Combs Kristen, Frick Steven, Kiebzak Gary
Medical Student, University of Central Florida College of Medicine, Orlando, FL.
Orthopedic Surgery, Nemours Children's Hospital.
Cureus. 2016 Dec 3;8(12):e911. doi: 10.7759/cureus.911.
Pediatric supracondylar humerus fractures are the most common elbow fractures in pediatric patients. Surgical fixation using pins is the primary treatment for displaced fractures. Pin site infections may follow supracondylar humerus fracture fixation; the previously reported incidence rate in the literature is 2.34%, but there is significant variability in reported incidence rates of pin site infection. This study aims to define the incidence rate and determine pre-, peri-, and postoperative factors that may contribute to pin site infection following operative reduction, pinning, and casting.
A retrospective chart analysis was performed over a one-year period on patients that developed pin site infection. A cast care form was added to Nemours' electronic medical records (EMR) system (Epic Systems Corp., Verona, WI) to identify pin site infections for retrospective review. The cast care form noted any inflamed or infected pins. Patients with inflamed or infected pin sites underwent a detailed chart review. Preoperative antibiotic use, number and size of pins used, method of postoperative immobilization, pin dressings, whether postoperative immobilization was changed prior to pin removal, and length of time pins were in place was recorded.
A total of 369 patients underwent operative reduction, pinning, and casting. Three patients developed a pin site infection. The pin site infection incidence rate was 3/369=0.81%. Descriptive statistics were reported for the three patients that developed pin site infections and three patients that developed pin site complications.
Pin site infection development is low. Factors that may contribute to the development of pin site infection include preoperative antibiotic use, length of time pins are left in, and changing the cast prior to pin removal.
小儿肱骨髁上骨折是小儿患者中最常见的肘部骨折。使用克氏针进行手术固定是移位骨折的主要治疗方法。肱骨髁上骨折固定后可能会发生针道感染；文献中先前报道的发生率为2.34%，但针道感染的报道发生率存在显著差异。本研究旨在确定发生率，并确定在手术复位、穿针和石膏固定后可能导致针道感染的术前、术中和术后因素。
对发生针道感染的患者进行了为期一年的回顾性病历分析。在Nemours的电子病历（EMR）系统（Epic Systems Corp.，威斯康星州维罗纳）中添加了石膏护理表格，以识别针道感染以便进行回顾性审查。石膏护理表格记录了任何发炎或感染的克氏针。针道发炎或感染的患者接受了详细的病历审查。记录术前抗生素的使用情况、所用克氏针的数量和尺寸、术后固定方法、克氏针敷料、在取出克氏针之前是否更换了术后固定以及克氏针留置的时间。
共有369例患者接受了手术复位、穿针和石膏固定。3例患者发生了针道感染。针道感染发生率为3/369 = 0.81%。报告了3例发生针道感染的患者和3例发生针道并发症的患者的描述性统计数据。
针道感染的发生率较低。可能导致针道感染发生的因素包括术前抗生素的使用、克氏针留置的时间以及在取出克氏针之前更换石膏。
