Sandro Hodel1, Björn-Christian Link2, Reto Babst1, W H Mallee3, Philippe Posso4, Frank J P Beeres5. 1. Department of Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, 6000, Luzern 16, Switzerland. 2. Department of Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Spitalstrasse 16, Luzern 16, Switzerland. 3. Department of Orthopaedic Surgery, Academic Medical Center of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. 4. Department of Orthopaedic Surgery, Luzerner Kantonsspital, 6000, Luzern 16, Switzerland. 5. Department of Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, 6000, Luzern 16, Switzerland. frank.beeres@luks.ch.
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.
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.
Authors: Kenneth A Egol; Nirmal C Tejwani; Edward L Capla; Philip L Wolinsky; Kenneth J Koval Journal: J Orthop Trauma Date: 2005-08 Impact factor: 2.512
Authors: Douglas R Haase; Lucas R Haase; Tyler J Moon; Marcus Trotter; Joshua K Napora; Brent T Wise Journal: Eur J Orthop Surg Traumatol Date: 2022-08-18
Authors: Franz Roth; Flavio Cagienard; Björn C Link; Sandro Hodel; Dirk Lehnick; Reto Babst; Frank J P Beeres Journal: Trials Date: 2020-02-19 Impact factor: 2.279