Perioperative management of external fixation in staged protocols: an international survey
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...
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| Veröffentlicht in: | European journal of orthopaedic surgery & traumatology 2018-05, Vol.28 (4), p.565-572 |
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| container_title | European journal of orthopaedic surgery & traumatology |
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| creator | Hodel, Sandro Link, Björn-Christian Babst, Reto Mallee, W. H. Posso, Philippe Beeres, Frank J. P. |
| description | 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. |
| doi_str_mv | 10.1007/s00590-018-2135-9 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1999686202</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2351570582</sourcerecordid><originalsourceid>FETCH-LOGICAL-c2879-8e8e6915854ab82249aed467ea69f29e941b183f1d7679ed39c97fb485cf49b93</originalsourceid><addsrcrecordid>eNp1kM1LwzAchoMobk7_AC9S8OKlmo8mTbzJ8AsEPejFS0jbX0dH28ykHdt_b2qnguApIb8nb948CJ0SfEkwTq88xlzhGBMZU8J4rPbQlCSMxgQLuR_2grFYYsEn6Mj7JcaEK8IP0YSqhKQskVP0_gKusitwpqvWEDWmNQtooO0iW0aw6cC1po7KahPmto2qNvJdIIpo5Wxnc1v768gM51_kwATc924N22N0UJraw8lunaG3u9vX-UP89Hz_OL95inMqUxVLkCBCLckTk0lKE2WgSEQKRqiSKghVMyJZSYpUpAoKpnKVllkieV4mKlNshi7G3FDpowff6abyOdS1acH2XhOllJCCYhrQ8z_o0vbDD72mjBOeYi4HioxU7qz3Dkq9clVj3FYTrAfxehSvg3g9iNdDibNdcp81UPzc-DYdADoCPozaBbjfp_9P_QQ5gI4Q</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2351570582</pqid></control><display><type>article</type><title>Perioperative management of external fixation in staged protocols: an international survey</title><source>Springer Nature - Complete Springer Journals</source><creator>Hodel, Sandro ; Link, Björn-Christian ; Babst, Reto ; Mallee, W. H. ; Posso, Philippe ; Beeres, Frank J. P.</creator><creatorcontrib>Hodel, Sandro ; Link, Björn-Christian ; Babst, Reto ; Mallee, W. H. ; Posso, Philippe ; Beeres, Frank J. P. ; Collaborators</creatorcontrib><description>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.</description><identifier>ISSN: 1633-8065</identifier><identifier>EISSN: 1432-1068</identifier><identifier>DOI: 10.1007/s00590-018-2135-9</identifier><identifier>PMID: 29417348</identifier><language>eng</language><publisher>Paris: Springer Paris</publisher><subject>Antibiotics ; Infections ; Medicine ; Medicine & Public Health ; Original Article • FRACTURES - INFECTION ; Response rates ; Surgeons ; Surgery ; Surgical Orthopedics ; Surgical techniques ; Trauma ; Traumatic Surgery</subject><ispartof>European journal of orthopaedic surgery & traumatology, 2018-05, Vol.28 (4), p.565-572</ispartof><rights>Springer-Verlag France SAS, part of Springer Nature 2018</rights><rights>European Journal of Orthopaedic Surgery and Traumatology is a copyright of Springer, (2018). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c2879-8e8e6915854ab82249aed467ea69f29e941b183f1d7679ed39c97fb485cf49b93</citedby><cites>FETCH-LOGICAL-c2879-8e8e6915854ab82249aed467ea69f29e941b183f1d7679ed39c97fb485cf49b93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00590-018-2135-9$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00590-018-2135-9$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29417348$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hodel, Sandro</creatorcontrib><creatorcontrib>Link, Björn-Christian</creatorcontrib><creatorcontrib>Babst, Reto</creatorcontrib><creatorcontrib>Mallee, W. H.</creatorcontrib><creatorcontrib>Posso, Philippe</creatorcontrib><creatorcontrib>Beeres, Frank J. P.</creatorcontrib><creatorcontrib>Collaborators</creatorcontrib><title>Perioperative management of external fixation in staged protocols: an international survey</title><title>European journal of orthopaedic surgery & traumatology</title><addtitle>Eur J Orthop Surg Traumatol</addtitle><addtitle>Eur J Orthop Surg Traumatol</addtitle><description>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.</description><subject>Antibiotics</subject><subject>Infections</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original Article • FRACTURES - INFECTION</subject><subject>Response rates</subject><subject>Surgeons</subject><subject>Surgery</subject><subject>Surgical Orthopedics</subject><subject>Surgical techniques</subject><subject>Trauma</subject><subject>Traumatic Surgery</subject><issn>1633-8065</issn><issn>1432-1068</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>BENPR</sourceid><recordid>eNp1kM1LwzAchoMobk7_AC9S8OKlmo8mTbzJ8AsEPejFS0jbX0dH28ykHdt_b2qnguApIb8nb948CJ0SfEkwTq88xlzhGBMZU8J4rPbQlCSMxgQLuR_2grFYYsEn6Mj7JcaEK8IP0YSqhKQskVP0_gKusitwpqvWEDWmNQtooO0iW0aw6cC1po7KahPmto2qNvJdIIpo5Wxnc1v768gM51_kwATc924N22N0UJraw8lunaG3u9vX-UP89Hz_OL95inMqUxVLkCBCLckTk0lKE2WgSEQKRqiSKghVMyJZSYpUpAoKpnKVllkieV4mKlNshi7G3FDpowff6abyOdS1acH2XhOllJCCYhrQ8z_o0vbDD72mjBOeYi4HioxU7qz3Dkq9clVj3FYTrAfxehSvg3g9iNdDibNdcp81UPzc-DYdADoCPozaBbjfp_9P_QQ5gI4Q</recordid><startdate>20180501</startdate><enddate>20180501</enddate><creator>Hodel, Sandro</creator><creator>Link, Björn-Christian</creator><creator>Babst, Reto</creator><creator>Mallee, W. H.</creator><creator>Posso, Philippe</creator><creator>Beeres, Frank J. P.</creator><general>Springer Paris</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20180501</creationdate><title>Perioperative management of external fixation in staged protocols: an international survey</title><author>Hodel, Sandro ; Link, Björn-Christian ; Babst, Reto ; Mallee, W. H. ; Posso, Philippe ; Beeres, Frank J. P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2879-8e8e6915854ab82249aed467ea69f29e941b183f1d7679ed39c97fb485cf49b93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Antibiotics</topic><topic>Infections</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original Article • FRACTURES - INFECTION</topic><topic>Response rates</topic><topic>Surgeons</topic><topic>Surgery</topic><topic>Surgical Orthopedics</topic><topic>Surgical techniques</topic><topic>Trauma</topic><topic>Traumatic Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hodel, Sandro</creatorcontrib><creatorcontrib>Link, Björn-Christian</creatorcontrib><creatorcontrib>Babst, Reto</creatorcontrib><creatorcontrib>Mallee, W. H.</creatorcontrib><creatorcontrib>Posso, Philippe</creatorcontrib><creatorcontrib>Beeres, Frank J. P.</creatorcontrib><creatorcontrib>Collaborators</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of orthopaedic surgery & traumatology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hodel, Sandro</au><au>Link, Björn-Christian</au><au>Babst, Reto</au><au>Mallee, W. H.</au><au>Posso, Philippe</au><au>Beeres, Frank J. P.</au><aucorp>Collaborators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Perioperative management of external fixation in staged protocols: an international survey</atitle><jtitle>European journal of orthopaedic surgery & traumatology</jtitle><stitle>Eur J Orthop Surg Traumatol</stitle><addtitle>Eur J Orthop Surg Traumatol</addtitle><date>2018-05-01</date><risdate>2018</risdate><volume>28</volume><issue>4</issue><spage>565</spage><epage>572</epage><pages>565-572</pages><issn>1633-8065</issn><eissn>1432-1068</eissn><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.</abstract><cop>Paris</cop><pub>Springer Paris</pub><pmid>29417348</pmid><doi>10.1007/s00590-018-2135-9</doi><tpages>8</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1633-8065 |
| ispartof | European journal of orthopaedic surgery & traumatology, 2018-05, Vol.28 (4), p.565-572 |
| issn | 1633-8065 1432-1068 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1999686202 |
| source | Springer Nature - Complete Springer Journals |
| subjects | Antibiotics Infections Medicine Medicine & Public Health Original Article • FRACTURES - INFECTION Response rates Surgeons Surgery Surgical Orthopedics Surgical techniques Trauma Traumatic Surgery |
| title | Perioperative management of external fixation in staged protocols: an international survey |
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