Skip to main content
Erschienen in: European Journal of Orthopaedic Surgery & Traumatology 4/2018

07.02.2018 | Original Article • FRACTURES - INFECTION

Perioperative management of external fixation in staged protocols: an international survey

verfasst von: Sandro Hodel, Björn-Christian Link, Reto Babst, W. H. Mallee, Philippe Posso, Frank J. P. Beeres, Collaborators (18)

Erschienen in: European Journal of Orthopaedic Surgery & Traumatology | Ausgabe 4/2018

Einloggen, um Zugang zu erhalten

Abstract

Introduction

Despite the frequent use of external fixation, various regimes of antibiotic prophylaxis, surgical technique and postoperative pin care exist and underline the lack of current evidence. The aim of the study was to assess the variability or consensus in perioperative protocols to prevent implant-associated infections for temporary external fixation in closed fractures of the extremities.

Materials and methods

A 26-question survey was sent to 170 members of the Traumaplatform. The survey included questions concerning demographics, level of training, type of training and perioperative protocols as: antibiotic prophylaxis, intraoperative management, disinfection and postoperative pin site care. All responses were statistically analysed, and intraoperative measures rated on a 5-point Likert scale.

Results

The responses of fifty orthopaedic trauma and general surgeons (response rate, 29.4%) were analysed. The level of experience was more than 5 years in 92% (n = 46) with up to 50 closed fractures of the extremities annually treated with external fixation in 80% (n = 40). Highest consensus could be identified in the following perioperative measures: preoperative antibiotic prophylaxis with a second-generation cephalosporin (86%, n = 43), changing gloves if manipulation of the external fixator is necessary during surgery (86%, n = 43; 4.12 points on the Likert scale), avoid overlapping of the pin sites with the definitive implant site (94%, n = 47; 4.12 points on the Likert scale) and soft tissue protection with a drill sleeve (83.6%, n = 41).

Conclusion

Our survey could identify some general principles, which were rated as important by a majority of the respondents. Futures studies’ focus should elucidate the role of perioperative antibiotics and different disinfection protocols on implant-associated infections after temporary external fixation in staged protocols.

Level of evidence

This study provides Level IV evidence according to Oxford centre for evidence-based medicine.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Anglen JO, Aleto T (1998) Temporary transarticular external fixation of the knee and ankle. J Orthop Trauma 12:431–434CrossRefPubMed Anglen JO, Aleto T (1998) Temporary transarticular external fixation of the knee and ankle. J Orthop Trauma 12:431–434CrossRefPubMed
3.
Zurück zum Zitat Sirkin M, Sanders R, DiPasquale T, Herscovici D (2004) A staged protocol for soft tissue management in the treatment of complex pilon fractures. J Orthop Trauma 18:S32–S38CrossRefPubMed Sirkin M, Sanders R, DiPasquale T, Herscovici D (2004) A staged protocol for soft tissue management in the treatment of complex pilon fractures. J Orthop Trauma 18:S32–S38CrossRefPubMed
4.
Zurück zum Zitat Egol KA, Tejwani NC, Capla EL et al (2005) Staged management of high-energy proximal tibia fractures (OTA types 41): the results of a prospective, standardized protocol. J Orthop Trauma 19:448–455 (Discussion 456) CrossRefPubMed Egol KA, Tejwani NC, Capla EL et al (2005) Staged management of high-energy proximal tibia fractures (OTA types 41): the results of a prospective, standardized protocol. J Orthop Trauma 19:448–455 (Discussion 456) CrossRefPubMed
5.
Zurück zum Zitat Mahan J, Seligson D, Henry SL et al (1991) Factors in pin tract infections. Orthopedics 14:305–308PubMed Mahan J, Seligson D, Henry SL et al (1991) Factors in pin tract infections. Orthopedics 14:305–308PubMed
7.
Zurück zum Zitat Antoci V, Ono CM, Raney EM (2008) Pin-tract infection during limb lengthening using external fixation. Am J Orthop 37:E150–E154PubMed Antoci V, Ono CM, Raney EM (2008) Pin-tract infection during limb lengthening using external fixation. Am J Orthop 37:E150–E154PubMed
10.
Zurück zum Zitat Green SA, Ripley MJ (1984) Chronic osteomyelitis in pin tracks. J Bone Joint Surg Am 66:1092–1098CrossRefPubMed Green SA, Ripley MJ (1984) Chronic osteomyelitis in pin tracks. J Bone Joint Surg Am 66:1092–1098CrossRefPubMed
16.
Zurück zum Zitat Vu TTT, Pignol JP, Rakovitch E et al (2007) Variability in radiation oncologists’ opinion on the indication of a bolus in post-mastectomy radiotherapy: an international survey. Clin Oncol (R Coll Radiol) 19:115–119CrossRef Vu TTT, Pignol JP, Rakovitch E et al (2007) Variability in radiation oncologists’ opinion on the indication of a bolus in post-mastectomy radiotherapy: an international survey. Clin Oncol (R Coll Radiol) 19:115–119CrossRef
22.
Zurück zum Zitat Magyar G, Toksvig-Larsen S, Lindstrand A (1999) Hemicallotasis open-wedge osteotomy for osteoarthritis of the knee. Complications in 308 operations. J Bone Joint Surg Br 81:449–451CrossRefPubMed Magyar G, Toksvig-Larsen S, Lindstrand A (1999) Hemicallotasis open-wedge osteotomy for osteoarthritis of the knee. Complications in 308 operations. J Bone Joint Surg Br 81:449–451CrossRefPubMed
Metadaten
Titel
Perioperative management of external fixation in staged protocols: an international survey
verfasst von
Sandro Hodel
Björn-Christian Link
Reto Babst
W. H. Mallee
Philippe Posso
Frank J. P. Beeres
Collaborators (18)
Publikationsdatum
07.02.2018
Verlag
Springer Paris
Erschienen in
European Journal of Orthopaedic Surgery & Traumatology / Ausgabe 4/2018
Print ISSN: 1633-8065
Elektronische ISSN: 1432-1068
DOI
https://doi.org/10.1007/s00590-018-2135-9

Weitere Artikel der Ausgabe 4/2018

European Journal of Orthopaedic Surgery & Traumatology 4/2018 Zur Ausgabe

Up-to date Review and Case Report • SHOULDER - ARTHROPLASTY

Review and clinical presentation in reverse shoulder arthroplasty in deltoid palsy

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.