The Experts below are selected from a list of 375 Experts worldwide ranked by ideXlab platform

Thomas S Roukis - One of the best experts on this subject based on the ideXlab platform.

Peter V Giannoudis - One of the best experts on this subject based on the ideXlab platform.

  • Pin-Site Care: can we reduce the incidence of infections?
    Injury, 2020
    Co-Authors: Ioannis Ktistakis, Enrique Guerado, Peter V Giannoudis
    Abstract:

    This study was conducted to determine the Pin-Site Care protocols currently in use and to analyse their effectiveness and outcomes. PubMed, the Cochrane Library and Embase databases were screened for manuscripts that described comparative studies of different methods of Pin-Site Care and referred to complications related to any kind of external fixator application. A total of 369 manuscripts were screened and only 13 of these met the inclusion criteria evaluating different protocols of Pin-Site Care. This review is based on a total of 574 patients. Infection rates were very variable depending on the type of implant used and the protocol of Pin-Site Care applied. None of the different protocols of Pin-Site Care that were evaluated in this study were associated with a 0% infection rate. There is currently no consensus in the international literature about which protocol should be applied universally. Meticulous surgical technique during Pin insertion and implementation of one of the existing protocols of Pin-Site Care are the mainstay of prevention and/or reduction of the incidence of Pin-Site infections. Copyright © 2015 Elsevier Ltd. All rights reserved.

  • Complications After Damage Control Surgery: Pin-Tract Infection
    Damage Control Management in the Polytrauma Patient, 2020
    Co-Authors: Peter V Giannoudis, P.j. Harwood
    Abstract:

    Damage control is an approach to Care for patients in extremis. In orthopaedic surgery this generally involves the application of temporary spanning external fixators to rapidly provide skeletal stabilisation. Definitive reconstruction is undertaken once the patients physiology has been stabilised. A major consideration when this approach is Pin-Site Care and infection, particularly where patients will ultimately undergo definitive internal fixation.Approaches to minimise the risk of septic complications in such patients include the use of a damage control approach only where appropriate, Careful planning and meticulous surgical technique when applying temporary fixators, ensuring that stable fixators are applied and rigorous Pin-Site Care. Diagnosis of PinSite infection is based on clinical signs and culture swabs are seldom helpful. Particularly where conversion to internal fixation is anticipated, infections should be aggressively managed by increased frequency of dressing, oral antibiotics where this is not effective and occasional surgical debridement and exchange of Pins where this is not effective. Where infection proves recalcitrant serious consideration should be given to using external fixation as a definitive management strategy where possible.Careful decision making about the timing of exchange to definitive fixation is crucial. This should logically be undertaken as soon as possible, but not before the patients physiology has recovered sufficiently to allow such surgery.Where conversion is delayed consideration should again be given to using external fixation methods definitively where possible.

  • Pin Site Care can we reduce the incidence of infections
    Injury-international Journal of The Care of The Injured, 2015
    Co-Authors: Ioannis Ktistakis, Enrique Guerado, Peter V Giannoudis
    Abstract:

    Abstract Background This study was conducted to determine the Pin-Site Care protocols currently in use and to analyse their effectiveness and outcomes. Methods PubMed, the Cochrane Library and Embase databases were screened for manuscripts that described comparative studies of different methods of Pin-Site Care and referred to complications related to any kind of external fixator application. Results A total of 369 manuscripts were screened and only 13 of these met the inclusion criteria evaluating different protocols of Pin-Site Care. This review is based on a total of 574 patients. Infection rates were very variable depending on the type of implant used and the protocol of Pin-Site Care applied. Conclusions None of the different protocols of Pin-Site Care that were evaluated in this study were associated with a 0% infection rate. There is currently no consensus in the international literature about which protocol should be applied universally. Meticulous surgical technique during Pin insertion and implementation of one of the existing protocols of Pin-Site Care are the mainstay of prevention and/or reduction of the incidence of Pin-Site infections.

  • ilizarov fixator Pin Site Care the role of crusts in the prevention of infection
    Injury-international Journal of The Care of The Injured, 2013
    Co-Authors: S Britten, Ali Ghoz, Beverley Duffield, Peter V Giannoudis
    Abstract:

    Abstract Pin Site infection is one of the most common local complications after procedures using the Ilizarov fine wire fixator. In this study, the rate of infection was investigated in two groups of patients, representing two consecutive case series, undergoing fracture stabilisation or lower limb reconstruction using an Ilizarov fine wire fixator. Both groups received identical Russian-style Pin Site Care, except in the first Group A where the crusts of dried exudate were removed at the time of Pin Site cleaning; while in the subsequent Group B, the adherent crusts were retained during cleaning. Pin Site infection was diagnosed if the Site was painful and inflamed or discharging. The first infected Pin Site while the fixator remained in situ was considered the outcome of interest. Group A consisted of 59 patients and Group B of 33 patients. A lower proportion of patients in Group B (12/33 – 36%) developed a Pin Site infection compared to Group A (36/59 – 61%) ( p  = 0.023). However, once infection had developed, a greater proportion of patients in Group B required more than one course of antibiotics to treat the infection when compared to patients in Group A ( p  = 0.005). No patient required hospitalisation for intravenous antibiotics or wire change in Group B (0/33), whereas 3/59 patients required hospitalisation in Group A; but this did not reach statistical significance (Chi-squared test, p  = 0.18). Retention of adherent crusts during Ilizarov fixator Pin Site Care significantly protects against the development of Pin Site infection, but renders subsequently infected Pin Sites more refractory to treatment. This study therefore suggests that crusts should be retained as long as a Pin Site remains uninfected. Retained crusts may act as a physical barrier to bacterial contamination (‘biological dressing’).

R. Pillay - One of the best experts on this subject based on the ideXlab platform.

  • Reduction of Halo Pin Site Morbidity with a New Pin Care Regimen
    Asian Spine Journal, 2013
    Co-Authors: Hussain Anthony Kazi, Marcus De Matas, R. Pillay
    Abstract:

    Study Design: A retrospective analysis of halo device associated morbidity over a 4-year period. Purpose: To assess the impact of a new Pin Care regimen on halo Pin Site related morbidity. Overview of Literature: Halo orthosis treatment still has a role in cervical sPine pathology, despite increasing possibilities of open surgical treatment. Published figures for Pin Site infection range from 12% to 22% with Pin loosening from 7% to 50%. Methods: We assessed the outcome of a new Pin Care regimen on morbidity associated with halo sPinal orthoses, using a retrospective cohort study from 2001 to 2004. In the last two years, our Pin Care regimen was changed. This involved Pin Site Care using chlorhexidene & regular torque checking as part of a standard protocol. Previously, povidone iodine was used as skin preparation in theatre, followed by regular sterile saline cleansing when Pin Sites became encrusted with blood. Results: There were 37 patients in the series, the median age was 49 (range, 22−83) and 20 patients were male. The overall infection rate prior to the new Pin Care protocol was 30% (n=6) and after the introduction, it dropped to 5.9% (n=1). This difference was statistically significant ( p

  • reduction of halo Pin Site morbidity with a new Pin Care regimen
    Asian Spine Journal, 2013
    Co-Authors: Hussain Anthony Kazi, Marcus De Matas, R. Pillay
    Abstract:

    Study Design: A retrospective analysis of halo device associated morbidity over a 4-year period. Purpose: To assess the impact of a new Pin Care regimen on halo Pin Site related morbidity. Overview of Literature: Halo orthosis treatment still has a role in cervical sPine pathology, despite increasing possibilities of open surgical treatment. Published figures for Pin Site infection range from 12% to 22% with Pin loosening from 7% to 50%. Methods: We assessed the outcome of a new Pin Care regimen on morbidity associated with halo sPinal orthoses, using a retrospective cohort study from 2001 to 2004. In the last two years, our Pin Care regimen was changed. This involved Pin Site Care using chlorhexidene & regular torque checking as part of a standard protocol. Previously, povidone iodine was used as skin preparation in theatre, followed by regular sterile saline cleansing when Pin Sites became encrusted with blood. Results: There were 37 patients in the series, the median age was 49 (range, 22−83) and 20 patients were male. The overall infection rate prior to the new Pin Care protocol was 30% (n=6) and after the introduction, it dropped to 5.9% (n=1). This difference was statistically significant ( p<0.05). Pin loosening occurred in one patient in the group prior to the formal Pin Care protocol (3%) and none thereafter. Conclusions: Reduced morbidity from halo use can be achieved with a modified Pin cleansing and tightening regimen.

Monica H Schweinberger - One of the best experts on this subject based on the ideXlab platform.

Chiahsieh Chang - One of the best experts on this subject based on the ideXlab platform.

  • seasonal temperature and Pin Site Care regimen affect the incidence of Pin Site infection in pediatric supracondylar humeral fractures
    BioMed Research International, 2015
    Co-Authors: Meichuan Chen, Wene Yang, Chiahsieh Chang
    Abstract:

    Pin Site infection is a common complication after fracture fixation and bone lengthening, and daily Pin Site Care is recommended. Weather is a strong environmental factor of infection, but few articles studied the issue of weather and Pin Site infection. We performed a prospective comparative study of 61 children with supracondylar humeral fractures treated by closed reduction and percutaneous Pinning. The patients were divided into high-temperature season or low-temperature season by the months they received surgery. The patients within each season were further allocated to 2 groups by the different postoperative Pin Site Care methods of daily Care or nonCare. The infection rate per patient was significantly higher in the high-temperature season compared to low-temperature season (45% versus 19%, P = 0.045). In the high-temperature season, the infection rate per patient was significantly higher in the daily Care group versus the nonCare group (70% versus 20%, P = 0.001). In the low-temperature season, the infection rate per patient was not significantly different in the daily Care group versus the nonCare group (10% versus 27.3%, P = 0.33). We recommend that Careful monitoring of infection signs, rather than Pin Site cleaning, would be appropriate in the treatment of pediatric supracondylar humeral fractures, especially during the summer months.

  • A prospective comparative study of Pin Site infection in pediatric supracondylar humeral fractures: daily Pin Care vs. no Pin Care
    Archives of Orthopaedic and Trauma Surgery, 2014
    Co-Authors: Meichuan Chen, Wene Yang, Chiahsieh Chang
    Abstract:

    Introduction Pin Site infection is a critical issue for patients’ safety in skeletal fixation using percutaneous Pins or wires. Closed reduction and percutaneous Kirschner wires fixation are the mainstay of treatment in pediatric supracondylar humeral fractures. Little information is available in the literature about the optimal regimen of Pin Site Care in children. Materials and methods We performed a prospective comparative study of 61 children with supracondylar humeral fractures between June 2011 and March 2013 after approval by the institutional review board. They were allocated into two groups of different postoperative Pin Site Care methods by the emergency department arrival date and received fracture fixation within 24 h. Postoperatively, 30 children underwent Pin Site cleaning every day whereas the other 31 patients did not have the Pin Sites cleaned until the Pins removal 4–6 weeks later. Results Demographic data were not significantly different between the two groups. The infection rate was significantly higher in patients who underwent daily Pin Site Care (90.3 vs. 53.3 %, p  = 0.001). Of the 144 Pin Sites, infection occurred at 42 (57.5 %) Pin Sites in the daily Care group and at 19 (26.8 %) Pin Sites in the non-Care group. The number of telephone consultations for postoperative Care was significantly higher in the daily Care group (1.0 vs. 0.27 call/case, p  = 0.007). Conclusions Daily Pin Site Care was associated with a higher infection rate and greater stress in postoperative Care that required more telephone consultations. The study results could not support daily Pin Site Care. Careful observation of Pin Sites was recommended in the treatment of pediatric supracondylar humeral fractures.

  • a prospective comparative study of Pin Site infection in pediatric supracondylar humeral fractures daily Pin Care vs no Pin Care
    Archives of Orthopaedic and Trauma Surgery, 2014
    Co-Authors: Meichuan Chen, Wene Yang, Chiahsieh Chang
    Abstract:

    Introduction Pin Site infection is a critical issue for patients’ safety in skeletal fixation using percutaneous Pins or wires. Closed reduction and percutaneous Kirschner wires fixation are the mainstay of treatment in pediatric supracondylar humeral fractures. Little information is available in the literature about the optimal regimen of Pin Site Care in children.