Hodel Sandro, Link Björn-Christian, Babst Reto, Mallee W H, Posso Philippe, Beeres Frank J P
Department of Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, 6000, Luzern 16, Switzerland.
Department of Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Spitalstrasse 16, Luzern 16, Switzerland.
Eur J Orthop Surg Traumatol. 2018 May;28(4):565-572. doi: 10.1007/s00590-018-2135-9. Epub 2018 Feb 7.
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.
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.
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).
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.
This study provides Level IV evidence according to Oxford centre for evidence-based medicine.
尽管外固定术应用频繁，但抗生素预防的各种方案、手术技术及术后钢针护理方法各异，这突出表明目前缺乏相关证据。本研究的目的是评估用于预防四肢闭合性骨折临时外固定植入物相关感染的围手术期方案的差异或共识。
向创伤平台的170名成员发送了一份包含26个问题的调查问卷。该问卷包括有关人口统计学、培训水平、培训类型以及围手术期方案的问题，如抗生素预防、术中管理、消毒及术后钢针部位护理。对所有回复进行统计分析，并对术中措施采用5分制李克特量表评分。
分析了50名骨科创伤外科医生和普通外科医生的回复（回复率为29.4%）。92%（n = 46）的医生经验超过5年，80%（n = 40）的医生每年使用外固定术治疗多达50例四肢闭合性骨折。在以下围手术期措施中可发现最高共识：术前使用第二代头孢菌素进行抗生素预防（86%，n = 43）、术中如需操作外固定器则更换手套（86%，n = 43；李克特量表评分为4.12分）、避免钢针部位与最终植入部位重叠（94%，n = 47；李克特量表评分为4.12分）以及使用钻套保护软组织（83.6%，n = 41）。
我们的调查确定了一些被大多数受访者认为重要的一般原则。未来研究应聚焦于阐明围手术期抗生素和不同消毒方案在分期方案中临时外固定后植入物相关感染方面的作用。
根据牛津循证医学中心，本研究提供IV级证据。
