Does temporary external fixation and staged protocol for closed fractures lead to bacterial contamination of the surgical site and associated complications? – A prospective trial

Hodel, Sandro; Koller, Tobias; Link, Björn‐Christian; Rossi, M; Babst, Reto; Beeres, Frank J.P.

doi:10.1016/j.injury.2018.05.028

Cited by 9 publications

(9 citation statements)

References 19 publications

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“…7 The overlapping correlation of the pins with surgical incisions, associated with infection, is also analyzed in a prospective study in which the external fixators installed for damage control are instruments for reducing fractures during definitive osteosynthesis. 1 In our sample, we observed that between the accident and the definitive osteosynthesis procedure, nine patients (18%) underwent a clinically proven inflammatory and infectious process in the path of the installed Schanz pins, all with evidence of soft tissue tension against the pins. All patients underwent local debridement and antibiotics by a preoperative systemic approach to definitive surgery.…”

Section: Discussionmentioning

confidence: 77%

Interference of External Damage Control Fixation in Definitive Osteosynthesis

et al. 2022

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Introduction: Indications for provisional external fixation prior to the definitive treatment of fractures are associated with the control of local and systemic damage and the impossibility of definitive osteosynthesis in the emergency. Objective: To identify complications associated with external fixation prior to definitive internal osteosynthesis. Methods: This is a comparative, prospective study (Level II). Inclusion criteria: patients treated as emergencies (November 2019 and March 2020) who underwent provisional external correction followed by definitive osteosynthesis. We look for signs of inadequacies in external correction and correlation with infections (erythema, hyperemia, fistulae in the path of the pins or surgical scars), systemic symptoms of infection, and radiographic parameters for treatment up to eight weeks after surgery. Results: The average time for conversion to definitive osteosynthesis was 15.9 days and 47 lower limbs and three upper limbs were fixed. Of the participants who had deep infections, three (6%) showed signs during initial treatment (external fixator) and nine (18%), after definitive internal osteosynthesis. We found no correlation between provisional external correction and complications in the definitive treatment with osteosynthesis. Conclusion: The use of temporary external fixation before definitive internal osteosynthesis in fractures of the appendicular skeleton failed to increase complication rates even if the path of the implants in both procedures overlapped. Level of Evidence II, Comparative Prospective Study.

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Section: Discussionmentioning

confidence: 77%

Interference of External Damage Control Fixation in Definitive Osteosynthesis

et al. 2022

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“…Patients received a single preoperative 2-g dose of cefazolin prior to surgery. The management of the external fixator was according to the local protocol, which has been described in detail previously 7 . After removal of the external fixator, pin-site wounds were thoroughly cleaned with a sharp spoon and rinsed with an isotonic electrolyte solution (Ringerfundin; B. Braun).…”

Section: Methodsmentioning

confidence: 99%

Primary Closure or Secondary Wound Healing of Pin Sites After External Fixator Removal

Roth

Hoepelman

Cagienard

et al. 2023

Journal of Bone and Joint Surgery

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Background: The aim of this single-center randomized controlled trial was to compare primary wound closure using a suture with secondary wound healing of pin sites after removal of temporary external fixation.Methods: This noninferiority trial included all patients who were treated with a temporary external fixator on an upper or lower extremity at 1 institution. The primary outcome was pin-site infection. Secondary outcomes were measured at 2, 6, 12, 24, and 52 weeks and included all other complications, time to pin-site wound healing (in weeks), the most satisfactory pin site as rated by the patient, the visual analog scale (VAS) score for pain, and the Vancouver Scar Scale (VSS). The most proximal pin site was randomly allocated (1:1) to either primary closure or secondary wound healing, and the other pin sites were treated alternately.

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“…8,17 Other surgeons prefer to remove all previous implants before prepping and to debride and exclude the pin sites from the sterile field to minimize contamination. 10 Previous studies have assessed the safety of prepping the ex-fix in situ by culturing the ex-fix 18 or surgical field 17 intraoperatively and by measuring residual bacterial load on ex-fix components in the laboratory after various prepping protocols. 19 One case series on second-stage pilon ORIF with the ex-fix prepped in situ reported similar infection rates to the general published literature on pilon fractures.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…8 Some surgeons prep the entire ex-fix into the surgical field or retain the intraosseous pins to apply the femoral distractor during surgery. 8,17 Other surgeons prefer to remove all previous implants before prepping and to debride and exclude the pin sites from the sterile field to minimize contamination. 10 Previous studies have assessed the safety of prepping the ex-fix in situ by culturing the ex-fix 18 or surgical field 17 intraoperatively and by measuring residual bacterial load on ex-fix components in the laboratory after various prepping protocols.…”

Section: Introductionmentioning

confidence: 99%

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