title: 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.affiliation: Department of Orthopaedic Surgery, University Malaya Medical Center, Kuala Lumpur, Malaysia.
authors.forename: A
authors.initials: A
authors.lastname: Saw
authors.forename: C K
authors.initials: CK
authors.lastname: Chan
authors.forename: R
authors.initials: R
authors.lastname: Penafort
authors.forename: S
authors.initials: S
authors.lastname: Sengupta
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001458:Bandages; D001858:Bone Nails / Q000382:microbiology; D001864:Bone Wires / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D016267:External Fixators / Q000382:microbiology*; D005260:Female; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012648:Self Care / Q000379:methods*; D017592:Skin Care / Q000379:methods*; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control*