Minimizing infection when converting ex fix to IM nail

With all the external fixation being done for temporary stability, what is the evidence for best practices for conversion to internal fixation? There are issues regarding timing, whether you can keep the ex fix in the operative field if needed, how to best sterilize it, what to do with the pin sites before and after the pins come out, etc. We review two recent papers: “External fixation before planned conversion to internal fixation in orthopaedic trauma: controversies and current trends” by Wynn et al in the Oct 1, 2024 JAAOS. We also review data from our own group entitled “Evaluating the efficacy of disinfecting agents on external fixator devices” (Horowitz et al) being presented at the OTA 2024 in Montreal this weekend, as well as the paper entitled “Safety of prepping the external fixator in situ during staged internal fixation of pilon fractures: a retrospective comparative cohort study” by Yeramosu et al in the September 2023 issue of JOT.