One of a collection or orthopaedic nursing care plans

Vanderbilt Medical Center Nursing Policy

Pin site and skin care for a patient in Halo Brace. Note - no supporting evidence in this document.

Purpose: to outline the management of a patient in a halo brace

The management of skeletal pin sites (largely for patients with external fixators) represents a major dilemma for orthopaedic nurses all over the world. Infection rates are high and there is very little evidence on which to base practice.

Irish Guideline

Correspondence in Acta Orthopaedica. Interesting discussion and references

Cochrane Review by J Temple and J Santy Cochrane Database of Systematic Reviews 2007 Issue 2 Copyright © 2007 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Report of progress on a research project to find a consensus on pin site care.

Article from Orthopaedic Nursing 2005 Vol 24 #2 pp 99-107 NAON Guidelines. Inconculsive

Two protocols for the operative technique and care of the pin-site with external fixation were compared prospectively. There was a total of 120 patients with 46 in group A and 74 in group B. Infection was defined as an episode of pain or inflammation at a pin site, accompanied by a discharge which was either positive on bacterial culture or responded to a course of antibiotics. Patients in group B had a lower proportion of infected pin sites (p = 0.003) and the time to the first episode of infection was longer (p <0.001). The risk of pin-site infection is lower if attention is paid to avoiding thermal injury and local formation of haematoma during surgery and if after-care includes the use of an alcoholic antiseptic and occlusive pressure dressings

Abstract of Heather Williams, Peter Griffiths British Journal of Community Nursing, Vol. 9, Iss. 5, 07 May 2004, pp 206 - 210
The study included two treatment groups, one using 0.9% normal saline and one using 70% alcohol, and a control group which had no cleansing. While the control group had a more favourable outcome than the treatment groups, there is still insufficient evidence from this one study to recommend no cleansing. It is also important to note that the most frequently recommended solution for cleansing pin sites in UK protocols (0.9% normal saline) had the worst outcome, therefore its efficacy in this population may need to be challenged.

Clinical Savvy: When Your Patient Wears an Ilizarov Device Ann Herman Driscoll The American Journal of Nursing, Vol. 93, No. 6 (Jun., 1993), pp. 63-65