Abstract
External fixation has been more commonly used during the last decades for correction of bone and soft tissue deformities and in frcture healing. The most common complication of external fixation is pin site infection.
Two hundred and nineteen younger and/or physically active patients (mean age 53 (18-75) years) suffering from knee osteoarthritis (OA) or knee deformities operated on by hemicallotasis osteotomy (HCO) were included.
In paper I, a commonly used daily pin site care performed by a district nurse was compared to weekly pin site care in the outpatient clinic. Sodium chloride (9 mg/ml) was used as cleansing agent, and prophylactic antibiotics was given for 14 days. There were no differences between daily and weekly pin site care. The clinical pin site infection rate was 15% minor infections and 30% of the pin sites had positive bacterial cultures. The mean total use of antibiotics during the treatment period was 47 days per patient.
In paper II, sodium cloride (9 mg/ml) was compared to chlorhexidine solution (2 mg/ml) as cleansing agent and prophylactic antibiotics were reduced to 3 days. In the chlorhexidine group there were less clinical infections, less positive cultures and lower total mean use of antibiotics as compared to the sodium group.
In paper III, 3 days of prophylactic antibiotics was compared to a singgle dose. Chlorhexidine (5 mg/ml with alcohol, 70 % ethanol) was used as cleansing agent. There were no differences between 3 days and one dose of prophylactic antibiotics.
In paper IV, the healing time and complications that cause longer time in external fixation were investigated in smokers and non-smokers. Smokers had longer healing time and more complications than non-smokers. Smoking was the single most important preoperative risk factor for postoperative complications.
In paper V, patients suffering from knee OA were prospectively followed up during the first two years, with special focus of the treatment time in external fixation. Pain, function and knee related quality of life were assessed with the knee-specific questionnaire, Knee injury and Knee Osteoarthritis Outcome Score (KOOS). The patients showed large improvements in self-rated pain, function and quality of life, most of which were seen already during the immediate postoperative period when the external fixation was still used.
The clinical pin site infection rate, rate of positive cultures and total use of antibiotics could be redused by changing different factors relating to pin site care. Prolonged prophylactic antibiotics had no benefit. The negative effect of cigarette smoking is an important factor to be considered in patient selection for HCO, and should be an important part of the preoperative information. The treatment by HCO reduced the pain and improved function and quality of life already during the treatment in external fixation and continued during the 2-year follow-up.
Two hundred and nineteen younger and/or physically active patients (mean age 53 (18-75) years) suffering from knee osteoarthritis (OA) or knee deformities operated on by hemicallotasis osteotomy (HCO) were included.
In paper I, a commonly used daily pin site care performed by a district nurse was compared to weekly pin site care in the outpatient clinic. Sodium chloride (9 mg/ml) was used as cleansing agent, and prophylactic antibiotics was given for 14 days. There were no differences between daily and weekly pin site care. The clinical pin site infection rate was 15% minor infections and 30% of the pin sites had positive bacterial cultures. The mean total use of antibiotics during the treatment period was 47 days per patient.
In paper II, sodium cloride (9 mg/ml) was compared to chlorhexidine solution (2 mg/ml) as cleansing agent and prophylactic antibiotics were reduced to 3 days. In the chlorhexidine group there were less clinical infections, less positive cultures and lower total mean use of antibiotics as compared to the sodium group.
In paper III, 3 days of prophylactic antibiotics was compared to a singgle dose. Chlorhexidine (5 mg/ml with alcohol, 70 % ethanol) was used as cleansing agent. There were no differences between 3 days and one dose of prophylactic antibiotics.
In paper IV, the healing time and complications that cause longer time in external fixation were investigated in smokers and non-smokers. Smokers had longer healing time and more complications than non-smokers. Smoking was the single most important preoperative risk factor for postoperative complications.
In paper V, patients suffering from knee OA were prospectively followed up during the first two years, with special focus of the treatment time in external fixation. Pain, function and knee related quality of life were assessed with the knee-specific questionnaire, Knee injury and Knee Osteoarthritis Outcome Score (KOOS). The patients showed large improvements in self-rated pain, function and quality of life, most of which were seen already during the immediate postoperative period when the external fixation was still used.
The clinical pin site infection rate, rate of positive cultures and total use of antibiotics could be redused by changing different factors relating to pin site care. Prolonged prophylactic antibiotics had no benefit. The negative effect of cigarette smoking is an important factor to be considered in patient selection for HCO, and should be an important part of the preoperative information. The treatment by HCO reduced the pain and improved function and quality of life already during the treatment in external fixation and continued during the 2-year follow-up.
Original language | English |
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Qualification | Doctor |
Awarding Institution |
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Supervisors/Advisors |
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Award date | 2005 Feb 11 |
Publisher | |
ISBN (Print) | 91-85439-02-9 |
Publication status | Published - 2005 |
Bibliographical note
Defence detailsDate: 2005-02-11
Time: 13:00
Place: Föreläsningssal 1, Centralblocket, Universitetssjukhuset, Lund
External reviewer(s)
Name: Wykman, Anders
Title: Docent
Affiliation: Ortopediska kliniken, Halmstad lasarett
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<div class="article_info">A W-Dahl, S Toksvig-Larsen and A Lindstrand. <span class="article_issue_date">2003</span>. <span class="article_title">No difference between daily and weekly pin site care: a randomized study of 50 patients with external fixation.</span> <span class="journal_series_title">Acta Orthop Scan</span>, <span class="journal_volume">vol 74(6)</span> <span class="journal_pages">pp 704-8</span>. <span class="journal_distributor">Acta Orthop Scan</span></div>
<div class="article_info">A W-Dahl and S Toksvig-Larsen. <span class="article_issue_date">2004</span>. <span class="article_title">Pin site care in External fixation - Sodium chloride or Chlorhexidine solution as a cleansing agent.</span> <span class="journal_series_title">Arch Orthop Trauma Surg</span>, <span class="journal_volume">vol 124(8)</span> <span class="journal_pages">pp 555-58</span>. <span class="journal_distributor">Arch Orthop Trauma Surg</span></div>
<div class="article_info">A W-Dahl and S Toksvig-Larsen. <span class="article_issue_date">0000</span>. <span class="article_title">Infection prophylaxis in patients operated on by the hemicallotasis osteotomy.</span> <span class="journal_distributor">Dept of Orthopaedics</span> (manuscript)</div>
<div class="article_info">A W-Dahl and S Toksvig-Larsen. <span class="article_issue_date">2004</span>. <span class="article_title">Cigarette smoking delays bone healing - A prospective study of 200 patients operated on by the hemicallotasis technique.</span> <span class="journal_series_title">Acta Orthop Scand.</span>, <span class="journal_volume">vol 75(3)</span> <span class="journal_pages">pp 347-51</span>. <span class="journal_distributor">Acta Orthop Scand.</span></div>
<div class="article_info">A W-Dahl, S Toksvig-Larsen and EM Roos. <span class="article_issue_date">0000</span>. <span class="article_title">A 2-year prospective study of patient-relevant outcomes in patients operated on for knee osteoarthritis with tibial osteotomy by the hemicallotasis technique.</span> <span class="journal_distributor">Dept of Orthopaedics</span> (submitted)</div>
Subject classification (UKÄ)
- Orthopedics
Free keywords
- ortopedi
- traumatologi
- Kirurgi
- Surgery
- knee osteoarthritis
- pin site infection
- hemicallotasis
- External fixation
- tibial osteotomy
- traumatology
- orthopaedics
- pin site care