Free Nursing Dissertations - This Study Revealed Individual Differences In Complications According To The
This study revealed individual differences in complications according to the age, severity of injury and co-morbidity amongst patients. Furthermore, Hedon and Larsson (2004) have shown that the incidence of severe infection amongst children subject to external fixation for femoral fractures is low, with only 5% experiencing a major infection.
There is no global definition of pin site infection, but major infections maybe associated with pus, pain and weeping discharge. Major infections may require re-hospitalisation of the patient with antibiotic therapy and removal of the pins. Pin site infection is the most common post-operative complication in treatment using external fixation techniques. Pin tracks can be regarded as infected if seepage or inflammation is observed and was followed by loosening of the pins (De Bastini, Aldergheri and Brivio, 1984).
There is considerable research that has examined differences in treatment and management regimes to minimise risk of infection (Temple and Santy, 2004), but also many professional protocols on pin site treatment that may not be based on clinical evidence, but personal experience (W-Dahl, Toksvig-Larsen and Lindstrand, 2004). Lee-Smith et al (2001) have summarised the expert nursing opinion on pin-site care during the post-operative phase. Regular pin-site observation is important to identify complications early, but unnecessary disturbance of dressings may aggravate underlying skin conditions and promote infection that would not have otherwise occurred through cross-infection and environmental exposure. Clinical guidelines based on expert opinion are a first step towards improved clinical practice and the prevention of skin infections in pin-site management and care (Davies, Lee-Smith, Booth, Mann, Santy and Kneale, 2001). However, they do not replace the need for high quality research evidence. It has been suggested that effective insertion techniques and subsequent quality of nursing care are vital to the prevention of infections (Hedon and Larsson, 2004), prevention of pin loosening and osteomyelitis (Green, 1984). A Cochrane Collaboration systematic review has compared the effects of different methods of cleansing and dressing orthopaedic pin sites on infection rates (Temple and Santy, 2004). However, the research authors encountered difficulty locating many research studies of appropriate methodological quality for inclusion in their systematic review. Only one randomised controlled trial of pinsite cleaning regimes, comparing cleaning with saline, to cleaning with 70% alcohol and no cleaning and found significantly fewer infections in pin site locations that had not been cleaned (Henry, 1996). This study was a randomised controlled trial of adolescent females who were undergoing leg lengthening surgery.
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