A simple practical protocol for care of metal-skin interface of external fixation.

Abstract

Patients treated with external fixation for limb reconsturciton or fracture stabilization equire regular and prolongedperiod of pin-tract care involving frequent visits to clinic and dressing traditionally carried out by trained nurses or medical assistants. A simple method of do-it-yourself dressing was introduced in our institution and this study was undertaken to evaluate the effectiveness of the protocol. Sixty patients (40 trauma-related problems and 20 congenital or developmental disorders) were enrolled into the study. Following application of external fixation, the patients and/or their caretakers were taught on how to do pin-site dressing using normal saline or drinking water as cleansing solution on daily basis. Patients were discharged on the second or third post-operative day and were followed-up every two weeks for an average 182 days (range 66 to 379 days) with special attention on identifying pin-tract infection. A simple grading system for pin-tract infections was proposed. Of 40 patients with trauma-related problems. 65% were post-traumatic infections. There were 788 metal-skin interfaces (239 half-pin fixations and 549 tensioned wire fixations. A total 143 metal-skin interface infections (18.1%) involving half-pin sites (41.3%) and tensioned wire sites (58.7%) was noted. Majority were grade I infections (79.7%), 18.8% grade II and only 1.4% grade III. Most infections (81%)were caused by Staphylococcus aureus. Grade I infections were successfully treated with frequent dressing, grade II by adjunctive oral antibiotic but grade III infections required removal of fixator. All eventually healed. Do yourself non-sterile dressing of metal-skin interfaces is a cost-effective method of pin-site care with a low infection rate. The infections were sucessfully treated using guidelines according to the proposed classification of pin-tract infections.

• Authors: A Saw, C K Chan, R Penafort, S Sengupta
• Journal: The Medical journal of Malaysia (Med J Malaysia) Vol. 61 Suppl A Pg. 62-5 (Feb 2006) ISSN: 0300-5283 [Print] Malaysia
• PMID: 17042233 (Publication Type: Journal Article)

Topics

• Adolescent
• Adult
• Aged
• Bandages
• Bone Nails (microbiology)
• Bone Wires (microbiology)
• Child
• Child, Preschool
• Clinical Protocols
• External Fixators (microbiology)
• Female
• Fractures, Bone (surgery)
• Humans
• Infant
• Male
• Middle Aged
• Prospective Studies
• Self Care (methods)
• Skin Care (methods)
• Surgical Wound Infection (etiology, prevention & control)