below.



Title 1:
Pin site care during circular external fixation using two different protocols.
Abstract 1:
Treatment of tibial fractures with Ilizarov external fixation is a valuable treatment alternative; however, development of problems at the pin site is one of the major drawbacks of this technique. Moreover, there is no general agreement regarding pin site care. The purpose of this study was to compare the efficacy of two different pin site care techniques after treatment of tibial fractures with an Ilizarov external fixator.
                Prospective randomized study.
                Department of Orthopaedic Surgery of education and research hospital.
                In this prospective randomized study, we followed up 610 pin sites in 39 cases using two different pin site care protocols.
                For the first 15 days, patients in both groups cleaned each pin site using sterile gauze impregnated with 10% polyvinylpyrrolidone iodine (Polyod) every 3 days. After 15 days, patients in group 1 (20 cases, 310 pin sites) were advised to perform pin care by daily showering and brushing the pin sites with soap and an ordinary soft toothbrush, whereas patients in group 2 (19 cases, 300 pin sites) were advised to perform pin care by daily showering and cleaning the crusts using sterile gauze impregnated with 10% polyvinylpyrrolidone iodine (Polyod). Each pin site was denominated according to location.
                Pin sites were inspected and graded on a scale of 0 to 5 according to slight modification of the system of Dahl described by Gordon et al during outpatient visits on the 5th, 10th, 15th, 30th, 45th, 60th, 75th, 90th, 120th, and 150th days of follow up after the operation until fixator removal. Grade 1 and grade 2 infections were categorized as minor infection not requiring any extra pin site care and grade 3 and above infections as major infection.
                Minor infection rate of all pin sites was determined as 50.7% in group 1 and 43.6% in group 2. Major infection rate was determined as 3.5% in group 1 and 3.7% in group 2. No statistically significant difference was noted between the two groups (all P > 0.05).
                Pin site care can be performed without impairing patient comfort and without prohibition of showering. Pin site care can be self-managed by the patients without complex sterilization techniques.


Title 2:
Multicenter pin care study.
Abstract 2:
Pin-site infection is a common complication of external fixation. Because few studies have compared methods of pin care that reduce infection rate, there is a need for evidence-based practice guidelines for pin-site care.
                Two of 10 original clinical centers completed a prospective, randomized pin-care study between May 2000 and May 2002 to determine which of seven methods for caring for skeletal pins (external fixator, traction, or halo) resulted in the fewest pin-site infections.
                The 92 subjects had an average infection rate of 34%, and the 527 pins had a rate of 20%. Thirty patients (98 pins) had stage II infections, two patients (12 pins) had stage III infections, and none had deep infection or osteomyelitis. The protocols were (1) half-strength peroxide cleansing and gauze wraps (45%), (2) half-strength peroxide cleansing and Xeroform wraps (9%), (3) saline cleansing and gauze wraps (33%), (4) saline cleansing and Xeroform wraps (26%), (5) antibacterial soap-and-water cleansing and gauze (38%), (6) antibacterial soap-and-water cleansing and Xeroform gauze (50%), and (7) stable dressings with no pin cleansing (36%). Logistic regression analysis demonstrated significant inverse relationships (p = .05) between infection rate and age, as well as fixator type; the latter may be related to exposed threads.
                Results suggest that other factors outside the realm of this study may affect children's pin-site infection rate and that half-strength peroxide and Xeroform dressings were superior to soap-and-water cleansing. This pilot study indicates a need for further research with a larger sample size and for exploring factors in a younger population.


Title 3:
Evaluation of effectiveness of 10% polyvinylpyrrolidone-iodine solution against infections in wire and pin holes for Ilizarov external fixators.
Abstract 3:
Superficial infection at wire and pin insertions in the skin is a frequent disorder among patients utilizing the Ilizarov method. The objective of this study was to evaluate the effectiveness of daily topical application of 10% polyvinylpyrrolidone-iodine solution against infections of the holes for Kirschner wires and Schanz pins among patients using Ilizarov external fixators, in comparison with cleaning these holes only with 0.9% sterile physiological saline solution.
                Controlled randomized clinical trial, in the Orthopedics and Traumatology Outpatient Clinic, Hospital São Paulo, and Orthopedics and Traumatology Center of Jundiaí.
                30 patients were treated using the Ilizarov technique: 15 were instructed to apply 0.9% physiological saline dressing on the wire and pin insertions and 15 to apply 0.9% physiological saline plus 10% polyvinylpyrrolidone-iodine. Patients were evaluated at outpatient return visits for identification of signs and symptoms of superficial infection at wire and pin insertion sites. Samples were collected from cases of purulent exudate secretion, for culturing and clinical tests.
                The chi-squared and Fischer exact tests were applied, but no statistically significant association between the intervention of topical polyvinylpyrrolidone-iodine solution and the prevention of infections at wire and pin insertions could be found.
                Topical 10% polyvinylpyrrolidone-iodine solution applied daily to Kirschner wire and Schanz pin insertions did not reduce the incidence of superficial infection at these holes, in comparison with mechanical removal of dirt using 0.9% physiological saline solution.


Title 4:
No difference between daily and weekly pin site care: a randomized study of 50 patients with external fixation.
Abstract 4:
We investigated whether there were any differences in the frequency and severity of pin site infections by performing pin site care daily or once a week. We studied patients operated on for gonarthrosis by the hemicallotasis technique, using hydroxyapatite-coated pins in the metaphyseal bone and standard pins in the diaphyseal bone.
                50 patients were prospectively randomized to daily (n = 27) or weekly (n = 23) pin site care. We evaluated pin sites, the occurrence of pain (VAS), the use of antibiotics and analgesics and complications every week. Bacterial cultures were taken from each pin site at 1, 6 and 10 weeks and from the pins on removal.
                We found no differences between daily or weekly pin site care as regards the frequency and severity of pin site infections, pain, or the use of antibiotics and analgesics. Grade I infections (Checketts-Otterburns classification) occurred around 11% of the pins and grade II infections around 4%. 70% of the bacterial cultures were negative. The most frequent bacteria were coagulase negative staphylococcus and corynebacterium. Antibiotics were given an average of 47 days. More problems occurred around the proximal pins. 5/200 (all proximal) pins were clinically loose on removal.
                Pin site care once a week seems appropriate.


Title 5:
Diluted povidone-iodine versus saline for dressing metal-skin interfaces in external fixation.
Abstract 5:
To compare infection rates associated with 2 dressing solutions for metal-skin interfaces.
                60 patients who underwent distraction osteogenesis with external fixators were equally randomised into 2 dressing solution groups (diluted povidone-iodine vs. saline). Fixations were attained using either rigid stainless steel 5-mm diameter half pins or smooth stainless steel 1.8-mm diameter wires. Half-pin fixation had one metal-skin interface, whereas wire fixation had 2 interfaces. Patients were followed up every 2 weeks for 6 months.
                Of all 788 metal-skin interfaces, 143 (18%) were infected: 72 (19%) of 371 in the diluted povidone-iodine group and 71 (17%) of 417 in the saline group. Dressing solution and patient age did not significantly affect infection rates. Half-pin fixation was more likely to become infected than wire fixation (25% vs 15%).
                Saline is as effective as diluted povidone-iodine as a dressing solution for metal-skin interfaces of external fixators. Saline is recommended in view of its easy availability and lower costs.
The available trial evidence was not extensive, was very heterogeneous and generally of poor quality, so there was insufficient evidence to be able to identify a strategy of pin site care that minimises infection rates. Adequately-powered randomised trials are required to examine the effects of different pin care regimens, and co-interventions - such as antibiotic use - and other extraneous factors must be controlled in the study designs.