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

Med J Malaysia. 2006 Feb:61 Suppl A:62-5.

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.

MeSH terms

  • 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
  • Surgical Wound Infection / prevention & control*