OBJECTIVE: To examine the degree of discomfort experienced by patients with routine removal of all external fixators without anesthesia. DESIGN: Retrospective review. SETTING: Outpatient clinic and hospital. PATIENTS: A total of 106 consecutive patients for whom removal of external fixators was indicated. INTERVENTION: External fixators were removed without anesthesia. MAIN OUTCOME MEASUREMENTS: Visual Analog Pain Scale (VAS) following external fixator removal and patients' reported willingness to repeat the procedure without anesthesia. RESULTS: Patients with pin site inflammation had a significantly higher VAS (4.82 vs. 2.92, P < 0.0001). The chi test revealed that pin site inflammation was less common with wrist spanning fixators than with lower extremity and pelvic fixators. No correlation existed between age, site of fixator, closed head injury, use of olive wires, or the duration of fixation and VAS. In all, 95 of 106 patients (89.6%) responded yes when asked if they would undergo removal of their fixator again without anesthesia. Despite the association between inflamed pin sites and a higher VAS, in 84% (37/44) of the cases with inflamed pin sites, the patient would choose to undergo fixator removal without anesthesia again. CONCLUSIONS: Removal of external fixators without anesthesia is well tolerated by the great majority of patients. Inflammation at pin sites is associated with a higher degree of discomfort during external fixator removal. Despite the higher pain score, most patients with pin-site inflammation report that they would repeat the procedure without anesthesia.
OBJECTIVE: To examine the degree of discomfort experienced by patients with routine removal of all external fixators without anesthesia. DESIGN: Retrospective review. SETTING:Outpatient clinic and hospital. PATIENTS: A total of 106 consecutive patients for whom removal of external fixators was indicated. INTERVENTION: External fixators were removed without anesthesia. MAIN OUTCOME MEASUREMENTS: Visual Analog Pain Scale (VAS) following external fixator removal and patients' reported willingness to repeat the procedure without anesthesia. RESULTS:Patients with pin site inflammation had a significantly higher VAS (4.82 vs. 2.92, P < 0.0001). The chi test revealed that pin site inflammation was less common with wrist spanning fixators than with lower extremity and pelvic fixators. No correlation existed between age, site of fixator, closed head injury, use of olive wires, or the duration of fixation and VAS. In all, 95 of 106 patients (89.6%) responded yes when asked if they would undergo removal of their fixator again without anesthesia. Despite the association between inflamed pin sites and a higher VAS, in 84% (37/44) of the cases with inflamed pin sites, the patient would choose to undergo fixator removal without anesthesia again. CONCLUSIONS: Removal of external fixators without anesthesia is well tolerated by the great majority of patients. Inflammation at pin sites is associated with a higher degree of discomfort during external fixator removal. Despite the higher pain score, most patients with pin-site inflammation report that they would repeat the procedure without anesthesia.
Authors: P M Mitchell; C M Corrigan; N A Patel; A J Silverberg; S E Greenberg; R V Thakore; W T Obremskey; J M Ehrenfeld; J M Evans; M K Sethi Journal: Eur J Trauma Emerg Surg Date: 2015-02-24 Impact factor: 3.693