Aftercare following external fixation
There is no universally agreed protocol for pin site care.
The following points are however recommended:
- Pin site care should continue until removal of the external fixator.
- The pin sites should be kept clean.
- Crusts or exudates should be removed.
- The pins may be cleaned with water, saline, disinfectant solution or alcohol. The frequency of cleaning varies from daily to weekly.
- Ointments or antibiotic solutions are not recommended for routine pin site care.
- Pin sites do not need to be protected whilst showering or bathing with clean water, but should be dried immediately.
Pin site infection
Initial management is with oral anti-staphylococcal antibiotics.
In case of pin loosening or unresponsive pin site infection, the following steps should be taken:
- Remove all involved pins and place new pins in a healthy location.
- Debride the pin sites in the operating theater, using curettage and irrigation.
- Take specimens for microbiological culture to guide appropriate antibiotic treatment.
Internal fixation following an infected external fixator pin has a high risk of infection and should be avoided unless no reasonable alternative is available.
See also the additional material on postoperative infection .
See the additional material on compartment syndrome .
Elevation is useful in the initial stages. A sling is helpful if fixator configuration allows its application.
The patient should be encouraged to move the wrist and elbow, within the limits of comfort.
The patient should be seen 7-10 days after surgery for a wound check.
X-rays are taken to check stability and alignment.
See also the additional material on healing times .