Intrarater Reliability of Digital Thermography in Detecting Pin Site Infection: A Proof of Concept Study

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Ab s t r ac t Aim and objective: The purpose of this study was to explore the capability and Intrarater reliability of thermography in detecting pin site infection. Materials and methods: This is an explorative proof of concept study. Clinical assessment of pin sites was performed by one examiner with the Modified Gordon Pin Infection Classification from grade 0 to 6. Thermography of the pin sites was performed with a FLIR C3 camera. The analysis of the thermographic images was done in the software FLIR Tools. The maximum skin temperature around the pin site and the maximum temperature for the whole thermographic picture were measured. An Intrarater agreement was established and test-retests were performed with different camera angles. Results: Thirteen (four females, nine males) patients (age 9–72 years) were included. Indications for frames: Fracture (n=4), two deformity correction, one lengthening and six bone transport. Days from surgery to thermography ranged from 27 to 385 days. Overall, 231 pin sites were included. Eleven pin sites were diagnosed with early signs of infection: five grade 1, five grade 2 and one grade 3. Mean pin site temperature for each patient was calculated, varied between patients from 29.0°C to 35.4°C (mean 33.9°C). With 34°C as cut-off value for infection, sensitivity was 73%; specificity, 67%; positive predictive value, 10%; and negative predictive value, 98%. Intrarater agreement for thermography was ICC 0.85 (0.77–0.92). The temperature measured was influenced by the camera positioning in relation to the pin site with a variance of 0.2. Conclusions: Measurements of pin site temperature using the hand-held FLIR C3 infrared camera was a reliable method and the temperature was related to infection grading. Clinical significance: This study demonstrated that digital thermography with a hand-held camera might be used for monitoring the pin sites after operations to detect early infection.

Original languageEnglish
JournalStrategies in Trauma and Limb Reconstruction (Print)
Issue number1
Pages (from-to)1-7
Number of pages7
Publication statusPublished - 1 Apr 2021

Bibliographical note

Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


  • FLIR C3 camera
  • Inter-rater/Intrarater reliability
  • Modified gordon pin infection classification
  • Pin site infection
  • Proof-of-concept study
  • Thermography


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