Is It Safe to Prep the External Fixator In Situ During Second-Stage Pilon Surgical Treatment?

Abstract

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Is It Safe to Prep the External Fixator In Situ During Staged ORIF of Bicondylar Tibial Plateau Fractures? A Retrospective Comparative Cohort Study

“…[2][3][4][5] However, various protocols for staged fixation of tibia fractures highlight the utility of prepping elements of a pre-existing external fixator into the sterile field. [6][7][8] Complete articular bicondylar tibial plateau (BTP) fractures are high-energy injuries that require complex reconstruction. [9][10][11][12] Staged open reduction internal fixation (ORIF) after a period of initial temporizing external fixation is commonly used for patients with open fractures, highenergy injuries, or significant soft tissue compromise.…”

“…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…”

“…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. 8…”

“…7,[12][13][14][15][16] Prepping the ex-fix into the sterile field during definitive fixation provides stability and distraction 7 and may improve efficiency and decrease costs. 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.…”

“…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.…”