Routine pin tract care in external fixation is unnecessary: A randomised, prospective, blinded controlled study

Camathias, Carlo; Valderrábano, Víctor; Oberli, H

doi:10.1016/j.injury.2012.08.010

Cited by 46 publications

(27 citation statements)

References 13 publications

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“…A standard method for the development of an instrument to assess a subjective state was used to develop an ISI inflammation score on the basis of nonvalidated ISI scoring systems used previously for humans. [19][20][21][22][23][24][25][26] Six metrics were defined: erythema, discharge amount, discharge type, swelling, hair loss or lack of hair regrowth, and granulation tissue. A scale from 1 to 10 (higher scores indicated greater severity of each of the assessed metrics of inflammation) was selected on the basis of ease of use, compared with ease of use for a visual analogue scale.…”

Section: Inflammation Scoring Systemmentioning

confidence: 99%

Assessment of an implant-skin interface scoring system for external skeletal fixation of dogs

McDonald-Lynch

Marcellin‐Little

Roe

et al. 2015

ajvr

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OBJECTIVE To assess intraobserver repeatability and interobserver and in vivo versus photographic agreement of a scoring system for the implant-skin interface (ISI) of external skeletal fixation (ESF). SAMPLE 42 photographs of ISIs from 18 dogs for interobserver agreement and intraobserver repeatability and 27 photographs of ISIs from 6 dogs for in vivo versus photograph agreement. PROCEDURES An ISI inflammation scoring system was developed. It included scales for 6 metrics (erythema, drainage amount, drainage type, swelling, hair loss or lack of hair regrowth, and granulation tissue). Photographs of the ISI of ESF were obtained by use of a standard protocol and evaluated to determine intraobserver repeatability and interobserver agreement (Cronbach α; 4 raters) of the ISI score. Agreement between in vivo and photographic ISI scores (2 raters) and correlation between median scores across metrics were evaluated. RESULTS 42 photographs met the inclusion criteria. Overall intraclass correlation coefficients ranged from 0.922 to 0.975. Interobserver overall Cronbach α ranged from 0.835 to 0.943. For in vivo versus photographic assessment, 27 ISIs in 6 dogs and their photographs were evaluated. The Cronbach α for both raters ranged from 0.614 to 0.938. Overall, the Cronbach α ranged from 0.725 to 0.932. Mean photographic scores were greater than mean in vivo scores for each metric. Pearson correlation coefficients ranged from 0.221 to 0.923. Erythema, swelling, and granulation were correlated with all other metrics. CONCLUSIONS AND CLINICAL RELEVANCE In this study, an ISI scoring system used in this study had high repeatability and agreement and may therefore be considered for use in clinical situations. Photographic scores were not equivalent to in vivo scores and should not be used interchangeably.

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Section: Inflammation Scoring Systemmentioning

confidence: 99%

Assessment of an implant-skin interface scoring system for external skeletal fixation of dogs

McDonald-Lynch

Marcellin‐Little

Roe

et al. 2015

ajvr

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“…Although a high number of pin-tract complications have been reported in traditional external fixation, [23][24][25] in the current study there was only 1 screw with secretions in the supercutaneous plating group, which was controlled with daily cleaning with povidone iodine. This low incidence of pin-tract complications may be related to the titanium alloy device of the screws.…”

Section: Discussionmentioning

confidence: 69%

Surgical Treatment of Extra-articular or Simple Intra-articular Distal Tibial Fractures: MIPO Versus Supercutaneous Plating

He¹,

Zhang²,

Li³

et al. 2014

Orthopedics

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Minimally invasive plate osteosynthesis (MIPO) has become a widely accepted technique to treat distal tibial fractures. Recently, the novel application of a locking plate used as an external fixator (supercutaneous plating) was introduced for the management of open fractures and infected nonunions and even as an adjunct in distraction osteogenesis, which is considered another less invasive method. The aim of this study was to compare the results of supercutaneous plating with closed reduction and minimally invasive plating in the treatment of distal tibial fractures. Forty-eight matched patients were divided according to age, sex, Injury Severity Score, and fracture pattern into the MIPO group and the supercutaneous plating group. Minimum follow-up was 12 months (mean, 18.5 months; range, 12-26 months). No patient had nonunion, hardware breakdown, or deep infection. Patients in the supercutaneous plating group had a significantly shorter mean operative time (65.6±13.2 vs 85.9±14.0 minutes; P=.000), hospital stay (7.5±2.0 vs 13.0±4.4 days; P=.000), and union time (15.2±2.4 vs 17.0±2.8 weeks; P=.000). In the MIPO group, 15 (62.5%) patients reported implant impingement or discomfort and there was 1 incidence of stripping of 15.6% at the time of locking screw removal, whereas in the supercutaneous plating group, no patient reported skin irritation, and removal of the supercutaneous plate was easily performed in clinic without anesthesia. Distal tibial fractures may be treated successfully with MIPO or supercutaneous plating. However, the supercutaneous plating technique may represent a superior surgical option because it offers advantages in terms of mean operative time, hospital stay, and union time; skin irritation; and implant removal.

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“…Daily cleansing was preferred by both international and UK practitioners, with 41.9%, n = 55 and 33.7%, n = 64 compared to weekly 12.2%, n = 16 and 27.9%, n = 53. Previous research has reported no significant differences in PSI between weekly and daily pin site care or between daily irrigation with saline and not cleansing . Similarly, no significant difference in infection was reported between cleansing and not cleansing of pin sites .…”

Section: Discussionmentioning

confidence: 78%

“…Previous research has reported no significant differences in PSI between weekly and daily pin site care or between daily irrigation with saline and not cleansing. 20,21 Similarly, no significant difference in infection was reported between cleansing and not cleansing of pin sites. [22][23][24] Interestingly, significantly higher PSI rates have been reported with daily cleansing with 75% alcohol compared to no cleansing (P = 0.007).…”

Section: Discussionmentioning

confidence: 98%

A web‐based survey to identify current practice in skeletal pin site management

Walker

Scammell

Bayston

2017

International Wound Journal

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Infections associated with percutaneous pins and wires are common complications which can have a significant impact on patient outcomes. A survey was undertaken to identify current practice and gain insight into variations of clinical practice. Invitations were sent by email to complete an electronic questionnaire using SurveyMonkey. The survey was left open for 100 days. The single largest group of respondents (37.4%, n = 120) cleansed pin sites daily, with significant differences identified between medical and nursing professions (P = 0.02), and country of practice (P < 0.001). Significant differences were also identified in the use of different cleansing solutions between medical and nursing professions (P < 0.001) and country (P < 0.001). The majority group preferences were saline 30% (n = 96) and alcoholic chlorhexidine 29.6% (n = 95). Pin site crusts were routinely removed by 57.9% (n = 186). Pin sites were left exposed by 50.3% (n = 160). Dry gauze was identified as the most common dressing used to dress pin sites, however, substantial variation was identified in the types of dressings used. Compression was not routinely applied to pin sites by 51.6% (n = 165). There remains considerable diversity of practice when caring for pin sites. Further research is required to identify the most effective methods in preventing pin site infection.

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Routine pin tract care in external fixation is unnecessary: A randomised, prospective, blinded controlled study

Cited by 46 publications

References 13 publications

Assessment of an implant-skin interface scoring system for external skeletal fixation of dogs

Assessment of an implant-skin interface scoring system for external skeletal fixation of dogs

Surgical Treatment of Extra-articular or Simple Intra-articular Distal Tibial Fractures: MIPO Versus Supercutaneous Plating

A web‐based survey to identify current practice in skeletal pin site management

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